Abstract
Tissue-engineered vascular grafts (TEVGs) are a promising alternative to treat vascular disease under complex hemodynamic conditions. However, despite efforts from the tissue engineering and regenerative medicine fields, the interactions between the material and the biological and hemodynamic environment are still to be understood, and optimization of the rational design of vascular grafts is an open challenge. This is of special importance as TEVGs not only have to overcome the surgical requirements upon implantation, they also need to withhold the inflammatory response and sustain remodeling of the tissue. This work aims to analyze and evaluate the bio-molecular interactions and hemodynamic phenomena between blood components, cells and materials that have been reported to be related to the failure of the TEVGs during the regeneration process once the initial stages of preimplantation have been resolved, in order to tailor and refine the needed criteria for the optimal design of TEVGs.
Highlights
Cardiovascular disease (CVD) comprises a series of disorders that affect the heart and the vascular system, causing an estimated 17.9 million deaths worldwide every year [1].The pathophysiology of vascular diseases is characterized by either the blockage of blood vessels or by degenerative processes in the vascular wall that elicit detrimental changes in their elasticity that compromise the blood flow [2]
Aiming to recognize the challenges and opportunities, to establish a baseline and a series of indicators that translational studies should consider for the design and evaluation of Tissue-engineered vascular grafts (TEVGs) in each of the three phases defined previously for pre-clinical models in light of the TEVG triad [20], here we provide a complete description of the critical targets in regeneration that might promote regeneration or unchain events related to the patency loss or failure of vascular grafts
While syntheticWhile graftssynthetic are expected blood perfusion response grafts to areallow expected to allow blood without perfusionactive without active response to complex conditions, hemodynamic conditions, andistheir failure related toorocclusion or periimto complex hemodynamic and their failure related to is occlusion periimplaplanation as infections, regenerative grafts nation complications suchcomplications as infections,such regenerative vascular graftsvascular or TEVGs failor toTEVGs fully fail to comply with theto required functions to overcome the lack of physiological integration comply with thefully required functions overcome the lack of physiological integration of the of the graft with thevessels
Summary
Cardiovascular disease (CVD) comprises a series of disorders that affect the heart and the vascular system, causing an estimated 17.9 million deaths worldwide every year [1]. The pathophysiology of vascular diseases is characterized by either the blockage of blood vessels or by degenerative processes in the vascular wall that elicit detrimental changes in their elasticity that compromise the blood flow [2]. As patients with CVDs may require surgical interventions to recover or redirect the blood flow, the replacement of the diseased vessel with vascular grafts (VGs) remains the primary alternative. Regardless of the benefits imparted by their implantation, critical issues of availability and morbidity limit their implementation as suitable as VGs [3,4]; commercially available synthetic vascular grafts provide a less than ideal alternative related to the lack of the needed cues for regeneration.
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