Abstract
In cardiovascular surgery, reconstruction and replacement of cardiac and vascular structures are routinely performed. Prosthetic or biological materials traditionally used for this purpose cannot be considered ideal substitutes as they have limited durability and no growth or regeneration potential. Tissue engineering aims to create materials having normal tissue function including capacity for growth and self-repair. These advanced materials can potentially overcome the shortcomings of conventionally used materials, and, if successfully passing all phases of product development, they might provide a better option for both the pediatric and adult patient population requiring cardiovascular interventions. This short review article overviews the most important cardiovascular pathologies where tissue engineered materials could be used, briefly summarizes the main directions of development of these materials, and discusses the hurdles in their clinical translation. At its beginnings in the 1980s, tissue engineering (TE) was defined as “an interdisciplinary field that applies the principles of engineering and the life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function” (1). Currently, the utility of TE products and materials are being investigated in several fields of human medicine, ranging from orthopedics to cardiovascular surgery (2–5). In cardiovascular surgery, reconstruction and replacement of cardiac and vascular structures are routinely performed. Considering the shortcomings of traditionally used materials, the need for advanced materials that can “restore, maintain or improve tissue function” are evident. Tissue engineered substitutes, having growth and regenerative capacity, could fundamentally change the specialty (6). This article overviews the most important cardiovascular pathologies where TE materials could be used, briefly summarizes the main directions of development of TE materials along with their advantages and shortcomings, and discusses the hurdles in their clinical translation.
Highlights
Reviewed by: Sharan Ramaswamy, Florida International University, United States Elisa Avolio, University of Bristol, United Kingdom
At its beginnings in the 1980s, tissue engineering (TE) was defined as “an interdisciplinary field that applies the principles of engineering and the life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function” [1]
Apart from decellularized allografts and porcine small intestinal submucosa, all other products are treated with glutaraldehyde [59] which can have a negative impact on cellular ingrowth following implantation [60]
Summary
Congenital heart defects affect ∼9 of 1,000 newborns [7] and often require corrective surgery at an early age. Patches are used for the closure of atrial or ventricular septal defects, for complex reconstructions in atrioventricular canal defects; in right ventricular outflow tract reconstruction in Tetralogy of Fallot; for aortic reconstruction in interrupted aortic arch or hypoplastic left heart syndrome; or when establishing cavo-pulmonary connection is required [9,10,11,12,13]. As most of these operations are performed at very young or even neonatal age, repair must stay effective and durable in a rapidly changing physiological environment. Balloon palliation can buy some time until valve repair or replacement [22], patients with congenital AS often require a sequence of reoperations until they reach adulthood [23, 24], largely due to the absence of an optimal valve substitute
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