Technology Insight: the evolution of tissue-engineered vascular grafts—from research to clinical practice

Abstract

There is a considerable clinical need for alternatives to the autologous vein and artery tissues used for vascular reconstructive surgeries such as CABG, lower limb bypass, arteriovenous shunts and repair of congenital defects to the pulmonary outflow tract. So far, synthetic materials have not matched the efficacy of native tissues, particularly in small diameter applications. The development of cardiovascular tissue engineering introduced the possibility of a living, biological graft that might mimic the functional properties of native vessels. While academic research in the field of tissue engineering in general has been active, as yet there has been no clear example of clinical and commercial success. The recent transition of cell-based therapies from experimental to clinical use has, however, reinvigorated the field of cardiovascular tissue engineering. Here, we discuss the most promising approaches specific to tissue-engineered blood vessels and briefly introduce our recent clinical results. The unique regulatory, reimbursement and production challenges facing personalized medicine are also discussed.

Expression of Versican Isoform V3 in the Absence of Ascorbate Improves Elastogenesis in Engineered Vascular Constructs

“…In addition, limitation of exposure to ascorbate significantly improved the structural and biomechanical properties of the constructs. While the constructs described here do not meet the threshold of burst strength considered desirable for safe implantation in vivo, 47,48 the use of V3-overexpressing ASMCs and limitation of ascorbate may ultimately improve the performance of TEBVs through provision of a stronger, more elastic vascular media. Potentially, by combining engineered media populated with ASMCs with mechanically strong, fibroblast-based engineered adventitial layers (fibroblastic constructs have recently shown promising results as vascular grafts in humans 3 ), a highly functional human TEBV could be produced.…”

Generation, Endothelialization, and Microsurgical Suture Anastomosis of Strong 1-mm-Diameter Collagen Tubes

“…1 Compared with autologous grafts, TEVGs are more readily available and more flexible in dimensions. As TEVGs can have a functional endothelial lumen, they are less likely to cause the acute thrombosis and chronic inflammation that are commonly associated with synthetic polymer grafts.…”

Novel Therapies for Hemodialysis Vascular Access Dysfunction

“…Conduits derived from native products, such as bovine carotid arteries or ureter, decellularized native vessels, and a patient's own transplanted veins, have been used with varying outcomes (86). Bioengineering approaches have been used to create autologous grafts from dermal fibroblasts and endothelial cells obtained through tissue biopsy and expanded in tissue culture (87,88). Clinical trials are currently underway in Europe and South America.…”