Clinical application of tissue engineered human heart valves using autologous progenitor cells

被引:203
作者
Cebotari, Serghei
Lichtenberg, Artur
Tudorache, Igor
Hilfiker, Andres
Mertsching, Heike
Leyh, Rainer
Breymann, Thomas
Kallenbach, Klaus
Maniuc, Liviu
Batrinac, Aurel
Repin, Oleg
Maliga, Oxana
Ciubotaru, Anatol
Haverich, Axel
机构
[1] Hannover Med Sch, Dept Thorac & Cardiovasc Surg, D-30625 Hannover, Germany
[2] Sci & Pract Ctr Cardiovasc Surg, Kishinev, Moldova
关键词
congenital; heart defects; surgery; valves;
D O I
10.1161/CIRCULATIONAHA.105.001065
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Tissue engineering (TE) of heart valves reseeded with autologous cells has been successfully performed in vitro. Here, we report our first clinical implantation of pulmonary heart valves (PV) engineered with autologous endothelial progenitor cells (EPCs) and the results of 3.5 years of follow-up. Methods and Results-Human PV allografts were decellularized (Trypsin/EDTA) and resulting scaffolds reseeded with peripheral mononuclear cells isolated from human blood. Positive stain for von Willebrand factor, CD31, and Flk-1 was observed in monolayers of cells cultivated and differentiated on the luminal surface of the scaffolds in a dynamic bioreactor system for up to 21 days, indicating endothelial nature. PV reseeded with autologous cells were implanted into 2 pediatric patients (age 13 and 11) with congenital PV failure. Postoperatively, a mild pulmonary regurgitation was documented in both children. Based on regular echocardiographic investigations, hemodynamic parameters and cardiac morphology changed in 3.5 years as follows: increase of the PV annulus diameter (18 to 22.5 mm and 22 to 26 mm, respectively), decrease of valve regurgitation (trivial/mild and trivial, respectively), decrease (16 to 9 mm Hg) or a increase (8 to 9.5 mm Hg) of mean transvalvular gradient, remained 26 mm or decreased (32 to 28 mm) right-ventricular end-diastolic diameter. The body surface area increased (1.07 to 1.42 m(2) and 1.07 to 1.46 m(2), respectively). No signs of valve degeneration were observed in both patients. Conclusions-TE of human heart valves using autologous EPC is a feasible and safe method for pulmonary valve replacement. TE valves have the potential to remodel and grow accordingly to the somatic growth of the child.
引用
收藏
页码:I132 / I137
页数:6
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