{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:04:01Z","timestamp":1791417841672,"version":"4.3.3"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,8,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Current methods for aortic dissection risk assessment are inadequate for patients with ascending aortic aneurysms associated with either bicuspid aortic valves (BAVs) or tricuspid aortic valves (TAVs). Biomechanical testing of aortic tissue may provide novel insights and biomarkers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              From March 2017 to August 2019, aneurysmal ascending aortas (BAV=23, TAV=23) were collected from elective aortic surgery, normal aortas from transplant donors (n=9), and dissected aortas from surgery for aortic dissection (n=7). These aortas underwent delamination testing in simulation of aortic dissection. Biaxial tensile testing was performed to determine modulus of elasticity (aortic stiffness), and energy loss (a measure of efficiency in performing the Windkessel function). Delamination strength (\n              <jats:italic>S<\/jats:italic>\n              <jats:sub>d<\/jats:sub>\n              ) was lowest in dissected aortas (18\u00b16\u00a0mN\/mm) and highest in normal aortas (58\u00b116\u00a0mN\/mm), and aneurysms fell in between, with greater\n              <jats:italic>S<\/jats:italic>\n              <jats:sub>d<\/jats:sub>\n              in the BAV group (37\u00b110\u00a0mN\/mm) than the TAV group (27\u00b110\u00a0mN\/mm) (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Bicuspid aortopathy was associated with greater stiffness (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), while aneurysms with TAV demonstrated greater energy loss (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n              <jats:italic>S<\/jats:italic>\n              <jats:sub>d<\/jats:sub>\n              decreased by 7.8\u00b11.2\u00a0mmol\/L per mm per decade of life (\n              <jats:italic>r<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =0.45,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and it was significantly lower for patients with hypertension (\n              <jats:italic>P<\/jats:italic>\n              =0.001).\n              <jats:italic>S<\/jats:italic>\n              <jats:sub>d<\/jats:sub>\n              decreased by 6.1\u00b12.1\u00a0mmol\/L per mm with each centimeter increase in aortic diameter (\n              <jats:italic>r<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =0.15,\n              <jats:italic>P<\/jats:italic>\n              =0.007). Increased energy loss was associated with decreased\n              <jats:italic>S<\/jats:italic>\n              <jats:sub>d<\/jats:sub>\n              (\n              <jats:italic>r<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =0.41), whereas there was no relationship between\n              <jats:italic>S<\/jats:italic>\n              <jats:sub>d<\/jats:sub>\n              and aortic stiffness.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Aneurysms with BAV had higher\n              <jats:italic>S<\/jats:italic>\n              <jats:sub>d<\/jats:sub>\n              than those with TAV, suggesting that BAV was protective. Energy loss was lower in aneurysms with BAV, and inversely associated with\n              <jats:italic>S<\/jats:italic>\n              <jats:sub>d<\/jats:sub>\n              , representing a potential novel biomarker.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.016715","type":"journal-article","created":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T09:09:09Z","timestamp":1595927349000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Biomechanics of Aortic Dissection: A Comparison of Aortas Associated With Bicuspid and Tricuspid Aortic Valves"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4079-2618","authenticated-orcid":false,"given":"Jennifer C.\u2010Y.","family":"Chung","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery University Health Network Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Industrial Engineering University of Toronto Toronto ON Canada"},{"name":"Translational Biology and Engineering Program Ted Rogers Centre for Heart Research Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyi","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Industrial Engineering University of Toronto Toronto ON Canada"},{"name":"Translational Biology and Engineering Program Ted Rogers Centre for Heart Research Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniella","family":"Eliathamby","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery University Health Network Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Forbes","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery University Health Network Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagdish","family":"Butany","sequence":"additional","affiliation":[{"name":"Department of Pathology University Health Network Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7729-1772","authenticated-orcid":false,"given":"Craig A.","family":"Simmons","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Industrial Engineering University of Toronto Toronto ON Canada"},{"name":"Translational Biology and Engineering Program Ted Rogers Centre for Heart Research Toronto ON Canada"},{"name":"Institute of Biomaterials and Biomedical Engineering University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maral","family":"Ouzounian","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery University Health Network Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1207059"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1286"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.1281"},{"key":"e_1_3_1_5_2","first-page":"e521","article-title":"2014 AHA\/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","author":"Nishimura RA","year":"2014","unstructured":"Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, et al. 2014 AHA\/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines. 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