Apte Sameer S, Paul Arghya, Prakash Satya, Shum-Tim Dominique
Division of Cardiac Surgery & Surgical Research, McGill University Health Center, Montreal, Quebec, Canada.
Future Cardiol. 2011 Jan;7(1):77-97. doi: 10.2217/fca.10.120.
The use of tissue-engineering methods to create autologous heart valve constructs has the potential to overcome the fundamental drawbacks of more traditional valve prostheses. Traditional mechanical valves, while durable, increase the risk for endocarditis and thrombogenesis, and require the recipient to continue lifelong anticoagulant therapy. Homograft or xenograft heart valve prostheses are associated with immune reaction and progressive deterioration with limited durability. Most importantly, neither option is capable of growth and remodeling in vivo and both options place the patient at risk for valve-related complications and reoperation. These shortcomings have prompted the application of tissue-engineering techniques to create fully autologous heart valve replacements. Future clinically efficacious tissue-engineered autologous valves should be nonthrombogenic, biocompatible, capable of growth and remodeling in vivo, implantable with current surgical techniques, hemodynamically perfect, durable for the patient's life and most importantly, significantly improve quality of life for the patient. In order to meet these expectations, the nature of the ideal biochemical milieu for conditioning an autologous heart valve will need to be elucidated. In addition, standardized criteria by which to quantitatively evaluate a tissue-engineered heart valve, as well as noninvasive analytical techniques for use in long-term animal models, will be required. This article highlights the advances, challenges and future clinical prospects in the field of tissue engineering of autologous heart valves, focusing on progress made by studies that have investigated a fully autologous, tissue-engineered pulmonary valve replacement in vivo.
利用组织工程方法构建自体心脏瓣膜结构有可能克服更传统瓣膜假体的根本缺陷。传统机械瓣膜虽然耐用，但会增加心内膜炎和血栓形成的风险，并且需要接受者持续进行终身抗凝治疗。同种异体或异种心脏瓣膜假体与免疫反应以及有限耐用性导致的渐进性退化相关。最重要的是，这两种选择都无法在体内生长和重塑，并且都会使患者面临瓣膜相关并发症和再次手术的风险。这些缺点促使人们应用组织工程技术来制造完全自体的心脏瓣膜替代品。未来临床上有效的组织工程自体瓣膜应具有抗血栓形成、生物相容性好、能够在体内生长和重塑、可通过当前手术技术植入、血流动力学完美、对患者寿命而言耐用，并且最重要的是能显著改善患者生活质量。为了满足这些期望，需要阐明用于培养自体心脏瓣膜的理想生化环境的性质。此外，还将需要用于定量评估组织工程心脏瓣膜的标准化标准以及用于长期动物模型的非侵入性分析技术。本文重点介绍了自体心脏瓣膜组织工程领域的进展、挑战和未来临床前景，重点关注研究在体内研究完全自体、组织工程化肺动脉瓣膜置换所取得的进展。
