Stress-stretch curves of planar biaxial tests of healthy aortic tissue ( ) Average stress in a fiber family at time , see Equation 23 Undeformed collagen fiber orientation vector Deviatoric part of a constituent-specific right Cauchy-Green tensor, see Equation 3

Cardiac surgeries may expose pulmonary arterial tissue to systemic conditions, potentially resulting in failure of that tissue. our goal was to quantitatively assess pulmonary artery adaptation due to changes in mechanical environment. In 17 sheep, we placed a pulmonary autograft in aortic position, with or without macroporous mesh reinforcement. It was exposed to systemic conditions for 6 months. All sheep underwent 3 ECG-gated MRI's. Explanted tissue was subjected to mechanical and histological analysis. Results showed progressive dilatation of the unreinforced autograft, while reinforced autografts stabilized after two months. Some unreinforced pulmonary autograft samples displayed more aorta-like mechanical behavior with increased collagen deposition. the mechanical behavior of reinforced autografts was dominated by the mesh. the decrease in media thickness and loss of vascular smooth muscle cells was more pronounced in reinforced than in unreinforced autografts. In conclusion, altering the mechanical environment of a pulmonary artery causes changes in its mechano-biological properties.

A commonly heard concern in the Ross procedure, where a diseased aortic valve is replaced by the patient's own pulmonary valve, is the possibility of pulmonary autograft dilatation. We performed a biomechanical investigation of the use of a personalized external aortic root support or exostent as a possibility for supporting the autograft. In ten sheep a short length of pulmonary artery was interposed in the descending aorta, serving as a simplified version of the Ross procedure. In seven of these cases, the autograft was supported by an external mesh or so-called exostent. Three sheep served as control, of which one was excluded from the mechanical testing. The sheep were sacrificed six months after the procedure. Samples of the relevant tissues were obtained for subsequent mechanical testing: normal aorta, normal pulmonary artery, aorta with exostent, pulmonary artery with exostent, and pulmonary artery in aortic position for six months. After mechanical testing, the material parameters of the Gasser-Ogden-Holzapfel model were determined for the different tissue types. Stress-strain curves of the different tissue types show significantly different mechanical behavior. At baseline, stress-strain curves of the pulmonary artery are lower than aortic stress-strain curves, but at the strain levels at which the collagen fibers are recruited, the pulmonary artery behaves stiffer than the aorta. After being in aortic position for six months, the pulmonary artery tends towards aorta-like behavior, indicating that growth and remodeling processes have taken place. When adding an exostent around the pulmonary autograft, the mechanical behavior of the composite artery (exostent + artery) differs from the artery alone, the non-linearity being more evident in the former.

Reinforcing an interposition pulmonary autograft in the descending aorta with a macroporous mesh showed promising results in limiting autograft dilatation in this sheep model. Histological evaluation revealed atrophy of the smooth muscle cell and consequently thinning of the vessel wall within the mesh support.

Computational investigations of how soft tissues grow and remodel are gaining more and more interest and several growth and remodeling theories have been developed. Roughly, two main groups of theories for soft tissues can be distinguished: kinematic-based growth theory and theories based on constrained mixture theory. Our goal was to apply these two theories on the same experimental data. Within the experiment, a pulmonary artery was exposed to systemic conditions. The change in diameter was followed-up over time.A mechanical and microstructural analysis of native pulmonary artery and pulmonary autograft was conducted. Whereas the kinematic-based growth theory is able to accurately capture the growth of the tissue, it does not account for the mechanobiological processes causing this growth. The constrained mixture theory takes into account the mechanobiological processes including removal, deposition and adaptation of all structural constituents, allowing us to simulate a changing microstructure and mechanical behavior.