Can tissue engineering applications replace cardiovascular medical devices? Searching for the key to clinical translation

Cardiovascular diseases are the number one killer worldwide. Malfunction of the conduction system, heart valves, the myocardial muscle or the vessels irrigating the tissue have been traditionally addressed with medical devices such as pacemakers, left ventricular assist devices, heart valves and vascular grafts. These positively impact critical outcomes such as functionality and mortality. However, by their non-biological nature, they cannot operate with the same efficiency as their original natural counterpart. Conversely, tissue engineering is an interdisciplinary field aimed at fabricating human tissues and organs in the lab. The same tissues that are replaced with device-based solutions are currently the focus of intense research in this area. In the present review, we provide a comparative overview of current medical device-based solutions and their tissue engineered counterparts in four highly impacting cardiovascular areas involving the cardiac conduction system, heart valves, myocardium (muscle) and the vessels. For each, we describe the characteristics of the diseases and their impact on cardiovascular homeostasis, as well as the existing device-based clinical solutions, before summarizing the main work in the tissue engineering field. Finally, we reflect on strategic initiatives that are required to advance experimental bioengineered systems to become a translational reality, analogous to the developmental path of implantable medical devices.