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Mechanisms of Cardiac Valve Failure and the Development of Tissue Engineered Heart Valves

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Cardiac Fibrosis and Heart Failure: Cause or Effect?

Part of the book series: Advances in Biochemistry in Health and Disease ((ABHD,volume 13))

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Abstract

Calcification of the aortic valve results in valvular dysfunction and is an important cause of morbidity and mortality. Our understanding of the process of aortic valve calcification has changed from a passive wear and tear process to that of an actively regulated process with known molecular mediators. Prior to calcification of the valve, activated valvular interstitial cells coordinate maladaptive extracellular matrix remodeling of the leaflets. Bioprosthetic heart valves used to surgically replace stenotic aortic valves have excellent hemodynamic profiles and are anti-thrombogenic. However, they fail due to similar mechanisms as native aortic valves and thus durability is a limiting factor. Mechanical prostheses necessitate anticoagulation. Ideal heart valve substitutes would be non-thrombogenic, maintain excellent hemodynamics, but would be durable and may hold the promise of growth. The basics of tissue engineering include fabricating a scaffold onto which autologous cells may be incorporated. The cells then transform the scaffold to autologous tissue with the ability to function in its desired location in the body. Popular scaffolds are decellularized allografts or xenogeneic aortic valves as they have the complex structure of the aortic valve still intact. Recellularization with valvular endothelial cells has been successful but avenues for recellularizing valvular interstitial cells are still being pursued. Alternative methods for generating scaffolds include three dimensional bioprinting and electrospinning.

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References

  1. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999) Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341(3):142–147. doi:10.1056/NEJM199907153410302

    Article  CAS  PubMed  Google Scholar 

  2. Kaden JJ, Dempfle CE, Grobholz R, Fischer CS, Vocke DC, Kilic R, Sarikoc A, Pinol R, Hagl S, Lang S, Brueckmann M, Borggrefe M (2005) Inflammatory regulation of extracellular matrix remodeling in calcific aortic valve stenosis. Cardiovasc Pathol 14(2):80–87. doi:10.1016/j.carpath.2005.01.002

    Article  CAS  PubMed  Google Scholar 

  3. Miller JD, Weiss RM, Heistad DD (2011) Calcific aortic valve stenosis: methods, models, and mechanisms. Circ Res 108(11):1392–1412. doi:10.1161/CIRCRESAHA.110.234138

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Freeman RV, Otto CM (2005) Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies. Circulation 111(24):3316–3326. doi:10.1161/CIRCULATIONAHA.104.486738

    Article  PubMed  Google Scholar 

  5. Jian B, Narula N, Li QY, Mohler ER, 3rd, Levy RJ (2003) Progression of aortic valve stenosis: TGF-beta1 is present in calcified aortic valve cusps and promotes aortic valve interstitial cell calcification via apoptosis. Ann Thorac Surg 75(2):457–465; (discussion 465–456)

    Article  PubMed  Google Scholar 

  6. Ghaisas NK, Foley JB, O’Briain DS, Crean P, Kelleher D, Walsh M (2000) Adhesion molecules in nonrheumatic aortic valve disease: endothelial expression, serum levels and effects of valve replacement. J Am Coll Cardiol 36(7):2257–2262

    Article  CAS  PubMed  Google Scholar 

  7. Olsson M, Dalsgaard CJ, Haegerstrand A, Rosenqvist M, Ryden L, Nilsson J (1994) Accumulation of T lymphocytes and expression of interleukin-2 receptors in nonrheumatic stenotic aortic valves. J Am Coll Cardiol 23(5):1162–1170

    Article  CAS  PubMed  Google Scholar 

  8. Walker GA, Masters KS, Shah DN, Anseth KS, Leinwand LA (2004) Valvular myofibroblast activation by transforming growth factor-beta: implications for pathological extracellular matrix remodeling in heart valve disease. Circ Res 95(3):253–260. doi:10.1161/01.RES.0000136520.07995.aa

    Article  CAS  PubMed  Google Scholar 

  9. Liu AC, Joag VR, Gotlieb AI (2007) The emerging role of valve interstitial cell phenotypes in regulating heart valve pathobiology. Am J Pathol 171(5):1407–1418. doi:10.2353/ajpath.2007.070251

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Meng X, Ao L, Song Y, Babu A, Yang X, Wang M, Weyant MJ, Dinarello CA, Cleveland JC Jr, Fullerton DA (2008) Expression of functional Toll-like receptors 2 and 4 in human aortic valve interstitial cells: potential roles in aortic valve inflammation and stenosis. Am J Physiol Cell Physiol 294(1):C29–35. doi:10.1152/ajpcell.00137.2007

    Article  CAS  PubMed  Google Scholar 

  11. Taylor PM, Batten P, Brand NJ, Thomas PS, Yacoub MH (2003) The cardiac valve interstitial cell. Int J Biochem Cell Biol 35(2):113–118

    Article  CAS  PubMed  Google Scholar 

  12. Fondard O, Detaint D, Iung B, Choqueux C, Adle-Biassette H, Jarraya M, Hvass U, Couetil JP, Henin D, Michel JB, Vahanian A, Jacob MP (2005) Extracellular matrix remodelling in human aortic valve disease: the role of matrix metalloproteinases and their tissue inhibitors. Eur Heart J 26(13):1333–1341. doi:10.1093/eurheartj/ehi248

    Article  CAS  PubMed  Google Scholar 

  13. Kaden JJ, Dempfle CE, Kilic R, Sarikoc A, Hagl S, Lang S, Brueckmann M, Borggrefe M (2005) Influence of receptor activator of nuclear factor kappa B on human aortic valve myofibroblasts. Exp Mol Pathol 78(1):36–40. doi:10.1016/j.yexmp.2004.09.001

    Article  CAS  PubMed  Google Scholar 

  14. Kaden JJ, Dempfle CE, Grobholz R, Tran HT, Kilic R, Sarikoc A, Brueckmann M, Vahl C, Hagl S, Haase KK, Borggrefe M (2003) Interleukin-1 beta promotes matrix metalloproteinase expression and cell proliferation in calcific aortic valve stenosis. Atherosclerosis 170(2):205–211

    Article  CAS  PubMed  Google Scholar 

  15. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS (2008) 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52(13):e1–142. doi:10.1016/j.jacc.2008.05.007

    Article  PubMed  Google Scholar 

  16. Nollert G, Miksch J, Kreuzer E, Reichart B (2003) Risk factors for atherosclerosis and the degeneration of pericardial valves after aortic valve replacement. J Thorac Cardiovasc Surg 126(4):965–968. doi:10.1016/S0022

    Article  PubMed  Google Scholar 

  17. Pibarot P, Dumesnil JG (2009) Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation 119(7):1034–1048. doi:10.1161/CIRCULATIONAHA.108.778886

    Article  PubMed  Google Scholar 

  18. Jamieson WR, Munro AI, Miyagishima RT, Allen P, Burr LH, Tyers GF (1995) Carpentier-Edwards standard porcine bioprosthesis: clinical performance to seventeen years. Ann Thorac Surg 60(4):999–1006; discussion 1007

    Article  CAS  PubMed  Google Scholar 

  19. Vyavahare N, Ogle M, Schoen FJ, Zand R, Gloeckner DC, Sacks M, Levy RJ (1999) Mechanisms of bioprosthetic heart valve failure: fatigue causes collagen denaturation and glycosaminoglycan loss. J Biomed Mater Res 46(1):44–50

    Article  CAS  PubMed  Google Scholar 

  20. Chen W, Schoen FJ, Levy RJ (1994) Mechanism of efficacy of 2-amino oleic acid for inhibition of calcification of glutaraldehyde-pretreated porcine bioprosthetic heart valves. Circulation 90(1):323–329

    Article  CAS  PubMed  Google Scholar 

  21. Golomb G, Schoen FJ, Smith MS, Linden J, Dixon M, Levy RJ (1987) The role of glutaraldehyde-induced cross-links in calcification of bovine pericardium used in cardiac valve bioprostheses. Am J Pathol 127(1):122–130

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Cohn LH, Collins JJ Jr, DiSesa VJ, Couper GS, Peigh PS, Kowalker W, Allred E (1989) Fifteen-year experience with 1678 Hancock porcine bioprosthetic heart valve replacements. Ann Surg 210(4):435–442; (discussion 442–433)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Moczar M, Houel R, Ginat M, Clerin V, Wheeldon D, Loisance D (2000) Structural changes in porcine bioprosthetic valves of a left ventricular assist system in human patients. J Heart Valve Dis 9(1):88–95; (discussion 95–86)

    CAS  PubMed  Google Scholar 

  24. Manji RA, Zhu LF, Nijjar NK, Rayner DC, Korbutt GS, Churchill TA, Rajotte RV, Koshal A, Ross DB (2006) Glutaraldehyde-fixed bioprosthetic heart valve conduits calcify and fail from xenograft rejection. Circulation 114(4):318–327. doi:10.1161/CIRCULATIONAHA.105.549311

    Article  CAS  PubMed  Google Scholar 

  25. McGregor CG, Carpentier A, Lila N, Logan JS, Byrne GW (2011) Cardiac xenotransplantation technology provides materials for improved bioprosthetic heart valves. J Thorac Cardiovasc Surg 141(1):269–275. doi:10.1016/j.jtcvs.2010.08.064

    Article  CAS  PubMed  Google Scholar 

  26. Konakci KZ, Bohle B, Blumer R, Hoetzenecker W, Roth G, Moser B, Boltz-Nitulescu G, Gorlitzer M, Klepetko W, Wolner E, Ankersmit HJ (2005) Alpha-Gal on bioprostheses: xenograft immune response in cardiac surgery. Eur J Clin Invest 35(1):17–23. doi:10.1111/j.1365–2362.2005.01441.x

    Article  CAS  PubMed  Google Scholar 

  27. Srivatsa SS, Harrity PJ, Maercklein PB, Kleppe L, Veinot J, Edwards WD, Johnson CM, Fitzpatrick LA (1997) Increased cellular expression of matrix proteins that regulate mineralization is associated with calcification of native human and porcine xenograft bioprosthetic heart valves. J Clin Invest 99(5):996–1009. doi:10.1172/JCI119265

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Grauss RW, Hazekamp MG, van Vliet S, Gittenberger-de Groot AC, DeRuiter MC (2003) Decellularization of rat aortic valve allografts reduces leaflet destruction and extracellular matrix remodeling. J Thorac Cardiovasc Surg 126(6):2003–2010. doi:10.1016/S0022

    Article  CAS  PubMed  Google Scholar 

  29. Meyer SR, Nagendran J, Desai LS, Rayat GR, Churchill TA, Anderson CC, Rajotte RV, Lakey JR, Ross DB (2005) Decellularization reduces the immune response to aortic valve allografts in the rat. J Thorac Cardiovasc Surg 130(2):469–476. doi:10.1016/j.jtcvs.2005.03.021

    Article  PubMed  Google Scholar 

  30. Korossis SA, Wilcox HE, Watterson KG, Kearney JN, Ingham E, Fisher J (2005) In-vitro assessment of the functional performance of the decellularized intact porcine aortic root. J Heart Valve Dis 14(3):408–421; (discussion 422)

    PubMed  Google Scholar 

  31. Liao J, Joyce EM, Sacks MS (2008) Effects of decellularization on the mechanical and structural properties of the porcine aortic valve leaflet. Biomaterials 29(8):1065–1074. doi:10.1016/j.biomaterials.2007.11.007

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Naso F, Gandaglia A, Bottio T, Tarzia V, Nottle MB, d'Apice AJ, Cowan PJ, Cozzi E, Galli C, Lagutina I, Lazzari G, Iop L, Spina M, Gerosa G (2013) First quantification of alpha-Gal epitope in current glutaraldehyde-fixed heart valve bioprostheses. Xenotransplantation 20(4):252–261. doi:10.1111/xen.12044

    Article  PubMed  Google Scholar 

  33. Goncalves AC, Griffiths LG, Anthony RV, Orton EC (2005) Decellularization of bovine pericardium for tissue-engineering by targeted removal of xenoantigens. J Heart Valve Dis 14(2):212–217

    PubMed  Google Scholar 

  34. O’Brien MF, Goldstein S, Walsh S, Black KS, Elkins R, Clarke D (1999) The SynerGraft valve: a new acellular (nonglutaraldehyde-fixed) tissue heart valve for autologous recellularization first experimental studies before clinical implantation. Semin Thorac Cardiovasc Surg 11(4 Suppl 1):194–200

    PubMed  Google Scholar 

  35. Elkins RC, Dawson PE, Goldstein S, Walsh SP, Black KS (2001) Decellularized human valve allografts. Ann Thorac Surg 71(5 Suppl):S428–S432

    Article  CAS  PubMed  Google Scholar 

  36. Zehr KJ, Yagubyan M, Connolly HM, Nelson SM, Schaff HV (2005) Aortic root replacement with a novel decellularized cryopreserved aortic homograft: postoperative immunoreactivity and early results. J Thorac Cardiovasc Surg 130(4):1010–1015. doi:10.1016/j.jtcvs.2005.03.044

    Article  PubMed  Google Scholar 

  37. da Costa FD, Costa AC, Prestes R, Domanski AC, Balbi EM, Ferreira AD, Lopes SV (2010) The early and midterm function of decellularized aortic valve allografts. Ann Thorac Surg 90(6):1854–1860. doi:10.1016/j.athoracsur.2010.08.022

    Article  PubMed  Google Scholar 

  38. Bechtel JF, Stierle U, Sievers HH (2008) Fifty-two months’ mean follow up of decellularized SynerGraft-treated pulmonary valve allografts. J Heart Valve Dis 17(1):98–104; (discussion 104)

    PubMed  Google Scholar 

  39. Cebotari S, Lichtenberg A, Tudorache I, Hilfiker A, Mertsching H, Leyh R, Breymann T, Kallenbach K, Maniuc L, Batrinac A, Repin O, Maliga O, Ciubotaru A, Haverich A (2006) Clinical application of tissue engineered human heart valves using autologous progenitor cells. Circulation 114(1 Suppl):I132–137. doi:10.1161/CIRCULATIONAHA.105.001065

    Google Scholar 

  40. Simon P, Kasimir MT, Seebacher G, Weigel G, Ullrich R, Salzer-Muhar U, Rieder E, Wolner E (2003) Early failure of the tissue engineered porcine heart valve SYNERGRAFT in pediatric patients. Eur J Cardiothorac Surg 23(6):1002–1006; (discussion 1006)

    Article  CAS  PubMed  Google Scholar 

  41. Kasimir MT, Rieder E, Seebacher G, Nigisch A, Dekan B, Wolner E, Weigel G, Simon P (2006) Decellularization does not eliminate thrombogenicity and inflammatory stimulation in tissue-engineered porcine heart valves. J Heart Valve Dis 15(2):278–286

    PubMed  Google Scholar 

  42. Steinhoff G, Stock U, Karim N, Mertsching H, Timke A, Meliss RR, Pethig K, Haverich A, Bader A (2000) Tissue engineering of pulmonary heart valves on allogenic acellular matrix conduits: in vivo restoration of valve tissue. Circulation 102(19 Suppl 3):III50–III55

    CAS  PubMed  Google Scholar 

  43. Baraki H, Tudorache I, Braun M, Hoffler K, Gorler A, Lichtenberg A, Bara C, Calistru A, Brandes G, Hewicker-Trautwein M, Hilfiker A, Haverich A, Cebotari S (2009) Orthotopic replacement of the aortic valve with decellularized allograft in a sheep model. Biomaterials 30(31):6240–6246. doi:10.1016/j.biomaterials.2009.07.068

    Article  CAS  PubMed  Google Scholar 

  44. Dohmen PM, Costa F, Lopes SV, Yoshi S, Souza FP, Vilani R, Costa MB, Konertz W (2005) Results of a decellularized porcine heart valve implanted into the juvenile sheep model. Heart Surg Forum 8(2):E100–E104; discussion E104. doi:10.1532/HSF98.20041140

    Article  CAS  PubMed  Google Scholar 

  45. Akhyari P, Kamiya H, Gwanmesia P, Aubin H, Tschierschke R, Hoffmann S, Karck M, Lichtenberg A (2010) In vivo functional performance and structural maturation of decellularised allogenic aortic valves in the subcoronary position. Eur J Cardiothorac Surg 38(5):539–546. doi:10.1016/j.ejcts.2010.03.024

    Article  PubMed  Google Scholar 

  46. Tudorache I, Calistru A, Baraki H, Meyer T, Hoffler K, Sarikouch S, Bara C, Gorler A, Hartung D, Hilfiker A, Haverich A, Cebotari S (2013) Orthotopic replacement of aortic heart valves with tissue-engineered grafts. Tissue Eng Part A 19(15–16):1686–1694. doi:10.1089/ten.TEA.2012.0074

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Syedain ZH, Meier LA, Reimer JM, Tranquillo RT (2013) Tubular heart valves from decellularized engineered tissue. Ann Biomed Eng 41(12):2645–2654. doi:10.1007/s10439-013-0872-9

    Article  PubMed  Google Scholar 

  48. Dijkman PE, Driessen-Mol A, Frese L, Hoerstrup SP, Baaijens FP (2012) Decellularized homologous tissue-engineered heart valves as off-the-shelf alternatives to xeno- and homografts. Biomaterials 33(18):4545–4554. doi:10.1016/j.biomaterials.2012.03.015

    Article  CAS  PubMed  Google Scholar 

  49. Driessen-Mol A, Emmert MY, Dijkman PE, Frese L, Sanders B, Weber B, Cesarovic N, Sidler M, Leenders J, Jenni R, Grunenfelder J, Falk V, Baaijens FP, Hoerstrup SP (2013) Transcatheter implantation of homologous “off-the-shelf” tissue engineered heart valves with self-repair capacity: long term functionality and rapid in vivo remodeling in sheep. J Am Coll Cardiol. doi:10.1016/j.jacc.2013.09.082

    Google Scholar 

  50. Lee DJ, Steen J, Jordan JE, Kincaid EH, Kon ND, Atala A, Berry J, Yoo JJ (2009) Endothelialization of heart valve matrix using a computer-assisted pulsatile bioreactor. Tissue Eng Part A 15(4):807–814. doi:10.1089/ten.tea.2008.0250

    Article  CAS  PubMed  Google Scholar 

  51. Pompilio G, Rossoni G, Sala A, Polvani GL, Berti F, Dainese L, Porqueddu M, Biglioli P (1998) Endothelial-dependent dynamic and antithrombotic properties of porcine aortic and pulmonary valves. Ann Thorac Surg 65(4):986–992

    Article  CAS  PubMed  Google Scholar 

  52. Butcher JT, Nerem RM (2007) Valvular endothelial cells and the mechanoregulation of valvular pathology. Philos Trans R Soc Lond B Biol Sci 362(1484):1445–1457. doi:10.1098/rstb.2007.2127

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Matsumoto Y, Adams V, Walther C, Kleinecke C, Brugger P, Linke A, Walther T, Mohr FW, Schuler G (2009) Reduced number and function of endothelial progenitor cells in patients with aortic valve stenosis: a novel concept for valvular endothelial cell repair. Eur Heart J 30(3):346–355. doi:10.1093/eurheartj/ehn501

    Article  PubMed  Google Scholar 

  54. Lin Y, Weisdorf DJ, Solovey A, Hebbel RP (2000) Origins of circulating endothelial cells and endothelial outgrowth from blood. J Clin Invest 105(1):71–77. doi:10.1172/JCI8071

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  55. Bertipaglia B, Ortolani F, Petrelli L, Gerosa G, Spina M, Pauletto P, Casarotto D, Marchini M, Sartore S (2003) Cell characterization of porcine aortic valve and decellularized leaflets repopulated with aortic valve interstitial cells: the VESALIO Project (Vitalitate Exornatum Succedaneum Aorticum Labore Ingenioso Obtenibitur). Ann Thorac Surg 75(4):1274–1282

    Article  PubMed  Google Scholar 

  56. Vincentelli A, Wautot F, Juthier F, Fouquet O, Corseaux D, Marechaux S, Le Tourneau T, Fabre O, Susen S, Van Belle E, Mouquet F, Decoene C, Prat A, Jude B (2007) In vivo autologous recellularization of a tissue-engineered heart valve: are bone marrow mesenchymal stem cells the best candidates? J Thorac Cardiovasc Surg 134(2):424–432. doi:10.1016/j.jtcvs.2007.05.005

    Article  PubMed  Google Scholar 

  57. Iop L, Renier V, Naso F, Piccoli M, Bonetti A, Gandaglia A, Pozzobon M, Paolin A, Ortolani F, Marchini M, Spina M, De Coppi P, Sartore S, Gerosa G (2009) The influence of heart valve leaflet matrix characteristics on the interaction between human mesenchymal stem cells and decellularized scaffolds. Biomaterials 30(25):4104–4116. doi:10.1016/j.biomaterials.2009.04.031

    Article  CAS  PubMed  Google Scholar 

  58. Shinoka T, Breuer CK, Tanel RE, Zund G, Miura T, Ma PX, Langer R, Vacanti JP, Mayer JE Jr (1995) Tissue engineering heart valves: valve leaflet replacement study in a lamb model. Ann Thorac Surg 60(6 Suppl):S513–S516

    Article  CAS  PubMed  Google Scholar 

  59. Sodian R, Hoerstrup SP, Sperling JS, Daebritz S, Martin DP, Moran AM, Kim BS, Schoen FJ, Vacanti JP, Mayer JE Jr (2000) Early in vivo experience with tissue-engineered trileaflet heart valves. Circulation 102(19 Suppl 3):III22–III29

    Google Scholar 

  60. Mol A, Driessen NJ, Rutten MC, Hoerstrup SP, Bouten CV, Baaijens FP (2005) Tissue engineering of human heart valve leaflets: a novel bioreactor for a strain-based conditioning approach. Ann Biomed Eng 33(12):1778–1788. doi:10.1007/s10439-005-8025-4

    Article  PubMed  Google Scholar 

  61. Mol A, Rutten MC, Driessen NJ, Bouten CV, Zund G, Baaijens FP, Hoerstrup SP (2006) Autologous human tissue-engineered heart valves: prospects for systemic application. Circulation 114(1 Suppl):I152–I158. doi:10.1161/CIRCULATIONAHA.105.001123

    Article  PubMed  Google Scholar 

  62. Duan B, Hockaday LA, Kang KH, Butcher JT (2013) 3D bioprinting of heterogeneous aortic valve conduits with alginate/gelatin hydrogels. J Biomed Mater Res A 101(5):1255–1264. doi:10.1002/jbm.a.34420

    Article  PubMed Central  PubMed  Google Scholar 

  63. Del Gaudio CB, A; Grigioni, M (2007) Electrospun bioresorbable trileaflet heart valve prosthesis for tissue engineering: in vitro functional assessment of a pulmonary cardiac valve design. Annali dell’Istituto superiore di sanita 44(2):178–186

    Google Scholar 

  64. Hinderer S, Seifert J, Votteler M, Shen N, Rheinlaender J, Schaffer TE, Schenke-Layland K (2014) Engineering of a bio-functionalized hybrid off-the-shelf heart valve. Biomaterials 35(7):2130–2139. doi:10.1016/j.biomaterials.2013.10.080

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Divisions of Cardiovascular Surgery and Diseases, Mayo Clinic, Rochester, MN, USA

    Meghana R.K. Helder MD

  2. Executive Dean School of Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, 66160, Kansas City, KS, USA

    Robert D. Simari MD

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Correspondence to Robert D. Simari MD .

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  1. Institute of Cardiovascular Sciences St. Boniface Hospital Research Centre Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada

    Ian M.C. Dixon

  2. Institute of Cardiovascular Sciences St. Boniface Hospital Research Centre Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Canada

    Jeffrey T. Wigle

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Helder, M., Simari, R. (2015). Mechanisms of Cardiac Valve Failure and the Development of Tissue Engineered Heart Valves. In: Dixon, I., Wigle, J. (eds) Cardiac Fibrosis and Heart Failure: Cause or Effect?. Advances in Biochemistry in Health and Disease, vol 13. Springer, Cham. https://doi.org/10.1007/978-3-319-17437-2_21

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