Abstract
Cardiovascular disease is the leading cause of death worldwide, with this trend predicted to continue for the foreseeable future. Common disorders are associated with the stenosis or occlusion of blood vessels. The preferred treatment for the long-term revascularization of occluded vessels is surgery utilizing vascular grafts, such as coronary artery bypass grafting and peripheral artery bypass grafting. Currently, autologous vessels such as the saphenous vein and internal thoracic artery represent the gold standard grafts for small-diameter vessels (<6 mm), outperforming synthetic alternatives. However, these vessels are of limited availability, require invasive harvest, and are often unsuitable for use. To address this, the development of a tissue-engineered vascular graft (TEVG) has been rigorously pursued. This article reviews the current state of the art of TEVGs. The various approaches being explored to generate TEVGs are described, including scaffold-based methods (using synthetic and natural polymers), the use of decellularized natural matrices, and tissue self-assembly processes, with the results of various in vivo studies, including clinical trials, highlighted. A discussion of the key areas for further investigation, including graft cell source, mechanical properties, hemodynamics, integration, and assessment in animal models, is then presented.
Highlights
Cardiovascular disease is the number one cause of death globally.[1]
Studies in murine models have shown noteworthy results with grafts produced from electrospun PCL or poly(glycerol sebacate) (PGS) and PCL exhibiting host remodeling, extracellular matrix (ECM) deposition, and native tissue structures when implanted in arterial positions.[79,80]
It is clear that a number of different approaches are being explored to produce a tissue-engineered vascular graft (TEVG) and, with clinical results being reported for a range of techniques, the best solution is yet to be determined
Summary
Cardiovascular disease is the number one cause of death globally.[1] Disorders are often associated with the narrowing or blockage of blood vessels leading to reduced blood flow and tissue damage due to inadequate nutrient supply. A vascular graft may be used to replace or bypass a damaged or occluded vessel. Despite the advances in endovascular surgery and its increased popularity over recent decades, vascular bypass grafting remains commonplace and is believed to be the optimal choice for patients requiring long-term revascularization solutions (life expectancy >2 years).[4,5,6,7,8] Around 400,000 coronary artery bypass grafting (CABG) procedures are performed each year in the United States alone.[9]
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