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Introduction: Many attempts have been undertaken for surgical correction of congenital heart defects. Reconstruction of the right ventricular outflow tract (RVOT) is a main component of many procedures. Homograft devices are considered as benchmark, but these are in short supply. Xenografts and tissue engineered heart valves (TEHV) have been proposed as solution. This review aims to explore what progress has been made for these two alternatives.
Methods: A systematic search for TEHV and the commonly used xenograft (Matrix P / P+, Shelhigh and Contegra) devices through ISI web of Knowledge was performed. The SynerGraft homograft was also included.
Results: Contegra, Shelhigh and Matrix P / Matrix P+ have been used with varying success. The problems are foreign body reaction, with inflammation, stenosis of the conduit or more distally in the pulmonary arteries and regurgitation. In spite of efforts during more than 20 years, TEHV has not left the laboratory: there is still an ongoing search for the ideal scaffold, adequate cell sources for cellular repopulation and culture media. There are no long-term animal models for the latter device.
Conclusions: To treat patients with congenital heart disease, reconstruction can be performed with xenograft devices, but their limitations have to be taken into account. Matrix P and P+ as well as Shelhigh suffer from inflammation with stenosis. The alternative, TEHV, will not be available for the foreseeable future. In any case, any TEHV device has to compete against more established values. |
