Bioengineered tissue solutions for repair, correction and reconstruction in cardiovascular surgery

Abstract

The treatment of cardiac alterations is still nowadays a dramatic issue in the cardiosurgical practice. Synthetic materials applied in this surgery have failed in their long-term therapeutic efficacy due to low biocompatibility and compliance, especially when used in contractile sites. In order to overcome these treatment pitfalls, novel solutions have been developed based on biological tissues. Patches in pericardium, small intestinal submucosa, as well as engineered tissues of myocardium, heart valves and blood vessels have undergone a large preclinical investigation in regenerative medicine studies. Clinical translation has been started or reached by several of these new bioengineered treatment alternatives. This review will describe the preclinical and clinical experiences realized so far with the application of biological tissues in cardiovascular surgery. It will depict the progressive steps realized in the evolution of this research, as well as it will point out the challenges yet to face in order to generate the ideal biomaterial for cardiovascular repair, corrective and reconstructive surgery.

A Comprehensive Comparison of Bovine and Porcine Decellularized Pericardia: New Insights for Surgical Applications

“…After performed analysis, both acellular pericardial scaffolds likely offer similar profiles in terms of structural, biochemical, biomechanical, and bioactivity properties, apart from the differences in thickness, water and GAGs contents. In addition, the comparison hereby performed evidences that also the less clinically applied acellular porcine pericardium could be a biomaterial of interest to be used for surgical reconstruction or replacement, as it is its GA-treated, native counterpart [11]. Although this work is intended to offer a wide-ranging overview of the differential, species-specific properties of the most clinically applied pericardia after their detergent decellularization, other aspects that are relevant for clinical use need to be still investigated.…”

“…In the therapeutic perspective of auto-or allotransplantation, patients' comorbidities and donors' scarcity represent critical limitations. Xenogeneic pericardia demonstrated possessing similar characteristics with respect to human ones; however GA-treatment has to be applied before clinical use to prevent catastrophic immune responses and, hence, graft failure [10,11].…”

“…Ideal biomedical materials for implantation surgeries are endowed with characteristics, such as strength, easy molding and suturability, absence of cytotoxicity, biocompatibility, radiolucency, sterile availability, and, not last, inexpensiveness and sustainability [11,22,70]. TRICOL bovine and porcine pericardia, manufactured with a cost-effective decellularization procedure, possess all these features.…”

“…Low rates of infection, complications and fibrotic adherence, and good hemodynamic behavior, have been reported. However, GA cytotoxicity and/or the incompletely shielded immunogenicity represent important limitations for the long-term performance of these pericardial substitutes and, hence, for the freedom from re-intervention in treated patients [10,11].…”

Decellularized Extracellular Matrices and Cardiac Differentiation: Study on Human Amniotic Fluid-Stem Cells

“…Cardiovascular (CV) diseases represent some of the main causes of mortality in worldwide [ 1 ], comprising 31% of global death [ 2 , 3 , 4 ]. The generation of fully differentiated cardiomyocytes (CMs) and cell-based tissue engineering approaches are among the goals of regenerative medicine.…”