Recent advances on electrospun scaffolds as matrices for tissue-engineered heart valves

Abstract

Valvular heart diseases (VHDs) are a major health problem increasing morbidity and mortality worldwide. Currently, treatment of VHDs relies on valve replacement with mechanical or biological valves, which have major drawbacks in terms of durability and the ability to grow, repair and remodel. To this end, tissue-engineered heart valves (TEHVs) have emerged as ideal substitutes. TEHVs are composed of biodegradable, biocompatible and mechanically stable scaffolds that resemble the native valves. These scaffolds are seeded with autologous cells and conditioned in a bioreactor prior to implantation. Scaffolds that have been utilized so far for such application are (i) biological, (ii) synthetic and (iii) cell entrapment in polymerized extra-cellular matrix based scaffolds. Synthetic scaffolds are considered superior over the other two types in terms of controlled mechanical properties and degradation rate. They can be subdivided into porous, hydrogel and fibrous scaffolds. Among the three subcategories, fibrous scaffolds are preferred because they resemble the natural extra-cellular matrix for the native valve. Such scaffolds can be fabricated using phase separation, self-assembly and electrospinning. Electrospinning is a versatile technique for fabricating scaffolds for tissue engineering applications that possess many advantages. Electrospun scaffolds processed using a wide range of synthetic and natural polymers were proven to be promising in terms of mechanical properties comparable to the native valves, fiber diameter within the range of the natural extracellular matrix and good cellular response. However, further investigation in fabricating fibrous scaffolds for tissue-engineered heart valves is still needed. In this review, we discussed electrospun scaffolds as TEHVs matrices, how far they succeeded in meeting the criteria of ideal scaffolds for such application and what the shortage aspects and possible solutions are.