综述全文：Heart Valve Tissue Engineering

henryjia

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Abstract—Tissue-engineered heart valves have been proposed by physicians and scientists alike to be the ultimate solution
" Y* T6 ^1 h3 F4 _% j! H# Q; @+ Zfor treating valvular heart disease. Rather than replacing a diseased or defective native valve with a mechanical or animal6 i4 `/ |% V  k8 N, ]$ L2 B
tissue–derived artificial valve, a tissue-engineered valve would be a living organ, able to respond to growth and9 i( I1 L/ D% h
physiological forces in the same way that the native aortic valve does. Two main approaches have been attempted over1 h! H. C* U( j( G1 I+ C
the past 10 to 15 years: regeneration and repopulation. Regeneration involves the implantation of a resorbable matrix
8 k0 f) q) n3 _2 _that is expected to remodel in vivo and yield a functional valve composed of the cells and connective tissue proteins of
; J9 D8 V' V; }1 e$ ~* I# @the patient. Repopulation involves implanting a whole porcine aortic valve that has been previously cleaned of all pig
0 }; [' G% }; @, X1 f' m% rcells, leaving an intact, mechanically sound connective tissue matrix. The cells of the patients are expected to repopulate
" o: t" H5 x% M2 K$ z" x: r3 jand revitalize the acellular matrix, creating living tissue that already has the complex microstructure necessary for proper# [- i& C! R, z$ C( ?8 R
function and durability. Regrettably, neither of the 2 approaches has fared well in animal experiments, and the only
2 e' |* m* U* A0 c0 k# L. cclinical experience with tissue-engineered valves resulted in a number of early failures and patient death. This article! m1 Q% i5 S, h3 T! {( u
reviews the technological details of the 2 main approaches, their rationale, their strengths and weaknesses, and the likely  c, o) G, b9 v! k% U9 h
mechanisms for their failure. Alternative approaches to valvular tissue engineering, as well as the role of industry in; K0 S; V+ d& h) i6 \$ ^& r/ ?
shaping this field in the future, are also reviewed. (Circ Res. 2005;97:743-755.)