综述全文：Heart Valve Tissue Engineering

henryjia

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! W8 r( ?! h7 [: AAbstract—Tissue-engineered heart valves have been proposed by physicians and scientists alike to be the ultimate solution
% T. u8 r/ S7 F% b$ P" D! `1 a4 nfor treating valvular heart disease. Rather than replacing a diseased or defective native valve with a mechanical or animal
# y: J- ~* S& w5 o0 P" O6 l( ztissue–derived artificial valve, a tissue-engineered valve would be a living organ, able to respond to growth and$ ^1 A$ P9 T. b! y7 n$ z. n% T0 x6 D" G
physiological forces in the same way that the native aortic valve does. Two main approaches have been attempted over
' c0 @" F/ p& |the past 10 to 15 years: regeneration and repopulation. Regeneration involves the implantation of a resorbable matrix! F- l9 l# k: K2 {
that is expected to remodel in vivo and yield a functional valve composed of the cells and connective tissue proteins of
$ l1 u5 J' A  U- Bthe patient. Repopulation involves implanting a whole porcine aortic valve that has been previously cleaned of all pig* n3 p( x/ m# b/ I, o
cells, leaving an intact, mechanically sound connective tissue matrix. The cells of the patients are expected to repopulate
5 a# X; \' i4 w# [8 t9 H9 Aand revitalize the acellular matrix, creating living tissue that already has the complex microstructure necessary for proper
) F8 l% V# e" v1 R( gfunction and durability. Regrettably, neither of the 2 approaches has fared well in animal experiments, and the only3 x3 ^, E2 s6 P3 N+ D2 l
clinical experience with tissue-engineered valves resulted in a number of early failures and patient death. This article
% Y& z, x: F( X; v* {& S9 Vreviews the technological details of the 2 main approaches, their rationale, their strengths and weaknesses, and the likely
6 f7 v9 \9 n, z$ Amechanisms for their failure. Alternative approaches to valvular tissue engineering, as well as the role of industry in/ ^# z6 o9 v8 w% b& f
shaping this field in the future, are also reviewed. (Circ Res. 2005;97:743-755.)