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Cardiovascular disease is a major cause of death in the Western World. Novel drugs and innovative devices have enhanced the quality of life for patients with cardiovascular disease, but such treatments are not without limitations and complications. The major constraint with these current treatments is the inability for growth, repair and remodeling of the structure. The emergence of tissue engineering as an alternative therapy for cardiovascular disease has generated an intensity of research into the development of many components of the cardiovascular system, including heart valves, small-calibre vascular grafts and biological stent materials. The composition of the biomaterial used as a support for the developing cardiovascular structure is a key mediator of cell behaviour and function in the tissue, and the ideal scaffold biomaterial for development of a successful end-product continues to be a matter of debate. Fibrin, a major structural protein involved in wound healing, represents an ideal scaffold for the rapid synthesis of autologous tissue-engineered cardiovascular grafts, as its primary scaffold constituents (fibrinogen and thrombin) can be isolated directly from a blood sample of the patient requiring the graft. Fibrin gel scaffolds offer immediate high cell seeding efficiency and homogenous cell distribution by gelation entrapment, and have a degradation rate that can be controlled by protease inhibitors, e.g. tranexamic acid or aprotinin. Fibrin is also known to stimulate the secretion of reinforcing extracellular matrix (ECM) proteins by seeded cells. The potential to control the fibrin polymerisation process also offers the opportunity to produce complex 3-D structures, like heart valve prostheses and to embed porous, textile or metal (stent) structures. This book chapter reviews the properties of fibrin that make it an ideal scaffold candidate for applications in the area of cardiovascular tissue engineering, and documents the successful development of fibrin-based heart valves, vascular grafts and biostents for clinical application.

Cardiovascular Tissue Engineering Based on Fibrin-Gel-Scaffolds