You already explained the advantages but what are the limits of tissue engineering?
Hoerstrup: There will always be patients for whom regenerative implants are not an option because their organism doesn't have a sufficient ability to regenerate. An application would be too risky in these instance because the heart valves would not remodel optimally and their long-term function would be restricted. We would likely have to use conventional prosthetic options in this case to be safe. This is an example of where tissue engineering would reach its limits, though we are now able to better predict this event with the new computer simulations.
These new developments are primarily important to ensure the safety and reliability of our implants but they are also an important aspect when it comes to assessments made by regulatory authorities. The clinical adoption of a new technology requires us to show that we did everything in our power to guarantee the safety and proper functioning of the implants. This is another reason our computer simulations, which now introduce a higher level of control and predictability to the overall technology, are very relevant for the approval processes.
Speaking of "approval": What comes next?
Hoerstrup: Our next step is to apply this technology and support patients who suffer from a congenital heart defect. Since a heart valve features an intricate architecture, we will initially only engineer a tube, meaning a blood vessel via computer simulation for children with heart defects. This is less risky and less sophisticated from a technical perspective. If we achieve positive results with our computer model, our subsequent step would be a heart valve implantation.
What potential do you see in the field of bioengineering?
Hoerstrup: Aside from the cardiovascular field, attempts are made to implement tissue engineering solutions in essentially all organ and tissue systems. We can see a fundamental paradigm shift in this area. From our point of view, it is not just a trend but a sensible medical step to have regenerative or viable implants at our disposal. From a conceptual perspective, a prediction of how these implants develop once inside the body will also become increasingly important. For example, this enables you to predict the forces that act on a bone and project whether a patient’s weight or other characteristics necessitate a customized implant. If our continued experiments garner positive results and if we achieve better control thanks to our computer simulations, I would expect that this technology can and will be implemented in almost all bioengineering fields.