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* B% Y, ]3 D  u. N
for treating valvular heart disease. Rather than replacing a diseased or defective native valve with a mechanical or animal1 q- m3 |8 v4 R
tissue–derived artificial valve, a tissue-engineered valve would be a living organ, able to respond to growth and) s  K6 W4 z$ [! a) ]
physiological forces in the same way that the native aortic valve does. Two main approaches have been attempted over
8 C2 F6 i" D' |+ n2 gthe past 10 to 15 years: regeneration and repopulation. Regeneration involves the implantation of a resorbable matrix
/ r1 [4 N9 U7 a% C+ s1 e: W6 fthat is expected to remodel in vivo and yield a functional valve composed of the cells and connective tissue proteins of; D" R' T- s9 `# e$ D, ]! U
the patient. Repopulation involves implanting a whole porcine aortic valve that has been previously cleaned of all pig
# w7 B$ H( y' Z% s9 T8 t3 k* d' I1 H# }6 Icells, leaving an intact, mechanically sound connective tissue matrix. The cells of the patients are expected to repopulate
* |, O) m: l; {. s/ O9 E4 m5 Zand revitalize the acellular matrix, creating living tissue that already has the complex microstructure necessary for proper$ u1 b* }  I2 l9 j! n
function and durability. Regrettably, neither of the 2 approaches has fared well in animal experiments, and the only
% o! E6 a# o; b6 {6 `/ j8 q: Tclinical experience with tissue-engineered valves resulted in a number of early failures and patient death. This article* n9 U0 V* W% ?; D$ _
reviews the technological details of the 2 main approaches, their rationale, their strengths and weaknesses, and the likely8 _+ t. S2 @9 t6 D8 [, x$ z- E
mechanisms for their failure. Alternative approaches to valvular tissue engineering, as well as the role of industry in
- W; h7 U( S5 U7 Q9 `shaping this field in the future, are also reviewed. (Circ Res. 2005;97:743-755.)