Tissue Engineered Materials in Cardiovascular Surgery: The Surgeon's Perspective

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.

Changing epidemiology of calcific aortic valve disease: 30-year trends of incidence, prevalence, and deaths across 204 countries and territories

“…In addition to increasingly perfected operative treatments, including the development and widely use of transcatheter aortic valve replacement, agents used to treat cardiovascular complications may work in CAVD [ 4 , 24 ]. Tissue-engineered heart valves may exert a widespread and far-reaching impact on the field of heart valve prosthesis [ 25 ]. Moreover, the possibility that lipid-lowering therapy improves CAVD outcomes cannot be ruled out [ 26 ], albeit this specific drug strategy has failed to reduce disease progression.…”

The “Cairo Accord”- Towards the Eradication of RHD: An Update

“…The technology and concepts involved in tissue engineering of heart valves continue to evolve, with more concentration on in situ tissue engineering (Figure 11) (102)(103)(104)(105). These techniques rely on understanding and exploiting the basic mechanisms involved in valve morphogenesis (Figure 12) (106) and normal valves (Figure 13) (107) with the use scaffolds capable of recruiting, housing, and instructing appropriate host cells and ECM (Figure 14) (108).…”

Biofabrication in Congenital Cardiac Surgery: A Plea from the Operating Theatre, Promise from Science

“…Despite having an autologous and viable valve replacement, post-operative Ross-patients still face late reoperations for autograft dilation [ 73 ], although at a lesser rate than that for the replacement of the RV-PA conduit [ 74 ]. Apparently, no other currently available prosthetic valve has growth and/or regeneration potential [ 75 ].…”