Stem cell research and tissue engineering have become leading fields in basic research worldwide. Especially in cardiovascular medicine, initial reports on the potential of using stem cells to recover cardiac function and replace organ subunits such as heart valves seemed to offer the promise of widespread clinical use in the near future. However, the broad application of this new therapy failed due to safety and efficacy concerns. Due in part to the initial reports, major basic research efforts were undertaken to explore the specific cell types in greater detail and identify their mechanisms of supporting function, resulting in remarkable new findings in stem cell biology. For example, the notion of resident human cardiac stem cells has disproved the earlier supposition that the human heart is a finitely differentiated organ without the intrinsic potential for regeneration. Furthermore, new technologies emerged to produce pluripotent cells without the ethical and immunological drawbacks of embryonic stem cells (for instance by nuclear transfer). Other autologous cell sources are presently under investigation in myocardial tissue engineering. For tissue engineering of heart valves and small calibre vessels, the use of autologous endothelial (precursor) cells may be the optimal means of seeding a biological or artificial scaffold. It is important that ongoing basic and clinical research in cardiovascular surgery might explore the potential of different cell types either using tissue engineering constructs or in cell transplantation approaches. © 2008 European Association for Cardio-Thoracic Surgery.
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