OBJECTIVES/SPECIFIC AIMS: Thoracic endovascular aortic repair (TEVAR) is more effective in remodeling the dissected aorta in acute versus chronic type B aortic dissection (TBAD). It has been hypothesized that this is due to differences in dissection flap biomechanical and structural properties but has not been confirmed in explanted human aortic tissue. We aimed to characterize and compare differences in tissue biomechanics and microstructure between acute and chronic dissection flaps that may underlie these findings. METHODS/STUDY POPULATION: Dissection flaps were obtained at time of operative repair for patients presenting for open aortic replacement to treat acute type A (ACUTE, n=7) or chronic type B (CHRONIC, n=7) aortic dissection. Given that the current treatment modality for acute complicated TBAD is TEVAR, it was not feasible to acquire acute TBAD flaps for analysis. Tissues were cryopreserved and subjected to biaxial tensile testing in the circumferential and longitudinal directions. Stiffness was quantified by the tangent modulus (TM) in the low and high linear regions of the compiled equibiaxial response curves for each cohort. Extensibility was defined as the intersection of the fitted line from the high linear region with the x-axis, and the degree of anisotropy (DA) was defined as the mean absolute percentage error of the strains in both directions. Flap architecture and collagen fiber organization were also compared between groups using two-photon microscopy. RESULTS/ANTICIPATED RESULTS: Average age of dissection flaps were 3.4±3.4 days in ACUTE and 1,868.7±1,354.0 days in CHRONIC (p=0.011). There were no differences in age, co-morbidities, maximum aortic diameter, and aortic wall thickness. ACUTE exhibited an anisotropic stress-strain response with increased extensibility longitudinally than circumferentially (0.18 vs. 0.09, p=0.022, DA=0.67) while CHRONIC demonstrated an isotropic response with similar extensibility in either direction (0.11 vs. 0.12, p=0.606, DA=0.26). CHRONIC and ACUTE had comparable stiffness in the circumferential direction (TMlow 439.92 vs. 541.08, p=0.729, and TMhigh 1585.19 kPa vs. 1869.35 kPa, p=0.817). In the longitudinal direction, CHRONIC was significantly stiffer than ACUTE (TMhigh 8347.61 kPa vs. 1201.34 kPa, p=0.049) (FIGURE). Microscopy corroborated these findings with greater collagen fiber organization circumferentially than longitudinally in ACUTE and increasing fibrosis, collagen predominance, and straightening of collagen fibers in CHRONIC. DISCUSSION/SIGNIFICANCE OF IMPACT: Compared to ACUTE, CHRONIC exhibited loss of anisotropy with increased tissue stiffness in the longitudinal direction. Increased dissection flap fibrosis and decreased compliance may explain the worse outcomes for aortic remodeling after TEVAR in chronic TBAD. This study offers biomechanical support for early TEVAR in the acute phase of uncomplicated TBAD.
Commentary: Stents or surgery for chronic type-B dissection