Tissue-engineered vascular grafts for congenital cardiac disease: Clinical experience and current status

Abstract

Congenital heart disease is a leading cause of death in the newborn period, and man-made grafts currently used for reconstruction are associated with multiple complications. Tissue engineering can provide an alternative source of vascular tissue in congenital cardiac surgery. Clinical trials have been successful overall, but the most frequent complication is graft stenosis. Recent studies in animal models have indicated the important role of the recipient’s immune response in neotissue formation, and that modulating the immune response can reduce the incidence of stenosis.

Immuno-driven and Mechano-mediated Neotissue Formation in Tissue Engineered Vascular Grafts

“…As the component polymers – a poly(glycolic acid) felt (PGA) and a poly( ε -caprolactone and L-lactide) sealant (P(CL/LA)) – degraded, host vascular cells invaded the scaffold and produced neotissue, thus resulting in the first tissue engineered neovessel having growth capacity. Although there was neither mortality nor severe morbidity due to graft-related causes in any of the initial 25 patients, graft stenosis requiring angioplasty manifested in 24% of these cases 6,14 . To better understand and ultimately to improve this promising TEVG, considerable effort subsequently turned toward mouse models wherein one can study more carefully the molecular, cellular, and biomechanical mechanisms of neovessel development.…”

Human Pluripotent Stem Cell-Derived Multipotent Vascular Progenitors of the Mesothelium Lineage Have Utility in Tissue Engineering and Repair

“…This could be related to limitations of mature cells to integrate into remodeling tissue or an inability to assemble into neo -vessels in a repair environment. In tissue engineering, combinations of SMCs, ECs, and mesenchymal stem cells (MSCs) are frequently used to seed vascular scaffolds, but this process is complicated, and the long-term efficacy of such constructs are unclear (Drews et al, 2017; Lee et al, 2016; Ren et al, 2015; Villalona et al, 2010). Our results suggest that vascular progenitor cells may be a solution to the problems associated with using mature vascular cell types.…”

Quickening: Translational design of resorbable synthetic vascular grafts

“…Biochemical interventions might recoup some of the rapid remodeling seen with cell-seeded grafts. (85) Still, PGA and PLGA may always require compositing with some longer-lasting material.…”