Bioartificial Hearts, Assist Devices, and Myocardium: New Developments

Area of Science:

• Biomedical Engineering
• Regenerative Medicine
• Cardiovascular Research

Background:

• Rising heart failure rates and donor heart scarcity drive innovation in bioartificial hearts (BAHs) and cardiac constructs.
• Current ventricular assist devices have limitations, necessitating advanced bioengineered solutions.

Purpose of the Study:

• To review recent developments in BAHs, engineered myocardium, and biohybrid ventricular assist devices.
• To evaluate the clinical readiness, outcomes, strengths, and limitations of these bioengineered cardiac solutions.

Main Methods:

• Systematic review of research on bioartificial hearts, engineered myocardium, and biohybrid ventricular assist devices.
• Analysis of study designs, preclinical outcomes, and limited clinical data.

Main Results:

• BAHs and large cardiac constructs are preclinical; cardiac patches show progress with 2 approved for clinical use.
• Key challenges include achieving myocardial contraction, vascularization, electrical integration, and biocompatibility.
• Hemodynamic performance of BAHs is marginal; cardiac patches' paracrine effects are promising but clinical benefits/safety are unproven.

Conclusions:

• Significant challenges impede clinical translation of bioengineered cardiac solutions.
• Innovations in bioprinting, materials, and bioelectronics advance the field, but functional outcomes remain limited.
• The development of fully functional BAHs or myocardial components is a complex and potentially unattainable long-term goal.