Rippel Radoslaw A, Ghanbari Hossein, Seifalian Alexander M
UCL Centre for Nanotechnology & Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, UK.
World J Surg. 2012 Jul;36(7):1581-91. doi: 10.1007/s00268-012-1535-y.
Heart valve disease is currently a growing problem, and demand for heart valve replacement is predicted to increase significantly in the future. Existing "gold standard" mechanical and biological prosthesis offers survival at a cost of significantly increased risks of complications. Mechanical valves may cause hemorrhage and thromboembolism, whereas biologic valves are prone to fibrosis, calcification, degeneration, and immunogenic complications.
A literature search was performed to identify all relevant studies relating to tissue-engineered heart valve in life sciences using the PubMed and ISI Web of Knowledge databases.
Tissue engineering is a new, emerging alternative, which is reviewed in this paper. To produce a fully functional heart valve using tissue engineering, an appropriate scaffold needs to be seeded using carefully selected cells and proliferated under conditions that resemble the environment of a natural human heart valve. Bioscaffold, synthetic materials, and preseeded composites are three common approaches of scaffold formation. All available evidence suggests that synthetic scaffolds are the most suitable material for valve scaffold formation. Different cell sources of stem cells were used with variable results. Mesenchymal stem cells, fibroblasts, myofibroblasts, and umbilical blood stem cells are used in vitro tissue engineering of heart valve. Alternatively scaffold may be implanted and then autoseeded in vivo by circulating endothelial progenitor cells or primitive circulating cells from patient's blood. For that purpose, synthetic heart valves were developed.
Tissue engineering is currently the only technology in the field with the potential for the creation of tissues analogous to a native human heart valve, with longer sustainability, and fever side effects. Although there is still a long way to go, tissue-engineered heart valves have the capability to revolutionize cardiac surgery of the future.
心脏瓣膜疾病目前是一个日益严重的问题，预计未来心脏瓣膜置换的需求将显著增加。现有的“金标准”机械瓣膜和生物瓣膜在提供生存机会的同时，会显著增加并发症的风险。机械瓣膜可能导致出血和血栓栓塞，而生物瓣膜则容易出现纤维化、钙化、退化和免疫原性并发症。
通过使用PubMed和ISI Web of Knowledge数据库进行文献检索，以识别生命科学中与组织工程心脏瓣膜相关的所有研究。
组织工程是一种新兴的替代方法，本文对此进行了综述。要使用组织工程制造出功能完全的心脏瓣膜，需要用精心挑选的细胞接种合适的支架，并在类似于天然人体心脏瓣膜的环境条件下使其增殖。生物支架、合成材料和预接种复合材料是支架形成的三种常见方法。所有现有证据表明，合成支架是最适合用于瓣膜支架形成的材料。使用了不同的干细胞来源，结果各不相同。间充质干细胞、成纤维细胞、肌成纤维细胞和脐血干细胞被用于心脏瓣膜的体外组织工程。或者，可以植入支架，然后通过循环内皮祖细胞或患者血液中的原始循环细胞在体内自动接种。为此，开发了合成心脏瓣膜。
组织工程目前是该领域唯一有可能制造出类似于天然人体心脏瓣膜、具有更长可持续性且副作用更少的组织的技术。尽管仍有很长的路要走，但组织工程心脏瓣膜有能力彻底改变未来的心脏外科手术。
