Biomechanical Evaluation of Stress–Strain Behavior of Different Bovine Pericardial Patches Preserved in Glutaraldehyde Solution

Biomechanical Evaluation of Stress–Strain Behavior of Different Bovine Pericardial Patches Preserved in Glutaraldehyde Solution | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Biomechanical Evaluation of Stress–Strain Behavior of Different Bovine Pericardial Patches Preserved in Glutaraldehyde Solution Abdulrahman ALBLOWI, Siyu LIN, Olivier BOUCHOT, Jeremy LAGRANGE, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8391468/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Bovine pericardial patches (BPPs) preserved in glutaraldehyde are widely used in cardiovascular surgery due to their durability, biocompatibility, and availability, particularly in infected or contaminated fields. However, differences in harvesting site, animal age, and decellularization techniques may influence biomechanical behavior, which can change the outcome of surgical treatment. Stiffer grafts may impair aortic compliance and contribute to adverse cardiac remodeling. This study assessed the biomechanical properties of commonly used commercial BPPs, focusing on intra- and inter-sample variability and measuring the BPPs at different elastic modulus values. Methods: Forty BPPs from four suppliers ( n = 10 each) were analyzed. Each patch was sectioned into four bone-shaped specimens (two horizontal, two vertical) according to our laboratory’s standardized protocol. Thickness was measured at three points per specimen. Uniaxial tensile testing was performed under physiological conditions with preconditioning cycles using the LM1 system. Elastic modulus values were assessed at three physiological loading stages: physiological elastic modulus (PEM: 80–140 mmHg), maximum physiological elastic modulus (MPEM: 360 mmHg), and maximum elastic modulus (MEM: failure point). Variability was analyzed using paired comparisons and the coefficient of variation. Results: Thickness ranged from 0.384 to 0.469 mm, with low variability across suppliers. Orientation-related thickness differences were not significant for most samples. Supple Peri-Guard patches exhibited significantly lower PEM values than Xenosure ( p = 0.0035) and Invengenx ( p = 0.0396). No significant differences among suppliers were found for MPEM or MEM. Orientation did not significantly influence biomechanical performance. Coefficient of variation values confirmed minimal intra-sample variability. Conclusion: BPPs preserved in glutaraldehyde demonstrate consistent thickness and homogeneous elastic behavior across suppliers, supporting their safe and reliable use in cardiovascular reconstruction. Further histological and long-term in vivo studies are recommended to evaluate remodeling and potential hemodynamic effects. Bovine pericardial patches xenograft material biomechanics stress–strain behavior tensile strength aortic graft Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Bovine pericardial patches (BPPs) preserved in glutaraldehyde solution are currently used in various specialties, especially in the cardiovascular field (Biasi, 1996 ; Ionescu et al., 1977 ; X. Li et al., 2011 ). In vascular surgery, their use has become standard practice in the context of infection, such as in mycotic aortic aneurysms, aortoenteric fistulas, or contaminated aortic grafts. BPPs offer benefits due to their consistent reliability, ease of use, long shelf life, biocompatibility, immediate availability, absence of aneurysmal degeneration, and low reinfection rate (X. Li et al., 2011 ; Weiss et al., 2024 ; Zouhair et al., 2020 ). BPPs are a type of xenograft material, harvested from calves under 2 years old and preserved in a glutaraldehyde solution. Glutaraldehyde is an organic compound frequently used in aqueous solutions (X. Li et al., 2011 ). It is highly valued for its protein crosslinking capability, stable mechanical properties, preservation of structural integrity, and reducible antigenicity due to the removal of living cells (Biondi-Zoccai et al., 2007 ; Lee et al., 2016 ; Migneault et al., 2004 ). The BPP is an avascular fibrous tissue that surrounds the heart. It consists of two layers with different histological structures and compositions. The first is an inner serous layer in direct contact with the heart, which is made up of endothelium and basement membrane. It is composed primarily of collagen type IV and laminin. The second is an external fibrous layer made up of connective tissue and mainly composed of collagen type I. A complex network of collagen and elastic fibers maintains the structural integrity of bovine pericardial tissue (Spodick, 1992 ; Xing et al., 2021 ). Replacing the native aorta with a rigid material can alter vascular pressure and flow patterns, potentially exacerbating peripheral vascular disease (Tremblay et al., 2009 ). These hemodynamic changes can also affect aortic valve and left ventricular function, leading to a higher cardiac workload and increased oxygen demand, especially during physical activity (Kim et al., 1995 ; Salvi, 2017 ). Pressure mismatch between the native aorta and a prosthetic graft is thought to promote the formation of false aneurysms (Mehigan et al., 1985 ) and intimal hyperplasia (Ballyk et al., 1998 ). This stress concentration at the junction between the native tissue and the graft can lead to structural remodeling, driven by the altered mechanical environment created by the pressure mismatch (Ballyk et al., 1998 ; Surovtsova, 2005 ). The maximum tensile strength of the ascending aorta, descending thoracic aorta, and abdominal aorta is 1.7 ± 1.4 MPa, 1.4 ± 0.9 MPa, and 0.7 ± 0.1 MPa, respectively (Z. Li et al., 2023 ; Vorp et al., 2003 ). For native neonatal bovine pericardial patches, the maximum tensile strength is reported to be 80 MPa, whereas for native adult bovine pericardial patches, the value is 30 MPa (Sizeland et al., 2014 ). The BPPs preserved in glutaraldehyde solution exhibit significant variability in maximum tensile strength, ranging from 15.3 MPa to 70 MPa. However, BPP suppliers have provided no specific details concerning this parameter (Aguiari et al., 2016 ). BPP suppliers possess confidential and sometimes ambiguous information regarding the harvesting zones, types, and ages of the bovine sources, the decellularization technique, and any additional treatments applied to BPPs (Iop et al., 2018 ; Sizeland et al., 2014 ; Stieglmeier et al., 2021 ). The wide range of maximum tensile strengths indicates that various decellularization techniques and distinct anatomical harvesting regions may modify their biomechanical properties. Understanding the biomechanical behavior of BPPs used in aortic replacements can enhance clinical practice by elucidating the physiological changes that occur in patients. Therefore, this study’s objective was to investigate the biomechanical and structural properties of BPPs preserved in glutaraldehyde and processed using different decellularization methods. Specifically, the study aimed to evaluate both inter- and intra-sample variability in thickness and elastic behavior by analyzing stress–strain curves obtained from uniaxial tensile testing. The elastic modulus was measured under multiple loading conditions to comprehensively assess the mechanical performance, structural homogeneity, and consistency of each BPP. Results Different biomechanical analyses were performed on BPPs from four different suppliers, with each supplier providing 10 BPPs, with two specimens oriented horizontally and two vertically. The mean thickness of BPPs from Edwards Lifesciences (Edwards) was 0.419 ± 0.074 mm (median 0.411; range 0.30–0.56 mm ) , while the mean thickness of BPPs from Supple Peri-Guard (Baxter) was 0.424 ± 0.085 mm (median 0.415; range 0.30–0.58 mm). The mean thickness of BPPs from Xenosure (LeMaitre) exhibited slightly lower values, with a mean of 0.384 ± 0.068 mm (median 0.377; range 0.28–0.49 mm). Finally, Invengenx-Tisgenx patches were the thickest, with a mean of 0.469 ± 0.084 mm (median 0.462; range 0.35–0.60 mm) (Table 1 ). Table 1 Description of BPPs’ thickness (in mm) from different suppliers, calculated from 10 samples. Group Mean ± SD Median Min–Max p25 p75 IQR Edwards Lifesciences 0.419 ± 0.074 mm 0.411 0.30–0.56 0.373 0.466 0.26 Supple Peri-Guard 0.424 ± 0.085 mm 0.415 0.30–0.58 0.367 0.477 0.28 Xenosure 0.384 ± 0.068 mm 0.377 0.28–0.49 0.332 0.446 0.21 Invengenx 0.469 ± 0.084 mm 0.462 0.35–0.60 0.391 0.537 0.25 Mean ± SD : Mean and standard deviation. p25, p50, p75 : 25th percentile, median, and 75th percentile. IQR : Interquartile range. The mean of the two specimens with the same orientation was used, resulting in two biomechanical measurements (horizontal and vertical) per patch. The mean CV% values were 13.4% for Edwards Lifesciences (Edwards), 15.5% for Supple Peri-Guard (Baxter), 17.9% for Xenosure (LeMaitre), and 18.7% for Tisgenx (Invengenx). This result indicates low variability and suggests a homogeneous structure within samples. Statistical analysis revealed no significant intra-sample differences across patch types. Paired t -tests were conducted to evaluate intra-sample variability between the horizontal and vertical orientations for each patch. The findings revealed no significant differences for Supple Peri-Guard (Baxter) ( p = 0.18) and Tisgenx (Invengenx) ( p = 0.20), signifying uniform thickness and homogeneity across orientations. On the other hand, Edwards Lifesciences (Edwards) patches demonstrated a borderline significant difference ( p = 0.048), but Xenosure (LeMaitre) patches revealed a highly significant difference ( p = 0.0006), indicating increased intra-sample variability in thickness between horizontal and vertical orientations. Tukey’s multiple comparisons test indicated no statistically significant differences in CV% across the four groups. Pairwise comparisons revealed that BPP groups had similar variability profiles, with no significant variations in mean CV% among the groups. The PEM values for the BPPs were as follows: Edwards Lifesciences (Edwards) exhibited a mean of 1.931 ± 1.456 MPa (range: 0.256–6.203 MPa), Supple Peri-Guard (Baxter) showed 1.392 ± 1.289 MPa (range: 0.090–5.860 MPa), Xenosure (LeMaitre) recorded 4.121 ± 2.467 MPa (range: 0.775–9.391 MPa), and Tisgenx (Invengenx) presented 3.985 ± 2.868 MPa (range: 0.289–11.020 MPa). Dunn’s multiple comparisons test showed that Supple Peri-Guard (Baxter) patches exhibited significantly lower values than Xenosure (LeMaitre) ( p = 0.0035) and Tisgenx (Invengenx) ( p = 0.0396). No other significant differences were observed among the remaining patch types (Fig. 4 -A). Paired analyses comparing horizontal and vertical orientations showed no significant intra-sample differences in PEM across BPPs (Fig. 5 ). The MPEM values for the BPPs were as follows: Edwards Lifesciences (Edwards) exhibited a mean of 2.928 ± 1.716 MPa (range: 0.426–7.752 MPa), Supple Peri-Guard (Baxter) showed 4.608 ± 6.706 MPa (range: 0.760–35.492 MPa), Xenosure (LeMaitre) recorded 6.929 ± 5.689 MPa (range: 1.255–24.669 MPa), and Tisgenx (Invengenx) presented 5.560 ± 4.080 MPa (range: 0.565–16.993 MPa). Dunn’s multiple comparisons test indicated no statistically significant variations in mean rank values across the four groups. All remaining pairwise comparisons were non-significant, demonstrating overall comparable performance among the evaluated materials (Fig. 4 -B). No significant differences were observed between the horizontal and vertical orientations for MPEM across BPPs (Fig. 6 ). The MEM values for the BPPs were as follows: Edwards Lifesciences (Edwards) demonstrated a mean of 17.724 ± 8.052 MPa (range: 5.469–44.045 MPa). Supple Peri-Guard (Baxter) showed a slightly higher mean of 20.357 ± 13.226 MPa (range: 0.062–61.272 MPa ) . Xenosure (LeMaitre) presented the highest mean value of 28.603 ± 15.650 MPa (range: 9.562–74.318 MPa), while Tisgenx (Invengenx) exhibited a mean of 21.230 ± 10.802 MPa (range: 7 .576–61.168 MPa). Dunn’s multiple comparisons test demonstrated no statistically significant differences in mean rank between the tested groups. All other pairwise comparisons showed no significant differences (Fig. 4 -C). No significant differences were observed between horizontal and vertical orientations for MEM across most BPPs. Only Tisgenx (Invengenx) showed a significant difference in variance ( p = 0.013), suggesting slightly higher variability between orientations, while all other patches demonstrated uniform elastic behavior (Fig. 7 ). Discussion In this study, we present the biomechanical properties of BPPs widely used in cardiovascular surgery. By evaluating patches from four commercial suppliers, we aim to provide surgeons with a clearer understanding of their biomechanical behavior and the potential impact of their differences on clinical outcomes. Uniaxial tensile testing was selected instead of biaxial testing because the original cutting orientation of the supplied patches was not specified, and variations introduced during sample preparation or surgical handling could not be controlled. Given these constraints, uniaxial testing offered a more consistent and reproducible method for assessing the biomechanical performance of the materials. In our study, the CV% analysis demonstrated minimal intra-sample variability, with no significant differences detected across the different patch types. However, thickness-related intra-sample variability was observed in the Edwards Lifesciences (Edwards) and Xenosure (LeMaitre) patches, where differences between horizontal and vertical orientations suggested reduced thickness homogeneity. This variation may be attributed to the relatively small sample size. Inter-sample CV% analysis revealed no statistically significant differences among the four groups, confirming consistent inter-group uniformity. In terms of biomechanical performance, comparisons of PEM showed that Supple Peri-Guard (Baxter) patches exhibited significantly lower values than Xenosure (LeMaitre) ( p = 0.0035) and Tisgenx (Invengenx) ( p = 0.0396), while no significant intra-sample variability in PEM was observed among the BPPs. PEM is a useful and realistic parameter (Duprey et al., 2010 ) for evaluating elasticity under normal physiological conditions to understand real biomechanical behaviors. To our knowledge, no study has determined PEM for bovine pericardial patches. MPEM represents a novel parameter designed to assess tissue elasticity under maximum physiological loading conditions, corresponding to the highest recorded physiological blood pressure of approximately 360–370 mmHg (Narloch & Brandstater, 1995 ). This new concept helped us to evaluate the biomaterials under high physiological conditions rather than under very high and abnormal conditions that could not happen in a physiological setting. This concept may be applicable to other medical disciplines for evaluating biomaterials or tissues subjected to high physiological loading conditions. For both MPEM and MEM, no significant inter-group variability was identified in our study. The only notable exception was the Tisgenx (Invengenx) patch, which displayed a significant difference in MEM variance ( p = 0.013), suggesting slightly higher orientation-dependent variability. Overall, the findings indicate that thickness variability among the BPPs remained consistent and was not influenced by the supplier. The results for PEM, MPEM, and MEM collectively demonstrate uniform biomechanical behavior regardless of orientation, reflecting structural homogeneity and stable stress distribution under physiological loading conditions. The BPP cutting orientation—whether horizontal or vertical—showed no significant differences in thickness or elastic properties, indicating comparable biomechanical performance across both directions. Therefore, the selection of orientation may be guided primarily by surgical preference and procedural requirements. Moreover, none of the suppliers specify the direction of BPPs, reinforcing the notion that BPP orientation has a limited impact on functional outcomes. In another study, BPPs exhibited minimal anisotropic behavior at low strain levels, with directional differences in mechanical response becoming apparent only at higher strain values (Tremblay et al., 2009 ). Our results, however, demonstrate that BPPs behave relatively isotropically, suggesting that orientation during aortic reconstruction does not significantly influence their mechanical performance. Across the bovine family, the pericardial layers demonstrate structural organization comparable to that of the human pericardium, with a typical thickness ranging between 0.4 mm and 1 mm (Allen et al., 1984 ; Mansour et al., 2018 ; Peebles et al., 2011 ). This value is slightly higher than that observed in our study, a difference that may be attributed to variations in the decellularization method and the use of glutaraldehyde for tissue preservation. The literature presents a diverse array of findings about the Young’s modulus or MEM of BPPs (Aguiari et al., 2016 ). These data suggest that there is a notable variation in the mechanical characteristics of BPPs observed across different studies. Reported values for uniaxial loading range widely, with the lowest modulus reaching approximately 9.9 MPa (Oswal et al., 2007 ), and the highest reaching 180 ± 49 MPa (Duncan & Boughner, 1998 ). This broad range underscores the multifactorial influence of tissue processing parameters, glutaraldehyde fixation, preconditioning protocols, and experimental testing methodologies on the mechanical behavior of BPPs. Additionally, variations in tensile testing apparatus, specimen geometry, and hydration conditions likely account for the heterogeneity observed across reported mechanical property values. In our study, all bovine pericardial patches were preserved in glutaraldehyde, chemically sterilized, and supplied ready for clinical use, ensuring consistency and minimizing sample heterogeneity. Unfortunately, prior studies that evaluated BPPs’ biomechanical properties did not mention the suppliers’ names, and they reported a wide range of elastic modulus values. Even the suppliers did not indicate the age of bovines, the harvesting site (Stieglmeier et al., 2021 ), or the average elastic modulus of these BPPs. The utilization of BPPs is not limited to cardiovascular surgery; multiple studies have mentioned their utilization in abdominal wall reconstruction (D’Ambra, 2012 ; Saiding et al., 2023 ), urinary bladder reconstruction (Chee et al., 2015 ; Moon et al., 2011 ), replacing ligaments and tendons (Baldo et al., 2018 ; Longo et al., 2010 ), and spinal cord herniation repairs (Zhang et al., 2022 ). These different uses show that BPPs can adapt to tissues with different biomechanical demands and anatomical location according to the surgical application. For aortic surgery, using BPPs shows good results in the short and medium term, as confirmed by Frisch et al. ( 2025 ). Sizeland et al. ( 2014 ) conducted a study evaluating the modulus of elasticity in neonatal and adult bovines. The results indicated that younger individuals have a greater modulus of elasticity (80 MPa) than adults (30 MPa). A clear age-related variation in arterial elasticity has been observed. In younger individuals, the femoral artery is the most elastic, with a value of 3.1 MPa, followed by the iliac artery at 2.9 MPa, the abdominal aorta at 1.0 MPa, the carotid artery at 0.8 MPa, and the descending thoracic aorta at 0.6 MPa. In contrast, older individuals demonstrate a marked reduction in arterial elasticity, with the iliac artery measuring 0.7 MPa and the femoral artery 1.4 MPa, while the descending thoracic aorta is 2.0 MPa, the abdominal aorta 1.2 MPa, and the carotid artery 1.1 MPa (Thubrikar, 2007 ). For cardiovascular surgery, our results confirm the possibility of using any of the tested BPPs, with no significant difference among them. The use of rigid materials to replace the proximal aorta may increase the risk of cardiac hypertrophy. This inability to replicate the native aortic elasticity can impose additional strain on the heart, resulting in elevated left ventricular workload, increased pulse pressure, and a potential progression toward congestive heart failure over time (Sultan et al., 2022 ). Most studies that evaluate vascular remodeling following thoracic endovascular aneurysm repair (TEVAR) procedures focus on assessing changes in aortic wall structure, compliance, and hemodynamic adaptation over time (Vallerio et al., 2019 ; van Bakel et al., 2019 ). The MEM of expanded polytetrafluoroethylene (e-PTFE) grafts is also variable, with results ranging from 17.4 to 55.2 MPa (Bouchet et al., 2019 ; Kleinstreuer et al., 2008 ). To our knowledge, the potential risk of cardiac hypertrophy following the use of BPPs has not yet been investigated. Factors such as material stiffness, graft length, patch or tubular configuration, and anatomical implantation site may play a crucial role in determining postoperative cardiac sequelae. A limitation of this study is that in vitro tissue testing does not replicate physiological internal pressure and involves simplified loading, typically applied in a uniaxial direction. The suppliers have provided insufficient data regarding the harvesting site and the age of the bovine sources. A histological study to evaluate the quantity of elastic and collagen would help strengthen our data. Conclusion The research conducted showed that BPPs preserved in glutaraldehyde exhibit consistent thickness, with minimal intra- and inter-sample variability. No significant differences were detected between horizontal and vertical orientations in either thickness or elastic modulus, confirming structural homogeneity. BPPs exhibit relatively isotropic mechanical behavior, indicating that no specific orientation is needed during aortic reconstruction. The proposed PEM and MPEM concepts provide meaningful evaluation under realistic physiological conditions. Overall, BPPs demonstrated biomechanical properties that support their safe and effective application in cardiovascular surgery. Future studies should include in vivo assessments and histological analyses to evaluate remodeling behavior, long-term outcomes, and potential hemodynamic effects on cardiac and aortic tissue. Methods A total of 40 BPPs preserved in glutaraldehyde solution were obtained from four different suppliers, with 10 patches from each source. The products included Edwards Lifesciences ® (Edwards Lifesciences Corporation, Irvine, CA, USA; model no. 4700; 10 × 15 cm), Supple Peri-Guard ® (Baxter International Inc., Deerfield, IL, USA; model no. PC-1016SN; 10 × 16 cm), Xenosure ® (LeMaitre Vascular Inc., Burlington, MA, USA; model no. 10BV16; 10 × 16 cm), and Invengenx ® (Tisgenx Inc., Irving, TX, USA; model no. XM-21; 7 × 10 cm). All BPPs underwent chemical sterilization and were supplied in a condition suitable for clinical application. Each BPP sample was cut into four bone-shaped pieces: two oriented horizontally and two vertically. Each piece measured 50 mm × 10 mm, with an experimental size of 36 mm, while 14 mm was allocated for the portion clamped with machine clamps (see Fig. 1 -A). Three separate thickness measurements were taken for each piece’s surface, as illustrated in Fig. 1 -B: one measurement on each side and one in the center, using a digital thickness micrometer device equipped with a constant-force transducer (Litematic VL-50, Mitutoyo Corp, Kanagawa, Japan). Horizontal uniaxial tensile testing was performed using the LM1 system (TA Instruments, ElectroForce® System Group, Eden Prairie, MN, USA), with a maximum displacement of 12 mm, chosen to remain within the instrument’s operating limits. A preload tension of 0.05 N was applied to ensure identical baseline stress conditions. This preload was defined as the zero-stress reference point for all subsequent measurements. Each specimen underwent 10 preconditioning cycles to eliminate hysteresis effects and ensure a consistent, repeatable stress–strain curve. To simulate physiological conditions and minimize gravitational interference, testing was conducted in distilled water maintained at 37 ± 0.1°C. Details of the horizontal uniaxial tensile testing machine are displayed in Fig. 2 . The samples were stretched to failure, with all measurements recorded at 0.0001-second intervals. The software utilized during the experiments was WinTest® 8 (TA Instruments, ElectroForce® System Group, Eden Prairie, MN, USA). Then, all data were analyzed to measure the elastic modulus at three different points: the physiological elastic modulus (PEM) when the pressure was between 80 and 140 mmHg, the maximum physiological elastic modulus (MPEM) when the pressure was 360 mmHg (Narloch & Brandstater, 1995 ), and the maximal elastic modulus (MEM) when the pressure reached the BPPs’ failure point (see Fig. 3 ). According to the results of the BPPs’ measured thickness, the distance between the two arms of the uniaxial tensile testing machine, and the applied stretching force, a stress–strain test was performed to determine the elastic modulus according to the following formula: E = ( F × L ₀) / ( w × t × Δ L ) Where: E : Elastic modulus (Pa or N/m²) F : Applied force (N) L ₀: Initial length of the specimen (m) w : Width of the specimen (m) t : Measured thickness of the specimen (m) Δ L : Elongation under load (m) GraphPad Prism 7 software (GraphPad Software, San Diego, California, USA) was utilized for parameter fitting and statistical analysis. Data derived from the BPPs’ mechanical tests using the LM1 system (TA Instruments, ElectroForce® System Group, USA) and measured specimen thickness were used to construct stress–strain curves and to determine the failure stress and strain for each specimen. Continuous variables are presented as means ± standard deviation (SD). For each BPP, the mean parameter values, including thickness, PEM, MPEM, and MEM, were calculated either from the four bone-shaped pieces or from the two pieces with the same orientation for specific horizontal and vertical comparison analysis. Normality was assessed using the Shapiro–Wilk test. For two-group or orientation comparisons, the Mann–Whitney U-test was used for nonparametric data and the t -test for parametric data. To compare more than two groups, ANOVA with Tukey’s post-hoc test was applied for parametric data, and the Kruskal–Wallis test with Dunn’s correction was used for nonparametric data. The coefficient of variation (CV%), defined as the ratio of the standard deviation to the mean (CV% = SD/Mean × 100), was used to assess intra-sample variability among BPPs. A p -value of less than 0.05 was considered statistically significant. Declarations Acknowledgments: The authors gratefully acknowledge the support of the manufacturers who generously supplied the bovine pericardial patches for this study. Funding: This research received no external funding. Authors’ contributions: Abdulrahman Alblowi: Conceptualization; Methodology; Investigation; Data Curation; Formal Analysis; Visualization; Writing – Original Draft; Writing – Review & Editing; Project Administration. Siyu Lin: Methodology; Validation; Investigation; Formal Analysis; Discussion of Results; Writing – Review & Editing. Olivier Bouchot: Investigation; Resources; Validation; Laboratory Support. Jérémy Lagrange: Formal Analysis; Statistical Analysis; Data Interpretation. Nicla Settembre: Writing – Review & Editing; Scientific Feedback. Serguei Malikov: Supervision; Writing – Review & Editing; Clinical Oversight. Alain Lalande: Supervision; Methodology; Data Interpretation; Writing – Review & Editing; Final Approval. Competing interests: The authors declare that they have no conflict of interest regarding this article. Availability of data and materials: Aggregated findings are available on reasonable request. References Aguiari, P., Fiorese, M., Iop, L., Gerosa, G., & Bagno, A. (2016). Mechanical testing of pericardium for manufacturing prosthetic heart valves. Interactive CardioVascular and Thoracic Surgery , 22 (1), 72–84. https://doi.org/10.1093/icvts/ivv282 Allen, D. J., DiDio, L. J., Zacharias, A., Fentie, I., McGrath, A. J., Puig, L. B., Pomerantzeff, P. N., & Zerbini, E. J. (1984). Microscopic study of normal parietal pericardium and unimplanted Puig-Zerbini pericardial valvular heterografts. The Journal of Thoracic and Cardiovascular Surgery , 87 (6), 845–855. Baldo, M. P., Cunha, R. S., Molina, M. del C. B., Chór, D., Griep, R. H., Duncan, B. B., Schmidt, M. I., Ribeiro, A. L. P., Barreto, S. M., Lotufo, P. A., Bensenor, I. M., Pereira, A. C., & Mill, J. G. (2018). Carotid-femoral pulse wave velocity in a healthy adult sample: The ELSA-Brasil study. International Journal of Cardiology , 251 , 90–95. https://doi.org/10.1016/j.ijcard.2017.10.075 Ballyk, P. D., Walsh, C., Butany, J., & Ojha, M. (1998). Compliance mismatch may promote graft-artery intimal hyperplasia by altering suture-line stresses. Journal of Biomechanics , 31 (3), 229–237. https://doi.org/10.1016/s0197-3975(97)00111-5 Biasi, G. (1996). Processed bovine pericardium as patch angioplasty for carotid endarterectomy: A preliminary report. Cardiovascular Surgery , 4 (5), 591–595. https://doi.org/10.1016/0967-2109(95)00086-0 Biondi-Zoccai, G. G. L., Fusaro, M., Tashani, A., Mollichelli, N., Medda, M., Pasquato, M., & Inglese, L. (2007). Antegrade access in a stented common femoral artery: Feasible but with a real bleeding risk. International Journal of Cardiology , 114 (2), E68–E69. https://doi.org/10.1016/j.ijcard.2006.07.030 Bouchet, M., Gauthier, M., Maire, M., Ajji, A., & Lerouge, S. (2019). Towards compliant small-diameter vascular grafts: Predictive analytical model and experiments. Materials Science and Engineering: C , 100 , 715–723. https://doi.org/10.1016/j.msec.2019.03.023 Chee, J., Durai, P., Wu, F., & Tiong, H. (2015). Bladder repair following iatrogenic cystotomy in irradiated small capacity bladders. Singapore Medical Journal , 56 (03), e49–e52. https://doi.org/10.11622/smedj.2015052 D’Ambra, L. (2012). Use of bovine pericardium graft for abdominal wall reconstruction in contaminated fields. World Journal of Gastrointestinal Surgery , 4 (7), 171. https://doi.org/10.4240/wjgs.v4.i7.171 Duncan, A. C., & Boughner, D. (1998). Effect of dynamic glutaraldehyde fixation on the viscoelastic properties of bovine pericardial tissue. Biomaterials , 19 (7–9), 777–783. https://doi.org/10.1016/s0142-9612(97)00215-9 Duprey, A., Khanafer, K., Schlicht, M., Avril, S., Williams, D., & Berguer, R. (2010). In vitro characterisation of physiological and maximum elastic modulus of ascending thoracic aortic aneurysms using uniaxial tensile testing. European Journal of Vascular and Endovascular Surgery , 39 (6), Article 6. https://doi.org/10.1016/j.ejvs.2010.02.015 Frisch, S., Settembre, N., Belkorissat, R. A., Guerci, P., Mandry, D., AlblowI, A., Lalevee, L., Lefevre, B., & Malikov, S. (2025). Management of infectious aortic aneurysms: Short- and mid-term outcomes. Annals of Vascular Surgery , 115 , 197–205. https://doi.org/10.1016/j.avsg.2025.01.042 Ionescu, M. I., Tandon, A. P., Mary, D. A., & Abid, A. (1977). Heart valve replacement with the Ionescu-Shiley pericardial xenograft. The Journal of Thoracic and Cardiovascular Surgery , 73 (1), 31–42. Iop, L., Palmosi, T., Dal Sasso, E., & Gerosa, G. (2018). Bioengineered tissue solutions for repair, correction and reconstruction in cardiovascular surgery. Journal of Thoracic Disease , 10 (S20), S2390–S2411. https://doi.org/10.21037/jtd.2018.04.27 Kim, S. Y., Hinkamp, T. J., Jacobs, W. R., Lichtenberg, R. C., Posniak, H., & Pifarré, R. (1995). Effect of an inelastic aortic synthetic vascular graft on exercise hemodynamics. The Annals of Thoracic Surgery , 59 (4), 981–989. https://doi.org/10.1016/0003-4975(95)00068-V Kleinstreuer, C., Li, Z., Basciano, C. A., Seelecke, S., & Farber, M. A. (2008). Computational mechanics of Nitinol stent grafts. Journal of Biomechanics , 41 (11), 2370–2378. https://doi.org/10.1016/j.jbiomech.2008.05.032 Lee, C., Lim, H.-G., Lee, C.-H., & Kim, Y. J. (2016). Effects of glutaraldehyde concentration and fixation time on material characteristics and calcification of bovine pericardium: Implications for the optimal method of fixation of autologous pericardium used for cardiovascular surgery. Interactive CardioVascular and Thoracic Surgery , ivw356. https://doi.org/10.1093/icvts/ivw356 Li, X., Guo, Y., Ziegler, K. R., Model, L. S., Eghbalieh, S. D. D., Brenes, R. A., Kim, S. T., Shu, C., & Dardik, A. (2011). Current usage and future directions for the bovine pericardial patch. Annals of Vascular Surgery , 25 (4), 561–568. https://doi.org/10.1016/j.avsg.2010.11.007 Li, Z., Pei, M., Zhang, J., Liu, N., Wang, J., & Zou, D. (2023). A study to characterize the mechanical properties and material constitution of adult descending thoracic aorta based on uniaxial tensile test and digital image correlation. Frontiers in Bioengineering and Biotechnology , 11 , 1178199. https://doi.org/10.3389/fbioe.2023.1178199 Longo, U. G., Lamberti, A., Maffulli, N., & Denaro, V. (2010). Tendon augmentation grafts: A systematic review. British Medical Bulletin , 94 (1), 165–188. https://doi.org/10.1093/bmb/ldp051 Mansour, M., Wilhite, D. R., & Rowe, J. (2018). Guide to ruminant anatomy: Dissection & clinical aspects . John Wiley & Sons Inc. Mehigan, D. G., Fitzpatrick, B., Browne, H. I., & Bouchier-Hayes, D. J. (1985). Is compliance mismatch the major cause of anastomotic arterial aneurysms? Analysis of 42 cases. The Journal of Cardiovascular Surgery , 26 (2), 147–150. Migneault, I., Dartiguenave, C., Bertrand, M. J., & Waldron, K. C. (2004). Glutaraldehyde: Behavior in aqueous solution, reaction with proteins, and application to enzyme crosslinking. BioTechniques , 37 (5), 790–802. https://doi.org/10.2144/04375RV01 Moon, S. J., Kim, D. H., Jo, J. K., Chung, J. H., Lee, J. Y., Park, S. Y., Kim, Y. T., Park, H. K., Choi, H. Y., & Moon, H. S. (2011). Bladder reconstruction using bovine pericardium in a case of enterovesical fistula. Korean Journal of Urology , 52 (2), 150. https://doi.org/10.4111/kju.2011.52.2.150 Narloch, J. A., & Brandstater, M. E. (1995). Influence of breathing technique on arterial blood pressure during heavy weight lifting. Archives of Physical Medicine and Rehabilitation , 76 (5), 457–462. https://doi.org/10.1016/S0003-9993(95)80578-8 Oswal, D., Korossis, S., Mirsadraee, S., Wilcox, H., Watterson, K., Fisher, J., & Ingham, E. (2007). Biomechanical characterization of decellularized and cross-linked bovine pericardium. The Journal of Heart Valve Disease , 16 (2), 165–174. Peebles, C. R., Shambrook, J. S., & Harden, S. P. (2011). Pericardial disease—Anatomy and function. The British Journal of Radiology , 84 (special_issue_3), S324–S337. https://doi.org/10.1259/bjr/16168253 Saiding, Q., Chen, Y., Wang, J., Pereira, C. L., Sarmento, B., Cui, W., & Chen, X. (2023). Abdominal wall hernia repair: From prosthetic meshes to smart materials. Materials Today Bio , 21 , 100691. https://doi.org/10.1016/j.mtbio.2023.100691 Salvi, P. (2017). Pulse waves: How vascular hemodynamics affects blood pressure (2nd ed. 2017). Springer. https://doi.org/10.1007/978-3-319-40501-8 Sizeland, K. H., Wells, H. C., Higgins, J., Cunanan, C. M., Kirby, N., Hawley, A., Mudie, S. T., & Haverkamp, R. G. (2014). Age dependent differences in collagen alignment of glutaraldehyde fixed bovine pericardium. BioMed Research International , 2014 , 1–10. https://doi.org/10.1155/2014/189197 Spodick, D. H. (1992). Macrophysiology, microphysiology, and anatomy of the pericardium: A synopsis. American Heart Journal , 124 (4), 1046–1051. https://doi.org/10.1016/0002-8703(92)90990-D Stieglmeier, F., Grab, M., König, F., Büch, J., Hagl, C., & Thierfelder, N. (2021). Mapping of bovine pericardium to enable a standardized acquirement of material for medical implants. Journal of the Mechanical Behavior of Biomedical Materials , 118 , 104432. https://doi.org/10.1016/j.jmbbm.2021.104432 Sultan, S., Acharya, Y., Soliman, O., Parodi, J. C., & Hynes, N. (2022). TEVAR and EVAR, the unknown knowns of the cardiovascular hemodynamics; and the immediate and long-term consequences of fabric material on major adverse clinical outcome. Frontiers in Surgery , 9 , 940304. https://doi.org/10.3389/fsurg.2022.940304 Surovtsova, I. (2005). Effects of compliance mismatch on blood flow in an artery with endovascular prosthesis. Journal of Biomechanics , 38 (10), 2078–2086. https://doi.org/10.1016/j.jbiomech.2004.09.004 Thubrikar, M. (2007). Vascular mechanics and pathology . Springer. Tremblay, D., Zigras, T., Cartier, R., Leduc, L., Butany, J., Mongrain, R., & Leask, R. L. (2009). A comparison of mechanical properties of materials used in aortic arch reconstruction. The Annals of Thoracic Surgery , 88 (5), 1484–1491. https://doi.org/10.1016/j.athoracsur.2009.07.023 Vallerio, P., Maloberti, A., D’Alessio, I., Lista, A., Varrenti, M., Castelnuovo, S., Marone, M., Piccinelli, E., Grassi, G., Palmieri, B., & Giannattasio, C. (2019). Cardiovascular remodeling after endovascular treatment for thoracic aortic injury. Annals of Vascular Surgery , 61 , 134–141. https://doi.org/10.1016/j.avsg.2019.04.015 van Bakel, T. M. J., Arthurs, C. J., Nauta, F. J. H., Eagle, K. A., van Herwaarden, J. A., Moll, F. L., Trimarchi, S., Patel, H. J., & Figueroa, C. A. (2019). Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms. European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery , 55 (6), 1061–1070. https://doi.org/10.1093/ejcts/ezy399 Vorp, D. A., Schiro, B. J., Ehrlich, M. P., Juvonen, T. S., Ergin, M. A., & Griffith, B. P. (2003). Effect of aneurysm on the tensile strength and biomechanical behavior of the ascending thoracic aorta. The Annals of Thoracic Surgery , 75 (4), 1210–1214. https://doi.org/10.1016/s0003-4975(02)04711-2 Weiss, S., Hugas Mallorqui, M., Czerny, M., Walter, T., Biro, G., Puttini, I., Almasi-Sperling, V., Lang, W., Schmidli, J., & Wyss, T. R. (2024). Physician made bovine pericardial tube grafts in aortic infection: A European multicentre study. European Journal of Vascular and Endovascular Surgery , 67 (6), 997–1005. https://doi.org/10.1016/j.ejvs.2024.02.004 Xing, Q., Parvizi, M., Lopera Higuita, M., & Griffiths, L. G. (2021). Basement membrane proteins modulate cell migration on bovine pericardium extracellular matrix scaffold. Scientific Reports , 11 (1), 4607. https://doi.org/10.1038/s41598-021-84161-5 Zhang, L., Wu, H., Liu, Z., Wang, X., Cheng, Y., & Wang, K. (2022). Dural repair with fat patch for idiopathic spinal cord herniation: Operative technique and a review of seven cases. Annals of Translational Medicine , 10 (16), 865–865. https://doi.org/10.21037/atm-22-3343 Zouhair, S., Dal Sasso, E., Tuladhar, S. R., Fidalgo, C., Vedovelli, L., Filippi, A., Borile, G., Bagno, A., Marchesan, M., De Rossi, G., Gregori, D., Wolkers, W. F., Romanato, F., Korossis, S., Gerosa, G., & Iop, L. (2020). A comprehensive comparison of bovine and porcine decellularized pericardia: New insights for surgical applications. Biomolecules , 10 (3), 371. https://doi.org/10.3390/biom10030371 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8391468","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589762037,"identity":"fd95e204-1517-419f-8c91-325c20c0f7d8","order_by":0,"name":"Abdulrahman ALBLOWI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIie3RvQrCMBDA8RPBLgeuFVFfIVIQheKzGAQ3oaObFaFdRFcFN19A3yCSoWPXjErAyUFwERz0/FqjboL5Q4ZAflxCAGy23ywjIQDIOYPwvgs/MRIYEVx/S8BtwWckP1lsZMB8Pi7owRHBLy2Fsz2YiKt2TE5Zh0dFPiwidLylQM81jlGCSWSySyQkIjkRMJKKSg4PUlgPzwgXIo4+mQhLR88pbiaiKYII1IxTqgqD21v6EfKoMWdtbyaxVjeRcpqsdNDzvUqcaLXvNUvjJNbKRF7f8bonrazxPJUX707YbDbb33cF+zpPA8xfZ9EAAAAASUVORK5CYII=","orcid":"","institution":"Université de Lorraine, INSERM, DCAC","correspondingAuthor":true,"prefix":"","firstName":"Abdulrahman","middleName":"","lastName":"ALBLOWI","suffix":""},{"id":589762038,"identity":"13b8d315-3062-4a68-b759-c6c9061c70b1","order_by":1,"name":"Siyu LIN","email":"","orcid":"","institution":"Université Bourgogne Europe","correspondingAuthor":false,"prefix":"","firstName":"Siyu","middleName":"","lastName":"LIN","suffix":""},{"id":589762039,"identity":"fd00455a-eea8-4687-8acf-3a6399b1f8fe","order_by":2,"name":"Olivier BOUCHOT","email":"","orcid":"","institution":"Université Bourgogne Europe","correspondingAuthor":false,"prefix":"","firstName":"Olivier","middleName":"","lastName":"BOUCHOT","suffix":""},{"id":589762043,"identity":"0dfad27e-b390-430c-bdc8-e6876ac87db1","order_by":3,"name":"Jeremy LAGRANGE","email":"","orcid":"","institution":"Université de Lorraine, INSERM, DCAC","correspondingAuthor":false,"prefix":"","firstName":"Jeremy","middleName":"","lastName":"LAGRANGE","suffix":""},{"id":589762044,"identity":"abf4e4d6-4caf-45be-abdd-54f1ee9b340b","order_by":4,"name":"Nicla SETTEMBRE","email":"","orcid":"","institution":"Université de Lorraine, INSERM, DCAC","correspondingAuthor":false,"prefix":"","firstName":"Nicla","middleName":"","lastName":"SETTEMBRE","suffix":""},{"id":589762045,"identity":"8920faa9-222e-4fab-a6e6-a63244e38b3b","order_by":5,"name":"Serguei MALIKOV","email":"","orcid":"","institution":"Université de Lorraine, INSERM, DCAC","correspondingAuthor":false,"prefix":"","firstName":"Serguei","middleName":"","lastName":"MALIKOV","suffix":""},{"id":589762046,"identity":"9f3493b2-ecc2-4fba-96ee-ec51056d2220","order_by":6,"name":"Alain LALANDE","email":"","orcid":"","institution":"Université Bourgogne Europe","correspondingAuthor":false,"prefix":"","firstName":"Alain","middleName":"","lastName":"LALANDE","suffix":""}],"badges":[],"createdAt":"2025-12-18 05:53:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8391468/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8391468/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102853935,"identity":"9fb509db-7783-4848-899b-2ca88b228726","added_by":"auto","created_at":"2026-02-17 14:46:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78199,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4: Elastic modulus comparison of bovine pericardial patches. (A) Physiological elastic modulus (PEM); Supple Peri-Guard (Baxter) patches exhibited significantly lower values than Tisgenx (Invengenx) (\u003cem\u003ep\u003c/em\u003e = 0.0396) (*) and Xenosure (LeMaitre) (\u003cem\u003ep\u003c/em\u003e = 0.0035)(**). (B) Maximum physiological elastic modulus (MPEM). (C) Maximum elastic modulus (MEM).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8391468/v1/d9dfb0882abbdd1061c567e3.png"},{"id":102963091,"identity":"aa9a5c23-fa9f-41a0-8169-1eb024ba992c","added_by":"auto","created_at":"2026-02-19 04:13:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":78395,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 5: Physiological elastic modulus of horizontal and vertical samples of bovine pericardial tissue patches (\u003cem\u003en\u003c/em\u003e = 10 per group). (A) Edwards Lifesciences (Edwards); (B) Supple Peri-Guard (Baxter); (C) Xenosure (LeMaitre); and (D) Tisgenx (Invengenx).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8391468/v1/c4db41b616bd9203fcd38a29.png"},{"id":102853929,"identity":"656c637e-fa92-47ad-9908-123ee607c07b","added_by":"auto","created_at":"2026-02-17 14:46:25","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":83202,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 6: Maximum physiological elastic modulus of horizontal and vertical samples of bovine pericardial tissue patches (\u003cem\u003en\u003c/em\u003e = 10 per group). (A) Edwards Lifesciences (Edwards); (B) Supple Peri-Guard (Baxter); (C) Xenosure (LeMaitre); and (D) Tisgenx (Invengenx).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8391468/v1/e73e0ed0c1a1789bd93e7ac3.png"},{"id":102853931,"identity":"83ba7b8a-67d1-4be0-a96e-858c20ba5c88","added_by":"auto","created_at":"2026-02-17 14:46:25","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":89006,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 7: Maximum elastic modulus of horizontal and vertical samples of bovine pericardial tissue patches (\u003cem\u003en\u003c/em\u003e = 10 per group). (A) Edwards Lifesciences (Edwards); (B) Supple Peri-Guard (Baxter); (C) Xenosure (LeMaitre); and (D) Tisgenx (Invengenx).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8391468/v1/01c0da726bfbc53fb6ff6ec0.png"},{"id":102853932,"identity":"d65ced96-8ed0-494b-ac4f-e40239d43c50","added_by":"auto","created_at":"2026-02-17 14:46:25","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":162272,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1: Bone-shaped specimens from BPPs. (A) Dimensions of the standardized sample. (B) Thickness measured at three points (I–III) using an electronic micrometer.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8391468/v1/fda730e84a1b281511d21e89.png"},{"id":102853934,"identity":"be7b2110-0c1e-4d37-932d-f57ee9a6e84c","added_by":"auto","created_at":"2026-02-17 14:46:25","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":487176,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2: \u003c/strong\u003eHorizontal \u003cstrong\u003euniaxial tensile testing machine: \u003c/strong\u003etensile testing machine (LM1 system, TA Instruments, ElectroForce® System Group, Eden Prairie, MN, USA) with metal clamps, displacement motor, and distilled water bath.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8391468/v1/e468f3c77d9be116b0354e35.png"},{"id":102853933,"identity":"3058f6af-d495-4ef8-a476-9b5add21a4a8","added_by":"auto","created_at":"2026-02-17 14:46:25","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":351949,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3: Stress–strain curve illustrating the three defined elastic modulus regions: PEM (physiological elastic modulus, 80–140 mmHg), MPEM (maximum physiological elastic modulus, 360 mmHg), and MEM (maximum elastic modulus at failure).\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-8391468/v1/0a99ec31698a436306ae52cf.png"},{"id":103431072,"identity":"e92dd4e6-eaf5-4c93-b54c-d496f58f92a2","added_by":"auto","created_at":"2026-02-25 15:26:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1844863,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8391468/v1/4c7df31e-fc35-486f-8ad7-ab9af47dc969.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Biomechanical Evaluation of Stress–Strain Behavior of Different Bovine Pericardial Patches Preserved in Glutaraldehyde Solution","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBovine pericardial patches (BPPs) preserved in glutaraldehyde solution are currently used in various specialties, especially in the cardiovascular field (Biasi, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1996\u003c/span\u003e; Ionescu et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1977\u003c/span\u003e; X. Li et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). In vascular surgery, their use has become standard practice in the context of infection, such as in mycotic aortic aneurysms, aortoenteric fistulas, or contaminated aortic grafts. BPPs offer benefits due to their consistent reliability, ease of use, long shelf life, biocompatibility, immediate availability, absence of aneurysmal degeneration, and low reinfection rate (X. Li et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Weiss et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Zouhair et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). BPPs are a type of xenograft material, harvested from calves under 2 years old and preserved in a glutaraldehyde solution. Glutaraldehyde is an organic compound frequently used in aqueous solutions (X. Li et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). It is highly valued for its protein crosslinking capability, stable mechanical properties, preservation of structural integrity, and reducible antigenicity due to the removal of living cells (Biondi-Zoccai et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Lee et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Migneault et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). The BPP is an avascular fibrous tissue that surrounds the heart. It consists of two layers with different histological structures and compositions. The first is an inner serous layer in direct contact with the heart, which is made up of endothelium and basement membrane. It is composed primarily of collagen type IV and laminin. The second is an external fibrous layer made up of connective tissue and mainly composed of collagen type I. A complex network of collagen and elastic fibers maintains the structural integrity of bovine pericardial tissue (Spodick, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1992\u003c/span\u003e; Xing et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eReplacing the native aorta with a rigid material can alter vascular pressure and flow patterns, potentially exacerbating peripheral vascular disease (Tremblay et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). These hemodynamic changes can also affect aortic valve and left ventricular function, leading to a higher cardiac workload and increased oxygen demand, especially during physical activity (Kim et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Salvi, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Pressure mismatch between the native aorta and a prosthetic graft is thought to promote the formation of false aneurysms (Mehigan et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1985\u003c/span\u003e) and intimal hyperplasia (Ballyk et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). This stress concentration at the junction between the native tissue and the graft can lead to structural remodeling, driven by the altered mechanical environment created by the pressure mismatch (Ballyk et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1998\u003c/span\u003e; Surovtsova, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). The maximum tensile strength of the ascending aorta, descending thoracic aorta, and abdominal aorta is 1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 MPa, 1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 MPa, and 0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1 MPa, respectively (Z. Li et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Vorp et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). For native neonatal bovine pericardial patches, the maximum tensile strength is reported to be 80 MPa, whereas for native adult bovine pericardial patches, the value is 30 MPa (Sizeland et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The BPPs preserved in glutaraldehyde solution exhibit significant variability in maximum tensile strength, ranging from 15.3 MPa to 70 MPa. However, BPP suppliers have provided no specific details concerning this parameter (Aguiari et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). BPP suppliers possess confidential and sometimes ambiguous information regarding the harvesting zones, types, and ages of the bovine sources, the decellularization technique, and any additional treatments applied to BPPs (Iop et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Sizeland et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Stieglmeier et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The wide range of maximum tensile strengths indicates that various decellularization techniques and distinct anatomical harvesting regions may modify their biomechanical properties.\u003c/p\u003e \u003cp\u003eUnderstanding the biomechanical behavior of BPPs used in aortic replacements can enhance clinical practice by elucidating the physiological changes that occur in patients. Therefore, this study\u0026rsquo;s objective was to investigate the biomechanical and structural properties of BPPs preserved in glutaraldehyde and processed using different decellularization methods. Specifically, the study aimed to evaluate both inter- and intra-sample variability in thickness and elastic behavior by analyzing stress\u0026ndash;strain curves obtained from uniaxial tensile testing. The elastic modulus was measured under multiple loading conditions to comprehensively assess the mechanical performance, structural homogeneity, and consistency of each BPP.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDifferent biomechanical analyses were performed on BPPs from four different suppliers, with each supplier providing 10 BPPs, with two specimens oriented horizontally and two vertically. The mean thickness of BPPs from Edwards Lifesciences (Edwards) was 0.419\u0026thinsp;\u0026plusmn;\u0026thinsp;0.074 mm (median 0.411; range 0.30\u0026ndash;0.56 mm\u003cb\u003e)\u003c/b\u003e, while the mean thickness of BPPs from Supple Peri-Guard (Baxter) was 0.424\u0026thinsp;\u0026plusmn;\u0026thinsp;0.085 mm (median 0.415; range 0.30\u0026ndash;0.58 mm). The mean thickness of BPPs from Xenosure (LeMaitre) exhibited slightly lower values, with a mean of 0.384\u0026thinsp;\u0026plusmn;\u0026thinsp;0.068 mm (median 0.377; range 0.28\u0026ndash;0.49 mm). Finally, Invengenx-Tisgenx patches were the thickest, with a mean of 0.469\u0026thinsp;\u0026plusmn;\u0026thinsp;0.084 mm (median 0.462; range 0.35\u0026ndash;0.60 mm) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of BPPs\u0026rsquo; thickness (in mm) from different suppliers, calculated from 10 samples.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep25\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep75\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIQR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEdwards Lifesciences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.419\u0026thinsp;\u0026plusmn;\u0026thinsp;0.074 mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.30\u0026ndash;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupple Peri-Guard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.424\u0026thinsp;\u0026plusmn;\u0026thinsp;0.085 mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.30\u0026ndash;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXenosure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.384\u0026thinsp;\u0026plusmn;\u0026thinsp;0.068 mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u0026ndash;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvengenx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.469\u0026thinsp;\u0026plusmn;\u0026thinsp;0.084 mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.35\u0026ndash;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e: Mean and standard deviation. \u003cb\u003ep25, p50, p75\u003c/b\u003e: 25th percentile, median, and 75th percentile. \u003cb\u003eIQR\u003c/b\u003e: Interquartile range.\u003c/p\u003e \u003cp\u003eThe mean of the two specimens with the same orientation was used, resulting in two biomechanical measurements (horizontal and vertical) per patch. The mean CV% values were 13.4% for Edwards Lifesciences (Edwards), 15.5% for Supple Peri-Guard (Baxter), 17.9% for Xenosure (LeMaitre), and 18.7% for Tisgenx (Invengenx). This result indicates low variability and suggests a homogeneous structure within samples. Statistical analysis revealed no significant intra-sample differences across patch types.\u003c/p\u003e \u003cp\u003ePaired \u003cem\u003et\u003c/em\u003e-tests were conducted to evaluate intra-sample variability between the horizontal and vertical orientations for each patch. The findings revealed no significant differences for Supple Peri-Guard (Baxter) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.18) and Tisgenx (Invengenx) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.20), signifying uniform thickness and homogeneity across orientations. On the other hand, Edwards Lifesciences (Edwards) patches demonstrated a borderline significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048), but Xenosure (LeMaitre) patches revealed a highly significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0006), indicating increased intra-sample variability in thickness between horizontal and vertical orientations. Tukey\u0026rsquo;s multiple comparisons test indicated no statistically significant differences in CV% across the four groups. Pairwise comparisons revealed that BPP groups had similar variability profiles, with no significant variations in mean CV% among the groups.\u003c/p\u003e \u003cp\u003eThe PEM values for the BPPs were as follows: Edwards Lifesciences (Edwards) exhibited a mean of 1.931\u0026thinsp;\u0026plusmn;\u0026thinsp;1.456 MPa (range: 0.256\u0026ndash;6.203 MPa), Supple Peri-Guard (Baxter) showed 1.392\u0026thinsp;\u0026plusmn;\u0026thinsp;1.289 MPa (range: 0.090\u0026ndash;5.860 MPa), Xenosure (LeMaitre) recorded 4.121\u0026thinsp;\u0026plusmn;\u0026thinsp;2.467 MPa (range: 0.775\u0026ndash;9.391 MPa), and Tisgenx (Invengenx) presented 3.985\u0026thinsp;\u0026plusmn;\u0026thinsp;2.868 MPa (range: 0.289\u0026ndash;11.020 MPa). Dunn\u0026rsquo;s multiple comparisons test showed that Supple Peri-Guard (Baxter) patches exhibited significantly lower values than Xenosure (LeMaitre) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0035) and Tisgenx (Invengenx) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0396). No other significant differences were observed among the remaining patch types (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e4\u003c/span\u003e-A). Paired analyses comparing horizontal and vertical orientations showed no significant intra-sample differences in PEM across BPPs (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe MPEM values for the BPPs were as follows: Edwards Lifesciences (Edwards) exhibited a mean of 2.928\u0026thinsp;\u0026plusmn;\u0026thinsp;1.716 MPa (range: 0.426\u0026ndash;7.752 MPa), Supple Peri-Guard (Baxter) showed 4.608\u0026thinsp;\u0026plusmn;\u0026thinsp;6.706 MPa (range: 0.760\u0026ndash;35.492 MPa), Xenosure (LeMaitre) recorded 6.929\u0026thinsp;\u0026plusmn;\u0026thinsp;5.689 MPa (range: 1.255\u0026ndash;24.669 MPa), and Tisgenx (Invengenx) presented 5.560\u0026thinsp;\u0026plusmn;\u0026thinsp;4.080 MPa (range: 0.565\u0026ndash;16.993 MPa). Dunn\u0026rsquo;s multiple comparisons test indicated no statistically significant variations in mean rank values across the four groups. All remaining pairwise comparisons were non-significant, demonstrating overall comparable performance among the evaluated materials (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e4\u003c/span\u003e-B). No significant differences were observed between the horizontal and vertical orientations for MPEM across BPPs (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe MEM values for the BPPs were as follows: Edwards Lifesciences (Edwards) demonstrated a mean of 17.724\u0026thinsp;\u0026plusmn;\u0026thinsp;8.052 MPa (range: 5.469\u0026ndash;44.045 MPa). Supple Peri-Guard (Baxter) showed a slightly higher mean of 20.357\u0026thinsp;\u0026plusmn;\u0026thinsp;13.226 MPa (range: 0.062\u0026ndash;61.272 MPa\u003cb\u003e)\u003c/b\u003e. Xenosure (LeMaitre) presented the highest mean value of 28.603\u0026thinsp;\u0026plusmn;\u0026thinsp;15.650 MPa (range: 9.562\u0026ndash;74.318 MPa), while Tisgenx (Invengenx) exhibited a mean of 21.230\u0026thinsp;\u0026plusmn;\u0026thinsp;10.802 MPa (range: \u003cb\u003e7\u003c/b\u003e.576\u0026ndash;61.168 MPa). Dunn\u0026rsquo;s multiple comparisons test demonstrated no statistically significant differences in mean rank between the tested groups. All other pairwise comparisons showed no significant differences (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e4\u003c/span\u003e-C). No significant differences were observed between horizontal and vertical orientations for MEM across most BPPs. Only Tisgenx (Invengenx) showed a significant difference in variance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013), suggesting slightly higher variability between orientations, while all other patches demonstrated uniform elastic behavior (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we present the biomechanical properties of BPPs widely used in cardiovascular surgery. By evaluating patches from four commercial suppliers, we aim to provide surgeons with a clearer understanding of their biomechanical behavior and the potential impact of their differences on clinical outcomes. Uniaxial tensile testing was selected instead of biaxial testing because the original cutting orientation of the supplied patches was not specified, and variations introduced during sample preparation or surgical handling could not be controlled. Given these constraints, uniaxial testing offered a more consistent and reproducible method for assessing the biomechanical performance of the materials.\u003c/p\u003e \u003cp\u003eIn our study, the CV% analysis demonstrated minimal intra-sample variability, with no significant differences detected across the different patch types. However, thickness-related intra-sample variability was observed in the Edwards Lifesciences (Edwards) and Xenosure (LeMaitre) patches, where differences between horizontal and vertical orientations suggested reduced thickness homogeneity. This variation may be attributed to the relatively small sample size.\u003c/p\u003e \u003cp\u003eInter-sample CV% analysis revealed no statistically significant differences among the four groups, confirming consistent inter-group uniformity. In terms of biomechanical performance, comparisons of PEM showed that Supple Peri-Guard (Baxter) patches exhibited significantly lower values than Xenosure (LeMaitre) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0035) and Tisgenx (Invengenx) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0396), while no significant intra-sample variability in PEM was observed among the BPPs.\u003c/p\u003e \u003cp\u003ePEM is a useful and realistic parameter (Duprey et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) for evaluating elasticity under normal physiological conditions to understand real biomechanical behaviors. To our knowledge, no study has determined PEM for bovine pericardial patches. MPEM represents a novel parameter designed to assess tissue elasticity under maximum physiological loading conditions, corresponding to the highest recorded physiological blood pressure of approximately 360\u0026ndash;370 mmHg (Narloch \u0026amp; Brandstater, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). This new concept helped us to evaluate the biomaterials under high physiological conditions rather than under very high and abnormal conditions that could not happen in a physiological setting. This concept may be applicable to other medical disciplines for evaluating biomaterials or tissues subjected to high physiological loading conditions.\u003c/p\u003e \u003cp\u003eFor both MPEM and MEM, no significant inter-group variability was identified in our study. The only notable exception was the Tisgenx (Invengenx) patch, which displayed a significant difference in MEM variance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013), suggesting slightly higher orientation-dependent variability.\u003c/p\u003e \u003cp\u003eOverall, the findings indicate that thickness variability among the BPPs remained consistent and was not influenced by the supplier. The results for PEM, MPEM, and MEM collectively demonstrate uniform biomechanical behavior regardless of orientation, reflecting structural homogeneity and stable stress distribution under physiological loading conditions.\u003c/p\u003e \u003cp\u003eThe BPP cutting orientation\u0026mdash;whether horizontal or vertical\u0026mdash;showed no significant differences in thickness or elastic properties, indicating comparable biomechanical performance across both directions. Therefore, the selection of orientation may be guided primarily by surgical preference and procedural requirements. Moreover, none of the suppliers specify the direction of BPPs, reinforcing the notion that BPP orientation has a limited impact on functional outcomes. In another study, BPPs exhibited minimal anisotropic behavior at low strain levels, with directional differences in mechanical response becoming apparent only at higher strain values (Tremblay et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Our results, however, demonstrate that BPPs behave relatively isotropically, suggesting that orientation during aortic reconstruction does not significantly influence their mechanical performance.\u003c/p\u003e \u003cp\u003eAcross the bovine family, the pericardial layers demonstrate structural organization comparable to that of the human pericardium, with a typical thickness ranging between 0.4 mm and 1 mm (Allen et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1984\u003c/span\u003e; Mansour et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Peebles et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). This value is slightly higher than that observed in our study, a difference that may be attributed to variations in the decellularization method and the use of glutaraldehyde for tissue preservation.\u003c/p\u003e \u003cp\u003eThe literature presents a diverse array of findings about the Young\u0026rsquo;s modulus or MEM of BPPs (Aguiari et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). These data suggest that there is a notable variation in the mechanical characteristics of BPPs observed across different studies. Reported values for uniaxial loading range widely, with the lowest modulus reaching approximately 9.9 MPa (Oswal et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), and the highest reaching 180\u0026thinsp;\u0026plusmn;\u0026thinsp;49 MPa (Duncan \u0026amp; Boughner, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). This broad range underscores the multifactorial influence of tissue processing parameters, glutaraldehyde fixation, preconditioning protocols, and experimental testing methodologies on the mechanical behavior of BPPs. Additionally, variations in tensile testing apparatus, specimen geometry, and hydration conditions likely account for the heterogeneity observed across reported mechanical property values. In our study, all bovine pericardial patches were preserved in glutaraldehyde, chemically sterilized, and supplied ready for clinical use, ensuring consistency and minimizing sample heterogeneity.\u003c/p\u003e \u003cp\u003eUnfortunately, prior studies that evaluated BPPs\u0026rsquo; biomechanical properties did not mention the suppliers\u0026rsquo; names, and they reported a wide range of elastic modulus values. Even the suppliers did not indicate the age of bovines, the harvesting site (Stieglmeier et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), or the average elastic modulus of these BPPs.\u003c/p\u003e \u003cp\u003eThe utilization of BPPs is not limited to cardiovascular surgery; multiple studies have mentioned their utilization in abdominal wall reconstruction (D\u0026rsquo;Ambra, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Saiding et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), urinary bladder reconstruction (Chee et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Moon et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), replacing ligaments and tendons (Baldo et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Longo et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), and spinal cord herniation repairs (Zhang et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These different uses show that BPPs can adapt to tissues with different biomechanical demands and anatomical location according to the surgical application. For aortic surgery, using BPPs shows good results in the short and medium term, as confirmed by Frisch et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Sizeland et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) conducted a study evaluating the modulus of elasticity in neonatal and adult bovines. The results indicated that younger individuals have a greater modulus of elasticity (80 MPa) than adults (30 MPa).\u003c/p\u003e \u003cp\u003eA clear age-related variation in arterial elasticity has been observed. In younger individuals, the femoral artery is the most elastic, with a value of 3.1 MPa, followed by the iliac artery at 2.9 MPa, the abdominal aorta at 1.0 MPa, the carotid artery at 0.8 MPa, and the descending thoracic aorta at 0.6 MPa. In contrast, older individuals demonstrate a marked reduction in arterial elasticity, with the iliac artery measuring 0.7 MPa and the femoral artery 1.4 MPa, while the descending thoracic aorta is 2.0 MPa, the abdominal aorta 1.2 MPa, and the carotid artery 1.1 MPa (Thubrikar, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). For cardiovascular surgery, our results confirm the possibility of using any of the tested BPPs, with no significant difference among them.\u003c/p\u003e \u003cp\u003eThe use of rigid materials to replace the proximal aorta may increase the risk of cardiac hypertrophy. This inability to replicate the native aortic elasticity can impose additional strain on the heart, resulting in elevated left ventricular workload, increased pulse pressure, and a potential progression toward congestive heart failure over time (Sultan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Most studies that evaluate vascular remodeling following thoracic endovascular aneurysm repair (TEVAR) procedures focus on assessing changes in aortic wall structure, compliance, and hemodynamic adaptation over time (Vallerio et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; van Bakel et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The MEM of expanded polytetrafluoroethylene (e-PTFE) grafts is also variable, with results ranging from 17.4 to 55.2 MPa (Bouchet et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Kleinstreuer et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo our knowledge, the potential risk of cardiac hypertrophy following the use of BPPs has not yet been investigated. Factors such as material stiffness, graft length, patch or tubular configuration, and anatomical implantation site may play a crucial role in determining postoperative cardiac sequelae.\u003c/p\u003e \u003cp\u003eA limitation of this study is that \u003cem\u003ein vitro\u003c/em\u003e tissue testing does not replicate physiological internal pressure and involves simplified loading, typically applied in a uniaxial direction. The suppliers have provided insufficient data regarding the harvesting site and the age of the bovine sources. A histological study to evaluate the quantity of elastic and collagen would help strengthen our data.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe research conducted showed that BPPs preserved in glutaraldehyde exhibit consistent thickness, with minimal intra- and inter-sample variability. No significant differences were detected between horizontal and vertical orientations in either thickness or elastic modulus, confirming structural homogeneity. BPPs exhibit relatively isotropic mechanical behavior, indicating that no specific orientation is needed during aortic reconstruction. The proposed PEM and MPEM concepts provide meaningful evaluation under realistic physiological conditions. Overall, BPPs demonstrated biomechanical properties that support their safe and effective application in cardiovascular surgery. Future studies should include \u003cem\u003ein vivo\u003c/em\u003e assessments and histological analyses to evaluate remodeling behavior, long-term outcomes, and potential hemodynamic effects on cardiac and aortic tissue.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA total of 40 BPPs preserved in glutaraldehyde solution were obtained from four different suppliers, with 10 patches from each source. The products included Edwards Lifesciences\u003cem\u003e\u0026reg;\u003c/em\u003e (Edwards Lifesciences Corporation, Irvine, CA, USA; model no. 4700; 10 \u0026times; 15 cm), Supple Peri-Guard\u003cem\u003e\u0026reg;\u003c/em\u003e (Baxter International Inc., Deerfield, IL, USA; model no. PC-1016SN; 10 \u0026times; 16 cm), Xenosure\u003cem\u003e\u0026reg;\u003c/em\u003e (LeMaitre Vascular Inc., Burlington, MA, USA; model no. 10BV16; 10 \u0026times; 16 cm), and Invengenx\u003cem\u003e\u0026reg;\u003c/em\u003e (Tisgenx Inc., Irving, TX, USA; model no. XM-21; 7 \u0026times; 10 cm). All BPPs underwent chemical sterilization and were supplied in a condition suitable for clinical application.\u003c/p\u003e \u003cp\u003eEach BPP sample was cut into four bone-shaped pieces: two oriented horizontally and two vertically. Each piece measured 50 mm \u0026times; 10 mm, with an experimental size of 36 mm, while 14 mm was allocated for the portion clamped with machine clamps (see Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003e-A). Three separate thickness measurements were taken for each piece\u0026rsquo;s surface, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003e-B: one measurement on each side and one in the center, using a digital thickness micrometer device equipped with a constant-force transducer (Litematic VL-50, Mitutoyo Corp, Kanagawa, Japan).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHorizontal uniaxial tensile testing was performed using the LM1 system (TA Instruments, ElectroForce\u0026reg; System Group, Eden Prairie, MN, USA), with a maximum displacement of 12 mm, chosen to remain within the instrument\u0026rsquo;s operating limits. A preload tension of 0.05 N was applied to ensure identical baseline stress conditions. This preload was defined as the zero-stress reference point for all subsequent measurements. Each specimen underwent 10 preconditioning cycles to eliminate hysteresis effects and ensure a consistent, repeatable stress\u0026ndash;strain curve. To simulate physiological conditions and minimize gravitational interference, testing was conducted in distilled water maintained at 37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u0026deg;C. Details of the horizontal uniaxial tensile testing machine are displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe samples were stretched to failure, with all measurements recorded at 0.0001-second intervals. The software utilized during the experiments was WinTest\u0026reg; 8 (TA Instruments, ElectroForce\u0026reg; System Group, Eden Prairie, MN, USA). Then, all data were analyzed to measure the elastic modulus at three different points: the physiological elastic modulus (PEM) when the pressure was between 80 and 140 mmHg, the maximum physiological elastic modulus (MPEM) when the pressure was 360 mmHg (Narloch \u0026amp; Brandstater, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1995\u003c/span\u003e), and the maximal elastic modulus (MEM) when the pressure reached the BPPs\u0026rsquo; failure point (see Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccording to the results of the BPPs\u0026rsquo; measured thickness, the distance between the two arms of the uniaxial tensile testing machine, and the applied stretching force, a stress\u0026ndash;strain test was performed to determine the elastic modulus according to the following formula:\u003c/p\u003e \u003cp\u003e \u003cb\u003eE\u003c/b\u003e \u003cb\u003e= (\u003c/b\u003e\u003cb\u003eF\u003c/b\u003e \u003cb\u003e\u0026times;\u003c/b\u003e \u003cb\u003eL\u003c/b\u003e\u003cb\u003e₀) / (\u003c/b\u003e\u003cb\u003ew\u003c/b\u003e \u003cb\u003e\u0026times;\u003c/b\u003e \u003cb\u003et\u003c/b\u003e\u0026thinsp;\u003cb\u003e\u0026times;\u0026thinsp;Δ\u003c/b\u003e\u003cb\u003eL\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWhere:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eE\u003c/em\u003e: Elastic modulus (Pa or N/m\u0026sup2;)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eF\u003c/em\u003e: Applied force (N)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eL\u003c/em\u003e₀: Initial length of the specimen (m)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ew\u003c/em\u003e: Width of the specimen (m)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003et\u003c/em\u003e: Measured thickness of the specimen (m)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eΔ\u003cem\u003eL\u003c/em\u003e: Elongation under load (m)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eGraphPad Prism 7 software (GraphPad Software, San Diego, California, USA) was utilized for parameter fitting and statistical analysis. Data derived from the BPPs\u0026rsquo; mechanical tests using the LM1 system (TA Instruments, ElectroForce\u0026reg; System Group, USA) and measured specimen thickness were used to construct stress\u0026ndash;strain curves and to determine the failure stress and strain for each specimen.\u003c/p\u003e \u003cp\u003eContinuous variables are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). For each BPP, the mean parameter values, including thickness, PEM, MPEM, and MEM, were calculated either from the four bone-shaped pieces or from the two pieces with the same orientation for specific horizontal and vertical comparison analysis. Normality was assessed using the Shapiro\u0026ndash;Wilk test. For two-group or orientation comparisons, the Mann\u0026ndash;Whitney U-test was used for nonparametric data and the \u003cem\u003et\u003c/em\u003e-test for parametric data. To compare more than two groups, ANOVA with Tukey\u0026rsquo;s post-hoc test was applied for parametric data, and the Kruskal\u0026ndash;Wallis test with Dunn\u0026rsquo;s correction was used for nonparametric data. The coefficient of variation (CV%), defined as the ratio of the standard deviation to the mean (CV% = SD/Mean \u0026times; 100), was used to assess intra-sample variability among BPPs. A \u003cem\u003ep\u003c/em\u003e-value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThe authors gratefully acknowledge the support of the manufacturers who generously supplied the bovine pericardial patches for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbdulrahman Alblowi:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Conceptualization; Methodology; Investigation; Data Curation; Formal Analysis; Visualization; Writing \u0026ndash; Original Draft; Writing \u0026ndash; Review \u0026amp; Editing; Project Administration.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSiyu Lin:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Methodology; Validation; Investigation; Formal Analysis; Discussion of Results; Writing \u0026ndash; Review \u0026amp; Editing.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOlivier Bouchot:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Investigation; Resources; Validation; Laboratory Support.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJ\u0026eacute;r\u0026eacute;my Lagrange:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Formal Analysis; Statistical Analysis; Data Interpretation.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNicla Settembre:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Writing \u0026ndash; Review \u0026amp; Editing; Scientific Feedback.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSerguei Malikov:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Supervision; Writing \u0026ndash; Review \u0026amp; Editing; Clinical Oversight.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlain Lalande:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Supervision; Methodology; Data Interpretation; Writing \u0026ndash; Review \u0026amp; Editing; Final Approval.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest regarding this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Aggregated findings are available on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAguiari, P., Fiorese, M., Iop, L., Gerosa, G., \u0026amp; Bagno, A. (2016). Mechanical testing of pericardium for manufacturing prosthetic heart valves. \u003cem\u003eInteractive CardioVascular and Thoracic Surgery\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 72\u0026ndash;84. https://doi.org/10.1093/icvts/ivv282\u003c/li\u003e\n\u003cli\u003eAllen, D. J., DiDio, L. J., Zacharias, A., Fentie, I., McGrath, A. J., Puig, L. B., Pomerantzeff, P. N., \u0026amp; Zerbini, E. J. (1984). Microscopic study of normal parietal pericardium and unimplanted Puig-Zerbini pericardial valvular heterografts. \u003cem\u003eThe Journal of Thoracic and Cardiovascular Surgery\u003c/em\u003e, \u003cem\u003e87\u003c/em\u003e(6), 845\u0026ndash;855.\u003c/li\u003e\n\u003cli\u003eBaldo, M. P., Cunha, R. S., Molina, M. del C. B., Ch\u0026oacute;r, D., Griep, R. H., Duncan, B. B., Schmidt, M. I., Ribeiro, A. L. P., Barreto, S. M., Lotufo, P. A., Bensenor, I. M., Pereira, A. C., \u0026amp; Mill, J. G. (2018). Carotid-femoral pulse wave velocity in a healthy adult sample: The ELSA-Brasil study. \u003cem\u003eInternational Journal of Cardiology\u003c/em\u003e, \u003cem\u003e251\u003c/em\u003e, 90\u0026ndash;95. https://doi.org/10.1016/j.ijcard.2017.10.075\u003c/li\u003e\n\u003cli\u003eBallyk, P. D., Walsh, C., Butany, J., \u0026amp; Ojha, M. (1998). Compliance mismatch may promote graft-artery intimal hyperplasia by altering suture-line stresses. \u003cem\u003eJournal of Biomechanics\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(3), 229\u0026ndash;237. https://doi.org/10.1016/s0197-3975(97)00111-5\u003c/li\u003e\n\u003cli\u003eBiasi, G. (1996). Processed bovine pericardium as patch angioplasty for carotid endarterectomy: A preliminary report. \u003cem\u003eCardiovascular Surgery\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(5), 591\u0026ndash;595. https://doi.org/10.1016/0967-2109(95)00086-0\u003c/li\u003e\n\u003cli\u003eBiondi-Zoccai, G. G. L., Fusaro, M., Tashani, A., Mollichelli, N., Medda, M., Pasquato, M., \u0026amp; Inglese, L. (2007). Antegrade access in a stented common femoral artery: Feasible but with a real bleeding risk. \u003cem\u003eInternational Journal of Cardiology\u003c/em\u003e, \u003cem\u003e114\u003c/em\u003e(2), E68\u0026ndash;E69. https://doi.org/10.1016/j.ijcard.2006.07.030\u003c/li\u003e\n\u003cli\u003eBouchet, M., Gauthier, M., Maire, M., Ajji, A., \u0026amp; Lerouge, S. (2019). Towards compliant small-diameter vascular grafts: Predictive analytical model and experiments. \u003cem\u003eMaterials Science and Engineering: C\u003c/em\u003e, \u003cem\u003e100\u003c/em\u003e, 715\u0026ndash;723. https://doi.org/10.1016/j.msec.2019.03.023\u003c/li\u003e\n\u003cli\u003eChee, J., Durai, P., Wu, F., \u0026amp; Tiong, H. (2015). Bladder repair following iatrogenic cystotomy in irradiated small capacity bladders. \u003cem\u003eSingapore Medical Journal\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(03), e49\u0026ndash;e52. https://doi.org/10.11622/smedj.2015052\u003c/li\u003e\n\u003cli\u003eD\u0026rsquo;Ambra, L. (2012). Use of bovine pericardium graft for abdominal wall reconstruction in contaminated fields. \u003cem\u003eWorld Journal of Gastrointestinal Surgery\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(7), 171. https://doi.org/10.4240/wjgs.v4.i7.171\u003c/li\u003e\n\u003cli\u003eDuncan, A. C., \u0026amp; Boughner, D. (1998). Effect of dynamic glutaraldehyde fixation on the viscoelastic properties of bovine pericardial tissue. \u003cem\u003eBiomaterials\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(7\u0026ndash;9), 777\u0026ndash;783. https://doi.org/10.1016/s0142-9612(97)00215-9\u003c/li\u003e\n\u003cli\u003eDuprey, A., Khanafer, K., Schlicht, M., Avril, S., Williams, D., \u0026amp; Berguer, R. (2010). In vitro characterisation of physiological and maximum elastic modulus of ascending thoracic aortic aneurysms using uniaxial tensile testing. \u003cem\u003eEuropean Journal of Vascular and Endovascular Surgery\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(6), Article 6. https://doi.org/10.1016/j.ejvs.2010.02.015\u003c/li\u003e\n\u003cli\u003eFrisch, S., Settembre, N., Belkorissat, R. A., Guerci, P., Mandry, D., AlblowI, A., Lalevee, L., Lefevre, B., \u0026amp; Malikov, S. (2025). Management of infectious aortic aneurysms: Short- and mid-term outcomes. \u003cem\u003eAnnals of Vascular Surgery\u003c/em\u003e, \u003cem\u003e115\u003c/em\u003e, 197\u0026ndash;205. https://doi.org/10.1016/j.avsg.2025.01.042\u003c/li\u003e\n\u003cli\u003eIonescu, M. I., Tandon, A. P., Mary, D. A., \u0026amp; Abid, A. (1977). Heart valve replacement with the Ionescu-Shiley pericardial xenograft. \u003cem\u003eThe Journal of Thoracic and Cardiovascular Surgery\u003c/em\u003e, \u003cem\u003e73\u003c/em\u003e(1), 31\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eIop, L., Palmosi, T., Dal Sasso, E., \u0026amp; Gerosa, G. (2018). Bioengineered tissue solutions for repair, correction and reconstruction in cardiovascular surgery. \u003cem\u003eJournal of Thoracic Disease\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(S20), S2390\u0026ndash;S2411. https://doi.org/10.21037/jtd.2018.04.27\u003c/li\u003e\n\u003cli\u003eKim, S. Y., Hinkamp, T. J., Jacobs, W. R., Lichtenberg, R. C., Posniak, H., \u0026amp; Pifarr\u0026eacute;, R. (1995). Effect of an inelastic aortic synthetic vascular graft on exercise hemodynamics. \u003cem\u003eThe Annals of Thoracic Surgery\u003c/em\u003e, \u003cem\u003e59\u003c/em\u003e(4), 981\u0026ndash;989. https://doi.org/10.1016/0003-4975(95)00068-V\u003c/li\u003e\n\u003cli\u003eKleinstreuer, C., Li, Z., Basciano, C. A., Seelecke, S., \u0026amp; Farber, M. A. (2008). Computational mechanics of Nitinol stent grafts. \u003cem\u003eJournal of Biomechanics\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(11), 2370\u0026ndash;2378. https://doi.org/10.1016/j.jbiomech.2008.05.032\u003c/li\u003e\n\u003cli\u003eLee, C., Lim, H.-G., Lee, C.-H., \u0026amp; Kim, Y. J. (2016). Effects of glutaraldehyde concentration and fixation time on material characteristics and calcification of bovine pericardium: Implications for the optimal method of fixation of autologous pericardium used for cardiovascular surgery. \u003cem\u003eInteractive CardioVascular and Thoracic Surgery\u003c/em\u003e, ivw356. https://doi.org/10.1093/icvts/ivw356\u003c/li\u003e\n\u003cli\u003eLi, X., Guo, Y., Ziegler, K. R., Model, L. S., Eghbalieh, S. D. D., Brenes, R. A., Kim, S. T., Shu, C., \u0026amp; Dardik, A. (2011). Current usage and future directions for the bovine pericardial patch. \u003cem\u003eAnnals of Vascular Surgery\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(4), 561\u0026ndash;568. https://doi.org/10.1016/j.avsg.2010.11.007\u003c/li\u003e\n\u003cli\u003eLi, Z., Pei, M., Zhang, J., Liu, N., Wang, J., \u0026amp; Zou, D. (2023). A study to characterize the mechanical properties and material constitution of adult descending thoracic aorta based on uniaxial tensile test and digital image correlation. \u003cem\u003eFrontiers in Bioengineering and Biotechnology\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e, 1178199. https://doi.org/10.3389/fbioe.2023.1178199\u003c/li\u003e\n\u003cli\u003eLongo, U. G., Lamberti, A., Maffulli, N., \u0026amp; Denaro, V. (2010). Tendon augmentation grafts: A systematic review. \u003cem\u003eBritish Medical Bulletin\u003c/em\u003e, \u003cem\u003e94\u003c/em\u003e(1), 165\u0026ndash;188. https://doi.org/10.1093/bmb/ldp051\u003c/li\u003e\n\u003cli\u003eMansour, M., Wilhite, D. R., \u0026amp; Rowe, J. (2018). \u003cem\u003eGuide to ruminant anatomy: Dissection \u0026amp; clinical aspects\u003c/em\u003e. John Wiley \u0026amp; Sons Inc.\u003c/li\u003e\n\u003cli\u003eMehigan, D. G., Fitzpatrick, B., Browne, H. I., \u0026amp; Bouchier-Hayes, D. J. (1985). Is compliance mismatch the major cause of anastomotic arterial aneurysms? Analysis of 42 cases. \u003cem\u003eThe Journal of Cardiovascular Surgery\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(2), 147\u0026ndash;150.\u003c/li\u003e\n\u003cli\u003eMigneault, I., Dartiguenave, C., Bertrand, M. J., \u0026amp; Waldron, K. C. (2004). Glutaraldehyde: Behavior in aqueous solution, reaction with proteins, and application to enzyme crosslinking. \u003cem\u003eBioTechniques\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(5), 790\u0026ndash;802. https://doi.org/10.2144/04375RV01\u003c/li\u003e\n\u003cli\u003eMoon, S. J., Kim, D. H., Jo, J. K., Chung, J. H., Lee, J. Y., Park, S. Y., Kim, Y. T., Park, H. K., Choi, H. Y., \u0026amp; Moon, H. S. (2011). Bladder reconstruction using bovine pericardium in a case of enterovesical fistula. \u003cem\u003eKorean Journal of Urology\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(2), 150. https://doi.org/10.4111/kju.2011.52.2.150\u003c/li\u003e\n\u003cli\u003eNarloch, J. A., \u0026amp; Brandstater, M. E. (1995). Influence of breathing technique on arterial blood pressure during heavy weight lifting. \u003cem\u003eArchives of Physical Medicine and Rehabilitation\u003c/em\u003e, \u003cem\u003e76\u003c/em\u003e(5), 457\u0026ndash;462. https://doi.org/10.1016/S0003-9993(95)80578-8\u003c/li\u003e\n\u003cli\u003eOswal, D., Korossis, S., Mirsadraee, S., Wilcox, H., Watterson, K., Fisher, J., \u0026amp; Ingham, E. (2007). Biomechanical characterization of decellularized and cross-linked bovine pericardium. \u003cem\u003eThe Journal of Heart Valve Disease\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(2), 165\u0026ndash;174.\u003c/li\u003e\n\u003cli\u003ePeebles, C. R., Shambrook, J. S., \u0026amp; Harden, S. P. (2011). Pericardial disease\u0026mdash;Anatomy and function. \u003cem\u003eThe British Journal of Radiology\u003c/em\u003e, \u003cem\u003e84\u003c/em\u003e(special_issue_3), S324\u0026ndash;S337. https://doi.org/10.1259/bjr/16168253\u003c/li\u003e\n\u003cli\u003eSaiding, Q., Chen, Y., Wang, J., Pereira, C. L., Sarmento, B., Cui, W., \u0026amp; Chen, X. (2023). Abdominal wall hernia repair: From prosthetic meshes to smart materials. \u003cem\u003eMaterials Today Bio\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e, 100691. https://doi.org/10.1016/j.mtbio.2023.100691\u003c/li\u003e\n\u003cli\u003eSalvi, P. (2017). \u003cem\u003ePulse waves: How vascular hemodynamics affects blood pressure\u003c/em\u003e (2nd ed. 2017). Springer. https://doi.org/10.1007/978-3-319-40501-8\u003c/li\u003e\n\u003cli\u003eSizeland, K. H., Wells, H. C., Higgins, J., Cunanan, C. M., Kirby, N., Hawley, A., Mudie, S. T., \u0026amp; Haverkamp, R. G. (2014). Age dependent differences in collagen alignment of glutaraldehyde fixed bovine pericardium. \u003cem\u003eBioMed Research International\u003c/em\u003e, \u003cem\u003e2014\u003c/em\u003e, 1\u0026ndash;10. https://doi.org/10.1155/2014/189197\u003c/li\u003e\n\u003cli\u003eSpodick, D. H. (1992). Macrophysiology, microphysiology, and anatomy of the pericardium: A synopsis. \u003cem\u003eAmerican Heart Journal\u003c/em\u003e, \u003cem\u003e124\u003c/em\u003e(4), 1046\u0026ndash;1051. https://doi.org/10.1016/0002-8703(92)90990-D\u003c/li\u003e\n\u003cli\u003eStieglmeier, F., Grab, M., K\u0026ouml;nig, F., B\u0026uuml;ch, J., Hagl, C., \u0026amp; Thierfelder, N. (2021). Mapping of bovine pericardium to enable a standardized acquirement of material for medical implants. \u003cem\u003eJournal of the Mechanical Behavior of Biomedical Materials\u003c/em\u003e, \u003cem\u003e118\u003c/em\u003e, 104432. https://doi.org/10.1016/j.jmbbm.2021.104432\u003c/li\u003e\n\u003cli\u003eSultan, S., Acharya, Y., Soliman, O., Parodi, J. C., \u0026amp; Hynes, N. (2022). TEVAR and EVAR, the unknown knowns of the cardiovascular hemodynamics; and the immediate and long-term consequences of fabric material on major adverse clinical outcome. \u003cem\u003eFrontiers in Surgery\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e, 940304. https://doi.org/10.3389/fsurg.2022.940304\u003c/li\u003e\n\u003cli\u003eSurovtsova, I. (2005). Effects of compliance mismatch on blood flow in an artery with endovascular prosthesis. \u003cem\u003eJournal of Biomechanics\u003c/em\u003e, \u003cem\u003e38\u003c/em\u003e(10), 2078\u0026ndash;2086. https://doi.org/10.1016/j.jbiomech.2004.09.004\u003c/li\u003e\n\u003cli\u003eThubrikar, M. (2007). \u003cem\u003eVascular mechanics and pathology\u003c/em\u003e. Springer.\u003c/li\u003e\n\u003cli\u003eTremblay, D., Zigras, T., Cartier, R., Leduc, L., Butany, J., Mongrain, R., \u0026amp; Leask, R. L. (2009). A comparison of mechanical properties of materials used in aortic arch reconstruction. \u003cem\u003eThe Annals of Thoracic Surgery\u003c/em\u003e, \u003cem\u003e88\u003c/em\u003e(5), 1484\u0026ndash;1491. https://doi.org/10.1016/j.athoracsur.2009.07.023\u003c/li\u003e\n\u003cli\u003eVallerio, P., Maloberti, A., D\u0026rsquo;Alessio, I., Lista, A., Varrenti, M., Castelnuovo, S., Marone, M., Piccinelli, E., Grassi, G., Palmieri, B., \u0026amp; Giannattasio, C. (2019). Cardiovascular remodeling after endovascular treatment for thoracic aortic injury. \u003cem\u003eAnnals of Vascular Surgery\u003c/em\u003e, \u003cem\u003e61\u003c/em\u003e, 134\u0026ndash;141. https://doi.org/10.1016/j.avsg.2019.04.015\u003c/li\u003e\n\u003cli\u003evan Bakel, T. M. J., Arthurs, C. J., Nauta, F. J. H., Eagle, K. A., van Herwaarden, J. A., Moll, F. L., Trimarchi, S., Patel, H. J., \u0026amp; Figueroa, C. A. (2019). Cardiac remodelling following thoracic endovascular aortic repair for descending aortic aneurysms. \u003cem\u003eEuropean Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery\u003c/em\u003e, \u003cem\u003e55\u003c/em\u003e(6), 1061\u0026ndash;1070. https://doi.org/10.1093/ejcts/ezy399\u003c/li\u003e\n\u003cli\u003eVorp, D. A., Schiro, B. J., Ehrlich, M. P., Juvonen, T. S., Ergin, M. A., \u0026amp; Griffith, B. P. (2003). Effect of aneurysm on the tensile strength and biomechanical behavior of the ascending thoracic aorta. \u003cem\u003eThe Annals of Thoracic Surgery\u003c/em\u003e, \u003cem\u003e75\u003c/em\u003e(4), 1210\u0026ndash;1214. https://doi.org/10.1016/s0003-4975(02)04711-2\u003c/li\u003e\n\u003cli\u003eWeiss, S., Hugas Mallorqui, M., Czerny, M., Walter, T., Biro, G., Puttini, I., Almasi-Sperling, V., Lang, W., Schmidli, J., \u0026amp; Wyss, T. R. (2024). Physician made bovine pericardial tube grafts in aortic infection: A European multicentre study. \u003cem\u003eEuropean Journal of Vascular and Endovascular Surgery\u003c/em\u003e, \u003cem\u003e67\u003c/em\u003e(6), 997\u0026ndash;1005. https://doi.org/10.1016/j.ejvs.2024.02.004\u003c/li\u003e\n\u003cli\u003eXing, Q., Parvizi, M., Lopera Higuita, M., \u0026amp; Griffiths, L. G. (2021). Basement membrane proteins modulate cell migration on bovine pericardium extracellular matrix scaffold. \u003cem\u003eScientific Reports\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 4607. https://doi.org/10.1038/s41598-021-84161-5\u003c/li\u003e\n\u003cli\u003eZhang, L., Wu, H., Liu, Z., Wang, X., Cheng, Y., \u0026amp; Wang, K. (2022). Dural repair with fat patch for idiopathic spinal cord herniation: Operative technique and a review of seven cases. \u003cem\u003eAnnals of Translational Medicine\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(16), 865\u0026ndash;865. https://doi.org/10.21037/atm-22-3343\u003c/li\u003e\n\u003cli\u003eZouhair, S., Dal Sasso, E., Tuladhar, S. R., Fidalgo, C., Vedovelli, L., Filippi, A., Borile, G., Bagno, A., Marchesan, M., De Rossi, G., Gregori, D., Wolkers, W. F., Romanato, F., Korossis, S., Gerosa, G., \u0026amp; Iop, L. (2020). A comprehensive comparison of bovine and porcine decellularized pericardia: New insights for surgical applications. \u003cem\u003eBiomolecules\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(3), 371. https://doi.org/10.3390/biom10030371\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bovine pericardial patches, xenograft material, biomechanics, stress–strain behavior, tensile strength, aortic graft","lastPublishedDoi":"10.21203/rs.3.rs-8391468/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8391468/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBovine pericardial patches (BPPs) preserved in glutaraldehyde are widely used in cardiovascular surgery due to their durability, biocompatibility, and availability, particularly in infected or contaminated fields. However, differences in harvesting site, animal age, and decellularization techniques may influence biomechanical behavior, which can change the outcome of surgical treatment. Stiffer grafts may impair aortic compliance and contribute to adverse cardiac remodeling. This study assessed the biomechanical properties of commonly used commercial BPPs, focusing on intra- and inter-sample variability and measuring the BPPs at different elastic modulus values.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eForty BPPs from four suppliers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10 each) were analyzed. Each patch was sectioned into four bone-shaped specimens (two horizontal, two vertical) according to our laboratory\u0026rsquo;s standardized protocol. Thickness was measured at three points per specimen. Uniaxial tensile testing was performed under physiological conditions with preconditioning cycles using the LM1 system. Elastic modulus values were assessed at three physiological loading stages: physiological elastic modulus (PEM: 80\u0026ndash;140 mmHg), maximum physiological elastic modulus (MPEM: 360 mmHg), and maximum elastic modulus (MEM: failure point). Variability was analyzed using paired comparisons and the coefficient of variation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThickness ranged from 0.384 to 0.469 mm, with low variability across suppliers. Orientation-related thickness differences were not significant for most samples. Supple Peri-Guard patches exhibited significantly lower PEM values than Xenosure (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0035) and Invengenx (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0396). No significant differences among suppliers were found for MPEM or MEM. Orientation did not significantly influence biomechanical performance. Coefficient of variation values confirmed minimal intra-sample variability.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBPPs preserved in glutaraldehyde demonstrate consistent thickness and homogeneous elastic behavior across suppliers, supporting their safe and reliable use in cardiovascular reconstruction. Further histological and long-term \u003cem\u003ein vivo\u003c/em\u003e studies are recommended to evaluate remodeling and potential hemodynamic effects.\u003c/p\u003e","manuscriptTitle":"Biomechanical Evaluation of Stress–Strain Behavior of Different Bovine Pericardial Patches Preserved in Glutaraldehyde Solution","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 14:46:16","doi":"10.21203/rs.3.rs-8391468/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ac0960c5-6724-4899-9814-c27d8a21171a","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-25T15:54:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 14:46:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8391468","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8391468","identity":"rs-8391468","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}