Tissue-engineered cardiovascular products

Cardiovascular disease remains the leading cause of death worldwide, provoking the need for alternative approaches to repairing the diseased or injured heart. The cardiovascular tissue engineering field emerged to develop therapeutic options for structural, functional, and vascular heart diseases, with an overarching goal of building functional cardiac and vascular tissue constructs that can restore or recapitulate healthy heart function. Since its inception, the intensive multidisciplinary nature of cardiovascular tissue engineering has revolutionized our understanding of cardiovascular biology and marshaled advances in both cell and scaffold technologies. The field initially focused on repair-oriented interventions, such as cell-based therapy, vascular grafts, bioprosthetic heart valves, and cardiac patches, but more recently viable cardiac wall and even organ replacements have been proposed. Although definitive repair of the heart remains elusive, today the use of tissue-engineered products has become an option in many clinical scenarios, and even the generation of bioartificial heart replacements has moved from fantasy to potential reality. Here, we discuss current cardiovascular tissue engineering approaches and therapies, the pathway(s) to approval, and how the field may progress in the near future. For the purpose of this chapter, tissue engineering is defined as the use of a combination of cells, scaffolds (both synthetic and biologic), and engineering principles for the formation of new viable tissues/organs for cardiac or vascular medical use.