Application of Tissue-Engineering Principles toward the Development of a Semilunar Heart Valve Substitute

Abstract

Heart valve disease is a significant medical problem worldwide. Current treatment for heart valve disease is heart valve replacement. State of the art replacement heart valves are less than ideal and are associated with significant complications. Using the basic principles of tissue engineering, promising alternatives to current replacement heart valves are being developed. Significant progress has been made in the development of a tissue-engineered semilunar heart valve substitute. Advancements include the development of different potential cell sources and cell-seeding techniques; advancements in matrix and scaffold development and in polymer chemistry fabrication; and the development of a variety of bioreactors, which are biomimetic devices used to modulate the development of tissue-engineered neotissue in vitro through the application of biochemical and biomechanical stimuli. This review addresses the need for a tissue-engineered alternative to the current heart valve replacement options. The basics of heart valve structure and function, heart valve disease, and currently available heart valve replacements are discussed. The last 10 years of investigation into a tissue-engineered heart valve as well as current developments are reviewed. Finally, the early clinical applications of cardiovascular tissue engineering are presented.

The Development of Tissue-Engineered Grafts for Reconstructive Cardiothoracic Surgical Applications

“…Currently, treatment for patients with valvular disease is heart valve replacement surgery using a mechanical prosthetic valve, glutaraldehyde-fixed xenograft, homograft, or autograft via the Ross procedure. Replacement valves can be life saving and often lead to improved quality of life; however, they are not without significant risks (18,19). The relative strengths and weaknesses of these replacement valves have been identified (Table 2), thus allowing clinicians to best tailor selection of the graft to the individual.…”

Cardiovascular tissue engineering: Approaches and preclinical applications

“…Yukarıda bahsedilen kapakların enfeksiyon, yenilenme, onarım sürelerinde dezavantajlar oldu¤u için daha dayanıklı ve ömürleri daha uzun olan kapakların üretilmesine gerek duyulmaktadır. [29] Bu sorunları göz önünde bulunduran Lee ve ark. [30] heterotropik kalp kapak nakli modeli gelitirmi kalp kapakçı¤ı donörü olarak fareleri kullanarak deneyler gerçekletirmilerdir.…”

Calcific Aortic Valve Disease

“…Mechanical forces exerted by the surrounding blood and heart drive the aortic valve's function. The dynamic structure and physiology of aortic heart valves enables them to avoid excess stress concentration and to withstand wear and tear over many years (Breuer et al, 2004). Aortic valve functionality must be seen in conjunction with the aortic root, and be viewed as one apparatus (Schoen, 2008).…”

“…By employing these properties, the native heart valve avoids excess stress concentration on the cusps and supporting tissues and can withstand biomechanical loads caused by repetitive deformations. In addition, biomechanical stress may induce the remodelling and repair of connective tissue (Breuer et al, 2004). The aortic valve tissue possesses a cellular make-up that withstands a large amount of pressures and stresses.…”