Tissue Engineering and Regenerative Medicine in Cardiovascular Disease

Cardiovascular diseases, such as coronary artery disease, aortic disease, peripheral vascular disease, and heart failure, contribute to significant causes of worldwide mortality despite modern advances in medicine and surgery. The use of expanded polytetrafluoroethylene (ePTFE, Goretex) or polyethylene terephthalate (PET, Dacron) for vascular graft implantation is common to treat patients with PAD and aortic disease. Current vascular grafts and prosthetic heart valves used to treat CVD have limitations such as the lack of growth capacity and risks of thrombosis, stenosis, and calcification. Similarly, left ventricular (LV) reconstruction surgery can reduce the dilated LV volume after cardiac remodeling, but is incapable of regenerating the myocardium. Theoretically, cardiovascular tissue engineering has the potential to address the limitations of current grafts and prosthetic heart valves. An ideal tissue-engineered vascular graft (TEVG) and heart valve (TEHV) is thrombus-free, easily handled, biocompatible, durable, and maintains mechanical integrity as the scaffold degrades and remodels into native tissue. However, small-diameter (<6 mm) TEVGs have not yet shown clinical effectiveness, and TEHVs still have limitations for clinical use. Cell injection therapies, which induce myocardial regeneration, are promising approaches for myocardial repair. Several clinical trials using human induced pluripotent stem cells-derived cardiomyocytes have been initiated. Here various advanced devices, approaches, and strategies to address current drawbacks were reviewed, focusing on current clinical studies and ongoing clinical trials for TEVG, TEHV, and myocardial regeneration based on cardiovascular medicine. Currently, the development of tissue-engineered arterial grafts seems to be trending towards biomaterial utilization rather than cell-based approaches. Contrastingly, the development of TEHVs has encountered a period of stagnation. However, as many researchers are continuing their studies, further results will be published.