Effect of altered hydration on the internal shear properties of porcine aortic valve cusps

Valve interstitial cells under impact load, a mechanobiology study

Understanding the relationship between mechanobiology and the biosynthetic activities of the valve interstitial cells (VICs) in health and disease under severe dynamic loading conditions is of particular interest. The purpose of this study is to further understand the mechanobiology of heart valve leaflet tissue and the VICs under impact forces. Two novel computational and experimental platforms were developed to study the effect of impact load on the VICs to monitor for apoptosis. The first objective was to design and develop an apparatus to experimentally study viability (apoptosis) of the porcine heart valve leaflet tissue VICs in the aortic position under controlled impact forces. Apoptosis was assessed based on terminal transferase dUTP nick end-labelling (TUNEL) assay. The second objective was to develop a computational platform to estimate the stress and strain fields in the vicinity of VICs when the tissue experiences impact forces. A nonlinear finite element (FE) model with an anisotropic, hyperelastic and heterogeneous material model for the matrix and cells was developed. Preliminary results confirm that interstitial cells are successfully resistant to impact loads up to 30 times more than normal physiological conditions. Additionally, the structure and composition of heart valve leaflet tissue provides a mechanical shield for VICs protecting them from excessive mechanical forces such as impact loads. Although, the entire tissue may experience excessive stresses, which may lead to structural damage, the stresses around and near VICs remain consistency low. Results of this study may be used for heart valve leaflet tissue-engineering, as well as further understanding the mechanobiology of the VICs in health and disease.

Characterization of chemoelastic effects in arteries using digital volume correlation and optical coherence tomography

Understanding stress-strain relationships in arteries is important for fundamental investigations in mechanobiology. Here we demonstrate the essential role of chemoelasticity in determining the mechanical properties of arterial tissues. Stepwise stress-relaxation uniaxial tensile tests were carried out on samples of porcine thoracic aortas immersed in a hyperosmotic solution. The tissue deformations were tracked using optical coherence tomography (OCT) during the tensile tests and digital volume correlation (DVC) was used to obtain measurements of depth-resolved strains across the whole thickness of the tested aortas. The hyperosmotic solution exacerbated chemoelastic effects, and we were able to measure different manifestations of these chemoelastic effects: swelling of the media inducing a modification of its optical properties, and existence of a transverse tensile strain. For the first time ever to our best knowledge, 3D strains induced by chemoelastic effects in soft tissues were quantified thanks to the OCT-DVC method. Without doubt, chemoelasticity plays an essential role in arterial mechanobiology in vivo and future work should focus on characterizing chemoelastic effects in arterial walls under physiological and disease conditions. STATEMENT OF SIGNIFICANCE: Chemoelasticity, coupling osmotic phenomena and mechanical stresses, is essential in soft tissue mechanobiology. For the first time ever, we measure and analyze 3D strain fields induced by these chemoelastic effects thanks to the unique combination of OCT imaging and digital volume correlation.

Mechanical considerations for polymeric heart valve development: Biomechanics, materials, design and manufacturing

The native human heart valve leaflet contains a layered microstructure comprising a hierarchical arrangement of collagen, elastin, proteoglycans and various cell types. Here, we review the various experimental methods that have been employed to probe this intricate microstructure and which attempt to elucidate the mechanisms that govern the leaflet's mechanical properties. These methods include uniaxial, biaxial, and flexural tests, coupled with microstructural characterization techniques such as small angle X-ray scattering (SAXS), small angle light scattering (SALS), and polarized light microscopy. These experiments have revealed complex elastic and viscoelastic mechanisms that are highly directional and dependent upon loading conditions and biochemistry. Of all engineering materials, polymers and polymer-based composites are best able to mimic the tissue-level mechanical behavior of the native leaflet. This similarity to native tissue permits the fabrication of polymeric valves with physiological flow patterns, reducing the risk of thrombosis compared to mechanical valves and in some cases surpassing the in vivo durability of bioprosthetic valves. Earlier work on polymeric valves simply assumed the mechanical properties of the polymer material to be linear elastic, while more recent studies have considered the full hyperelastic stress-strain response. These material models have been incorporated into computational models for the optimization of valve geometry, with the goal of minimizing internal stresses and improving durability. The latter portion of this review recounts these developments in polymeric heart valves, with a focus on mechanical testing of polymers, valve geometry, and manufacturing methods.

Mechanical Properties of Arterial Elastin With Water Loss

Elastin is a peculiar elastomer in that it requires water to maintain resilience, and its mechanical properties are closely associated with the immediate aqueous environment. The bulk, extra- and intrafibrillar water plays important roles in both elastic and viscoelastic properties of elastin. In this study, a two-stage liquid-vapor method was developed to investigate the effects of water loss on the mechanical properties of porcine aortic elastin. The tissue samples started in a phosphate-buffered saline (PBS) solution at their fully hydrated condition, with a gravimetric water content of 370±36%. The hydration level was reduced by enclosing the tissue in dialysis tubing and submerging it in polyethylene glycol (PEG) solution at concentrations of 10%, 20%, 30%, and 45% w/v, which reduced the water content of the samples to 258±34%, 224±20%, 109±9%, and 58±3%, respectively. The samples were then transferred to a humidity chamber to maintain the hydration level while the samples underwent equi-biaxial tensile and stress relaxation tests. The concentration of 10% PEG treatment induced insignificant changes in tissue dimensions and stiffness, indicating that the removal of bulk water has less effect on elastin. Significant increases in tangent modulus were observed after 20% and 30% PEG treatment due to the decreased presence of extrafibrillar water. Elastin treated with 45% PEG shows a very rigid behavior as most of the extrafibrillar water is eliminated. These results suggest that extrafibrillar water is crucial for elastin to maintain its elastic behavior. It was also observed that the anisotropy of elastin tends to decrease with water loss. An increase in stress relaxation was observed for elastin treated with 30% PEG, indicating a more viscous behavior of elastin when the amount of extrafibrillar water is significantly reduced. Results from this study shed light on the close association between the bulk, extra- and intrafibrillar water pools and the mechanics of elastin.

Active tissue stiffness modulation controls valve interstitial cell phenotype and osteogenic potential in 3D culture

Calcific aortic valve disease (CAVD) progression is a highly dynamic process whereby normally fibroblastic valve interstitial cells (VIC) undergo osteogenic differentiation, maladaptive extracellular matrix (ECM) composition, structural remodeling, and tissue matrix stiffening. However, how VIC with different phenotypes dynamically affect matrix properties and how the altered matrix further affects VIC phenotypes in response to physiological and pathological conditions have not yet been determined. In this study, we develop 3D hydrogels with tunable matrix stiffness to investigate the dynamic interplay between VIC phenotypes and matrix biomechanics. We find that VIC populated within hydrogels with valve leaflet like stiffness differentiate towards myofibroblasts in osteogenic media, but surprisingly undergo osteogenic differentiation when cultured within lower initial stiffness hydrogels. VIC differentiation progressively stiffens the hydrogel microenvironment, which further upregulates both early and late osteogenic markers. These findings identify a dynamic positive feedback loop that governs acceleration of VIC calcification. Temporal stiffening of pathologically lower stiffness matrix back to normal level, or blocking the mechanosensitive RhoA/ROCK signaling pathway, delays the osteogenic differentiation process. Therefore, direct ECM biomechanical modulation can affect VIC phenotypes towards and against osteogenic differentiation in 3D culture. These findings highlight the importance of the homeostatic maintenance of matrix stiffness to restrict pathological VIC differentiation.

STATEMENT OF SIGNIFICANCE

We implement 3D hydrogels with tunable matrix stiffness to investigate the dynamic interaction between valve interstitial cells (VIC, major cell population in heart valve) and matrix biomechanics. This work focuses on how human VIC responses to changing 3D culture environments. Our findings identify a dynamic positive feedback loop that governs acceleration of VIC calcification, which is the hallmark of calcific aortic valve disease. Temporal stiffening of pathologically lower stiffness matrix back to normal level, or blocking the mechanosensitive signaling pathway, delays VIC osteogenic differentiation. Our findings provide an improved understanding of VIC-matrix interactions to aid in interpretation of VIC calcification studies in vitro and suggest that ECM disruption resulting in local tissue stiffness decreases may promote calcific aortic valve disease.

Glycosaminoglycan entrapment by fibrin in engineered heart valve tissues

Tissue engineered heart valves (TEHVs) may provide a permanent solution to congenital heart valve disease by permitting somatic valve growth in the pediatric patient. However, to date, TEHV studies have focused primarily on collagen, the dominant component of valve extracellular matrix (ECM). Temporal decreases in other ECM components, such as the glycosaminoglycans (GAGs), generally decrease as cells produce more collagen under mechanically loaded states; nevertheless, GAGs represent a key component of the valve ECM, providing structural stability and hydration to the leaflets. In an effort to retain GAGs within the engineered constructs, here we investigated the utility of the protein fibrin in combination with a valve-like, cyclic flexure and steady flow (flex-flow) mechanical conditioning culture process using adult human periodontal ligament cells (PLCs). We found both fibrin and flex-flow mechanical components to be independently significant (p<0.05), and hence important in influencing the DNA, GAG and collagen contents of the engineered tissues. In addition, the interaction of fibrin with flex-flow was found to be significant in the case of collagen; specifically, the combination of these environments promoted PLC collagen production resulting in a significant difference compared to dynamic and statically cultured specimens without fibrin. Histological examination revealed that the GAGs were retained by fibrin entrapment and adhesion, which were subsequently confirmed by additional experiments on native valve tissues. We conclude that fibrin in the flex-flow culture of engineered heart valve tissues: (i) augments PLC-derived collagen production; and (ii) enhances retention of GAGs within the developing ECM.

The tensile and viscoelastic properties of aortic valve leaflets treated with a hyaluronidase gradient

Purpose

When diseased, aortic valves are typically replaced with bioprosthetic heart valves (BPHVs), porcine valves or bovine pericardium that are fixed in glutaraldehyde. These replacements fail within 10-15 years due to calcification and fatigue, and their failure coincides with a loss of glycosaminoglycans (GAGs). This study investigates this relationship between GAG concentration and the tensile and viscoelastic properties of aortic valve leaflets.

Methods

Aortic valve leaflets were dissected from porcine hearts and digested in hyaluronidase in concentrations ranging from 0-5 U/mL for 0-24 hours, yielding a spectrum of GAG concentrations that was measured using the uronic acid assay and confirmed by Alcian Blue staining. Digested leaflets with varying GAG concentrations were then tested in tension in the circumferential and radial directions with varying strain rate, as well as in stress relaxation.

Results

The GAG concentration of the leaflets was successfully reduced using hyaluronidase, although water content was not affected. Elastic modulus, the maximum stress, and hysteresis significantly increased with decreasing GAG concentration. Extensibility and the radius of transition curvature did not change with GAG concentration. The stress relaxation behavior and strain-rate independent nature of the leaflet did not change with GAG concentration.

Conclusions

These results suggest that GAGs in the spongiosa lubricate tissue motion and reduce stresses experienced by the leaflet. This study forms the basis for predictive models of BPHV mechanics based on GAG concentration, and guides the rational design of future heart valve replacements.

Elastic fibers in the aortic valve spongiosa: a fresh perspective on its structure and role in overall tissue function

This study characterizes the elastic fiber structure within the aortic valve spongiosa, the middle layer of the tri-laminate leaflet. The layer is rich in glycosaminoglycans and proteoglycans, through which it resists compression and lubricates shear between the outer layers. Elastin in this layer forms a fine, interweaving structure, yet it is unclear how this particular structure, which uses elasticity to preload the leaflet, assists spongiosa function. In this study, immunohistochemistry (IHC) and scanning electron microscopy (SEM) are used to characterize spongiosa elastin, as well as investigate regional differences in structure. IHC for elastin highlights an intermediate structure which varies in thickness and density between regions. In particular, the spongiosa elastin is thicker in the hinge and coaptation region than in the belly. SEM of NaOH-digested leaflets shows a rectilinear pattern of elastic fibers in the hinge and coaptation region, as opposed to a radially oriented stripe pattern in the belly. In conclusion, elastic fibers in the spongiosa connect the two outer layers and vary regionally in structure, while possibly playing a role in responding to regionally specific loading patterns.

The effects of hammer pressure on cellular response in a porcine heart valve tissue

Our objective was to design, develop, characterize and validate a prototype device for testing the response of aortic valve tissue to impact forces. With each cardiac cycle, the aortic valve, on closure, is subjected to a substantial impact force and the ability of valvular interstitial cells to withstand such forces without apoptosis has not been examined. Our aim was to correlate impact force with apoptosis, identifying the latter using a terminal transferase dUTP nick end-labelling (Tunel) assay. With our drop tower design, we created reproducible impact forces on heart valve tissue resulting in cellular trauma. The reliability of the impact tester design were verified and results showed that normal tissue can withstand impact forces more than 30× greater than the physiological forces to which the tissue is normally exposed. This provides a wide safety margin and indicates that bioengineered aortic valve tissue should have similar properties if it is to withstand physiologic forces long term.

An efficient technique for adjusting and maintaining specific hydration levels in soft biological tissues in vitro

Elucidating how mechanics is affected by hydration in soft biological tissues is critical for understanding the potential effects of diseases where tissue extracellular matrix (ECM) is altered. The ability to control ECM water content is necessary for studying hydration-dependent tissue mechanics and for minimizing confounding effects caused by differences in tissue water content among specimens. In this paper, we describe an approach to adjust and maintain water content using a two-stage hydration technique, in order to overcome unique challenges faced in mechanical testing of biological tissues. Bovine aortic tissue was selected to demonstrate the approach. A liquid phase approach using PEG solutions allowed for efficient initial adjustment of tissue hydration. This was followed by a vapor phase approach using a humidity chamber for maintaining stable water content for a defined test duration of 45 min. Incubation in PEG solution brought bovine aortic tissue samples to equilibrium water content in approximately 6 h, much more efficiently than using a humidity chamber alone. Characteristic relationships between tissue water content and PEG concentration as well as relative humidity were obtained. It was found that PEG concentrations ranging from 0 to 40% had an inverse relationship with tissue water content ranging from 80 to 380%, which corresponded to relative humidities between 53 and 99%.

On the biomechanics of heart valve function

Heart valves (HVs) are fluidic control components of the heart that ensure unidirectional blood flow during the cardiac cycle. However, this description does not adequately describe the biomechanical ramifications of their function in that their mechanics are multi-modal. Moreover, they must replicate their cyclic function over an entire lifetime, with an estimated total functional demand of least 3x10(9) cycles. The focus of the present review is on the functional biomechanics of heart valves. Thus, the focus of the present review is on functional biomechanics, referring primarily to biosolid as well as several key biofluid mechanical aspects underlying heart valve physiological function. Specifically, we refer to the mechanical behaviors of the extracellular matrix structural proteins, underlying cellular function, and their integrated relation to the major aspects of valvular hemodynamic function. While we focus on the work from the author's laboratories, relevant works of other investigators have been included whenever appropriate. We conclude with a summary of important future trends.

Anisotropy of high-frequency integrated backscatter from aortic valve cusps

The biaxial anisotropy of integrated backscatter from aortic valve cusps was characterized ex vivo as an initial assessment of the suitability of high-frequency ultrasound for nondestructive evaluation of fiber alignment in tissue-engineered heart valves. Apparent integrated backscatter (AIB) from eight fresh, intact porcine cusps was measured over an 80 degrees range of insonification angles using a 40-MHz ultrasound system. Angular dependence of backscatter was characterized by fitting a sinusoid to plots of AIB versus insonification angle for data acquired while rotating the transducer about the cusps in the circumferential and radial directions. Angular variations in backscatter were detected along both directions in individual specimens, although the mean amplitude of the fitted sinusoid was significantly greater for the circumferential data (12.1 +/- 2.6 dB) than the radial data (3.5 +/- 3.1 dB, p = 0.002). The higher angular variation of backscatter in the circumferential direction implies that collagen fibers in the fibrosa layer are the most prominent source of high-frequency scattering from porcine aortic valve cusps. The ability to characterize anisotropic backscattering from individual specimens demonstrates that high-frequency ultrasound can be used for nondestructive evaluation of fiber alignment in heart valve biomaterials.

On the biaxial mechanical properties of the layers of the aortic valve leaflet

All existing constitutive models for heart valve leaflet tissues either assume a uniform transmural stress distribution or utilize a membrane tension formulation. Both approaches ignore layer specific mechanical contributions and the implicit nonuniformity of the transmural stress distribution. To begin to address these limitations, we conducted novel studies to quantify the biaxial mechanical behavior of the two structurally distinct, load bearing aortic valve (AV) leaflet layers: the fibrosa and ventricularis. Strip biaxial tests, with extremely sensitive force sensing capabilities, were further utilized to determine the mechanical behavior of the separated ventricularis layer at very low stress levels. Results indicated that both layers exhibited very different nonlinear, highly anisotropic mechanical behaviors. While the leaflet tissue mechanical response was dominated by the fibrosa layer, the ventricularis contributed double the amount of the fibrosa to the total radial tension and experienced four times the stress level. The strip biaxial test results further indicated that the ventricularis exhibited substantial anisotropic mechanical properties at very low stress levels. This result suggested that for all strain levels, the ventricularis layer is dominated by circumferentially oriented collagen fibers, and the initial loading phase of this layer cannot be modeled as an isotropic material. Histological-based thickness measurements indicated that the fibrosa and ventricularis constitute 41% and 29% of the total layer thickness, respectively. Moreover, the extensive network of interlayer connections and identical strains under biaxial loading in the intact state suggests that these layers are tightly bonded. In addition to advancing our knowledge of the subtle but important mechanical properties of the AV leaflet, this study provided a comprehensive database required for the development of a true 3D stress constitutive model for the native AV leaflet.

Bioprosthetic heart valve heterograft biomaterials: structure, mechanical behavior and computational simulation

The present review surveys significant developments in the biomechanical characterization and computational simulation of biologically derived chemically cross-linked soft tissues, or 'heterograft' biomaterials, used in replacement bioprosthetic heart valve (BHV). A survey of mechanical characterization techniques, relevant mechanical properties and computational simulation approaches is presented for both the source tissues and cross-linked biomaterials. Since durability remains the critical problem with current bioprostheses, changes with the mechanical behavior with fatigue are also presented. Moreover, given the complex nature of the mechanical properties of heterograft biomaterials it is not surprising that most constitutive (stress-strain) models, historically used to characterize their behavior, were oversimplified. Simulations of BHV function utilizing these models have inevitably been inaccurate. Thus, more recent finite element simulations utilizing nonlinear constitutive models, which achieve greater model fidelity, are reviewed. An important conclusion of this review is the need for accurate constitutive models, rigorously validated with appropriate experimental data, in order that the design benefits of computational models can be realized. Finally, for at least the coming 20 years, BHVs fabricated from heterograft biomaterials will continue to be extensively used, and will probably remain as the dominant valve design. We should thus recognize that rational, scientifically based approaches to BHV biomaterial development and design can lead to significantly improved BHV, over the coming decades, which can potentially impact millions of patients worldwide with heart valve disease.

Effect of Cryopreservation Techniques on Aortic Valve Glycosaminoglycans

This study was designed to evaluate the effect of cryopreservation on the glycosaminoglycan (GAG) content of the aortic allografts. Twenty-one porcine aortic valves were obtained. Five aortic roots were immediately analyzed without cryopreservation, eight were cryopreserved in closed leaflet position, and eight in open leaflet position. The groups were compared in terms of GAG concentration and subclass proportion in three different zones including the aortic root wall, the commissures, and the leaflets. GAG content at the commissures was significantly lower in the closed leaflet group than in the other groups (P = 0.001). The electrophoretic analysis did not show any significant difference in the zonal distribution of GAG classes between groups. Quantitative analysis in various aortic valve zones suggests that cryopreservation can alter the GAG content. Cryopreservation of the aortic valve in an open leaflet position can preserve the matrix more efficiently and might prolong the durability of the aortic allograft.

Evaluation of an algorithm for semiautomated segmentation of thin tissue layers in high-frequency ultrasound images

An algorithm consisting of speckle reduction by median filtering, contrast enhancement using top- and bottom-hat morphological filters, and segmentation with a discrete dynamic contour (DDC) model was implemented for nondestructive measurements of soft tissue layer thickness. Algorithm performance was evaluated by segmenting simulated images of three-layer phantoms and high-frequency (40 MHz) ultrasound images of porcine aortic valve cusps in vitro. The simulations demonstrated the necessity of the median and morphological filtering steps and enabled testing of user-specified parameters of the morphological filters and DDC model. In the experiments, six cusps were imaged in coronary perfusion solution (CPS) then in distilled water to test the algorithm's sensitivity to changes in the dimensions of thin tissue layers. Significant increases in the thickness of the fibrosa, spongiosa, and ventricularis layers, by 53.5% (p < 0.001), 88.5% (p < 0.001), and 35.1% (p = 0.033), respectively, were observed when the specimens were submerged in water. The intraobserver coefficient of variation of repeated thickness estimates ranged from 0.044 for the fibrosa in water to 0.164 for the spongiosa in CPS. Segmentation accuracy and variability depended on the thickness and contrast of the layers, but the modest variability provides confidence in the thickness measurements.

Stability and function of glycosaminoglycans in porcine bioprosthetic heart valves

Glycosaminoglycans (GAGs) are important structural and functional components in native aortic heart valves and in glutaraldehyde (Glut)-fixed bioprosthetic heart valves (BHVs). However, very little is known about the fate of GAGs within the extracellular matrix of BHVs and their contribution to BHV longevity. BHVs used in heart valve replacement surgery have limited durability due to mechanical failure and pathologic calcification. In the present study we bring evidence for the dramatic loss of GAGs from within the BHV cusp structure during storage in saline and both short- and long-term Glut fixation. In order to gain insight into role of GAGs, we compared properties of fresh and Glut-fixed porcine heart valve cusps before and after complete GAG removal. GAG removal resulted in significant morphological and functional tissue alterations, including decreases in cuspal thickness, reduction of water content and diminution of rehydration capacity. By virtue of this diminished hydration, loss of GAGs also greatly increased the "with-curvature" flexural rigidity of cuspal tissue. However, removal of GAGs did not alter calcification potential of BHV cups when implanted in the rat subdermal model. Controlling the extent of pre-implantation GAG degradation in BHVs and development of improved GAG crosslinking techniques are expected to improve the mechanical durability of future cardiovascular bioprostheses.

Three-dimensional visualization and thickness estimation of aortic valve cusps using high-frequency ultrasound

High-frequency ultrasound techniques are introduced for three-dimensional imaging and thickness estimation of fresh heart valve cusps. Images of porcine aortic valve specimens were acquired within a 12 x 8 x 8 mm3 volume using a VisualSonics VS40 micro-imaging system operating at a 40 MHz centre frequency. Two image volumes were obtained from each of six left coronary cusps. One volume was acquired with the specimen submerged in distilled water and the second volume was acquired through either Hanks physiologic solution or coronary perfusion solution (CPS). The fibrosa, spongiosa and ventricularis were most readily distinguished when the specimen was imaged in distilled water. Colour thickness maps were computed from B-mode image data, and the mean and standard deviations of the thickness were determined for each cusp. In 11 of 12 trials, the image analysis algorithm yielded valid thickness estimates over greater than 98% of the region examined. Mean thickness estimates obtained with specimens submerged in Hanks solution or CPS ranged from 0.66 to 1.03 mm, and submersion in distilled water increased the mean thickness by 20-40%. This observation suggests that the cusps osmotically absorbed water. Information provided by high-frequency ultrasound is expected be valuable for characterizing the morphological properties of heart valves.