Strategies for development of decellularized heart valve scaffolds for tissue engineering

Valvular heart diseases (VHDs) are currently treated using either mechanical or bioprosthetic heart valves. Unfortunately, mechanical valves require lifelong anticoagulation therapy, and bioprosthetic valves calcify and degrade over time, requiring subsequent valve replacement surgeries. Besides, both valves cannot grow with patients. Heart valve tissue engineering uses scaffolds as valve replacements with the potential to grow with patents, function indefinitely, and not require anticoagulation medication. These scaffolds provide three-dimensional supports for cellular adhesion and growth, leading to tissue formation and, finally, a new functional heart valve development. Heart valve scaffolds are made of either polymeric materials or decellularized tissue obtained from allogeneic or xenogeneic sources. This review discusses processes for preparing decellularized heart valve scaffolds, including decellularization, crosslinking, surface-coating, and sterilization. We also examine the predominant issues in scaffold development. Further, decellularized heart valve scaffold function in vitro and in vivo is evaluated.