TEHV – Tissue Engineering of Heart Valves
Pp. 289-310 (22)
Wilhelm Peter Mistiaen
The development of tissue engineered heart valves has seemed promising:
with its development, a living tissue, capable of growth, repair and remodelling would
cure the valve disease. Nevertheless, TEHV will have to compete with well established
procedures and devices such as pericardial BHV.
The release of a device that can compete with currently available valves will take
probably many more years. The development of TEHV is complex and requires several
First, the scaffold has to be chosen: a synthetic and biodegradable device or a
decellularized scaffold from biological origin. For the latter, many decellularization
protocols exist, all with their pro’s and con’s.
Second, the decision for cell reseeding has to be made. The source for the cells has its
importance. Differentiated cells of the same type but from a different region (vascular
EC vs. valvular EC) can behave differently. Autologous mesenchymal stem cells
derived from bone marrow and progenitor cells from other sources seem promising.
After reseeding, culturing in a bioreactor can improve the biomechanical properties of
the device. Much depends however on the mechanical loading protocols and on the
biochemical composition of the culture medium. Small differences in such protocols
lead to a great variety of tissues.
It seems that the “silver bullet”, leading to the desired differentiation of the seeded cells,
which are capable of remodelling an repairing the ECM, still has to be found. Moreover,
long-term animal studies, in vivo evaluation of the device and bench-to-bed series are
still lacking. Attempts to implant TEHV in young patients with congenital heart disease
were and still are not promising.
Biochemical protocols, bioreactor, cell sources, collagen,
decellularization, endothelial cells, extracellular matrix, glycosminoglycan,
mechanical loading protocol, mesenchymal stem cells, myofibroblasts, reseeding,
scaffold, smooth muscle cells.
Artesis University College Antwerp Department of Healthcare Sciences University of Antwerp Belgium