综述全文：Heart Valve Tissue Engineering

henryjia

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$ A. @/ N( J! c. PAbstract—Tissue-engineered heart valves have been proposed by physicians and scientists alike to be the ultimate solution- W5 r; z7 J, p9 I* l% u
for treating valvular heart disease. Rather than replacing a diseased or defective native valve with a mechanical or animal- g+ {) c% z* L# V: o- z
tissue–derived artificial valve, a tissue-engineered valve would be a living organ, able to respond to growth and
# i7 V& J; m! }. I9 I8 Tphysiological forces in the same way that the native aortic valve does. Two main approaches have been attempted over
: C$ K8 |+ |' r* M$ y, E* Uthe past 10 to 15 years: regeneration and repopulation. Regeneration involves the implantation of a resorbable matrix* }; {) B, d5 V: u4 k5 A
that is expected to remodel in vivo and yield a functional valve composed of the cells and connective tissue proteins of0 |- v" t, l$ h2 `
the patient. Repopulation involves implanting a whole porcine aortic valve that has been previously cleaned of all pig% `& a* t$ U7 p
cells, leaving an intact, mechanically sound connective tissue matrix. The cells of the patients are expected to repopulate
! {: |6 Y& |- }and revitalize the acellular matrix, creating living tissue that already has the complex microstructure necessary for proper
+ E& r2 w3 i* E/ D/ @function and durability. Regrettably, neither of the 2 approaches has fared well in animal experiments, and the only( E2 ~5 g: ~  [. N. M0 d. J; P2 t
clinical experience with tissue-engineered valves resulted in a number of early failures and patient death. This article$ V' o, E9 U2 F
reviews the technological details of the 2 main approaches, their rationale, their strengths and weaknesses, and the likely  N; i  q+ H; J) @9 M
mechanisms for their failure. Alternative approaches to valvular tissue engineering, as well as the role of industry in
2 Q. R! V6 p, L0 T9 }# bshaping this field in the future, are also reviewed. (Circ Res. 2005;97:743-755.)