Congenital, reconstructive and regenerative cardiac surgery

Abstract

The development of bioengineered heart valves that have prolonged durability and improved hydraulic functionality will significantly improve the management of pediatric congenital cardiac patients by limiting multiple reoperations. However, progressing one step further to tissue engineered heart valves that contain viable and phenotypically appropriate cell populations will result in growth capable heart valves that can remodel constructively and synchronously with the patient's somatic growth. Pediatric cardiac surgical and interventional catheter therapeutics now consists of a huge menu of multistage and palliative procedures. Readily available, patient specific or “personal” tissue engineered viable constructs for use as replacements for missing, hypoplastic, or structurally defective cardiac structures will fundamentally alter therapeutic strategies for numerous diagnoses. These transformational developments will result in definitive operations that can be performed early in the patient's life. Altered strategies that will become available are explored for tetralogy of Fallot, pulmonary atresia, congenital aortic stenosis, the single ventricle, and the “failing Fontan”. The barriers and challenges to achieving routinely applicable Tissue Engineered and Regenerative (TERM) Cardiac Surgery Methods are also explored as is a novel concept for the Cardiac Hybrid Operating Room Suite of the 21st Century.