Abstract
Vascular bypass is a surgical procedure which aims at restoring normal blood circulation in cardiovascular diseases affecting small (e.g., coronary artery disease) and/or large diameter (e.g., congenital heart disease, peripheral vascular disease) blood vessels. After outlining some of the major medical conditions where vascular grafts represent a therapeutic approach, we review the current gold standards for surgical bypass grafting as well as their limitations. We subsequently provide an overview of in vitro tissue engineering approaches which may offer a solution for achieving autologous vascular replacement. We first describe cell sources – including induced pluripotent stem cells – and scaffold materials used for in vitro tissue engineering and give a summary of clinical trials using this approach. After reviewing the limitations of in vitro tissue-engineered vascular grafts (extensive production times, interpatient variability, difficulties in storage and preservation), we describe the emerging in situ tissue engineering approach – one which recognizes off-the-shelf availability as a fundamental prerequisite to facilitate broad clinical adoption. Off-the-shelf solutions, such as polymer-only-based grafts and decellularized ECM-based conduits, have shown promising results in preclinical studies. However, further studies are required to assess the long-term functionality of such implants, to better understand the immune response they elicit and how they remodel, both in healthy and diseased individuals.
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Fioretta, E.S., von Boehmer, L., Generali, M., Hoerstrup, S.P., Emmert, M.Y. (2020). Off-the-Shelf Tissue-Engineered Vascular Conduits: Clinical Translation. In: Walpoth, B.H., Bergmeister, H., Bowlin, G.L., Kong, D., Rotmans, J.I., Zilla, P. (eds) Tissue-Engineered Vascular Grafts. Reference Series in Biomedical Engineering(). Springer, Cham. https://doi.org/10.1007/978-3-030-05336-9_21
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