Tissue-engineered heart valves

The native heart valves are adaptive living tissues that are capable of growth and remodeling in response to changes in the hemodynamic environment. It is the intrinsic lack of this growth and remodeling capacity that causes current heart valve replacements to fail over time. Therefore, heart valve tissue engineering (HVTE) is being pursued with the aim of creating living, autologous replacement valves with the capacity for somatic growth and increased valve longevity. This chapter elaborates on the various HVTE paradigms, ranging from the in vitro creation of living valves to the use of acellular valvular grafts that are designed to induce endogenous regeneration in situ. This includes a delineation of the various cell types, scaffolds, and bioreactor systems that form the building blocks of HVTE, as well as a concise description of the added value of computational models. Finally, the merging of HVTE with percutaneous delivery techniques and the main current challenges toward robust clinical translation are discussed.