1. Pulmonary valve tissue engineering strategies in large animal models
- Author
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Uiterwijk, M., Valk, D.C. van der, Vliet, R. van, Brouwer, I.J. de, Hooijmans, C.R., Kluin, J., Maghsoudlou, Panayiotis, Graduate School, 03 Heart Centre, ACS - Atherosclerosis & ischemic syndromes, Cardiothoracic Surgery, ACS - Heart failure & arrhythmias, and Cell-Matrix Interact. Cardiov. Tissue Reg.
- Subjects
Medical Implants ,Cancer development and immune defence Radboud Institute for Health Sciences [Radboudumc 2] ,Database and Informatics Methods ,Mathematical and Statistical Techniques ,Medicine and Health Sciences ,Database Searching ,Multidisciplinary ,Statistics ,Eukaryota ,Heart ,Metaanalysis ,Extracellular Matrix ,medicine.anatomical_structure ,Systematic review ,Heart Valve Prosthesis ,Models, Animal ,Physical Sciences ,Cardiology ,Engineering and Technology ,Medicine ,Animal studies ,Anatomy ,Cellular Structures and Organelles ,Research Article ,Biotechnology ,medicine.medical_specialty ,Blinding ,Randomization ,Science ,Bioengineering ,Large Animals ,Research and Analysis Methods ,All institutes and research themes of the Radboud University Medical Center ,Internal medicine ,medicine ,Animals ,Heart valve ,Statistical Methods ,Pulmonary Valve ,Tissue Engineering ,business.industry ,Clinical study design ,Organisms ,Biology and Life Sciences ,Cell Biology ,Study heterogeneity ,Pulmonary valve ,Cardiovascular Anatomy ,Animal Studies ,Medical Devices and Equipment ,business ,Zoology ,Mathematics - Abstract
In the last 25 years, numerous tissue engineered heart valve (TEHV) strategies have been studied in large animal models. To evaluate, qualify and summarize all available publications, we conducted a systematic review and meta-analysis. We identified 80 reports that studied TEHVs of synthetic or natural scaffolds in pulmonary position (n = 693 animals). We identified substantial heterogeneity in study designs, methods and outcomes. Most importantly, the quality assessment showed poor reporting in randomization and blinding strategies. Meta-analysis showed no differences in mortality and rate of valve regurgitation between different scaffolds or strategies. However, it revealed a higher transvalvular pressure gradient in synthetic scaffolds (11.6 mmHg; 95% CI, [7.31–15.89]) compared to natural scaffolds (4,67 mmHg; 95% CI, [3,94–5.39]; p = 0.003). These results should be interpreted with caution due to lack of a standardized control group, substantial study heterogeneity, and relatively low number of comparable studies in subgroup analyses. Based on this review, the most adequate scaffold model is still undefined. This review endorses that, to move the TEHV field forward and enable reliable comparisons, it is essential to define standardized methods and ways of reporting. This would greatly enhance the value of individual large animal studies.
- Published
- 2021
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