Heart valve tissue engineering: quo vadis?

Surgical replacement of diseased heart valves by mechanical and tissue valve substitutes is now commonplace and generally enhances survival and quality of life. However, a fundamental problem inherent to the use of existing mechanical and biological prostheses in the pediatric population is their failure to grow, repair, and remodel. A tissue engineered heart valve could, in principle, accommodate these requirements, especially somatic growth. This review provides a brief overview of the field of heart valve tissue engineering, with emphasis on recent studies and evolving concepts, especially those that establish design criteria and key hurdles that must be surmounted before clinical implementation.

Research highlights
► A living tissue engineered heart valve may accommodate somatic growth in young recipients.
► Native valve mechano-biological dynamics define design parameters of an engineered tissue valve.
► Valvular interstitial cells and extracellular matrix are the key elements of an engineered valve.
► Heart valves are a particularly difficult application for realization of the tissue engineering approach.
► Key technical hurdles impose barriers to clinical implementation of engineered tissue heart valves.