AUTHOR=Exarchos Vasileios , Zacharova Ema , Neuber Sebastian , Giampietro Costanza , Motta Sarah E. , Hinkov Hristian , Emmert Maximilian Y. , Nazari-Shafti Timo Z. TITLE=The path to a hemocompatible cardiovascular implant: Advances and challenges of current endothelialization strategies JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=9 YEAR=2022 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.971028 DOI=10.3389/fcvm.2022.971028 ISSN=2297-055X ABSTRACT=

Cardiovascular (CV) implants are still associated with thrombogenicity due to insufficient hemocompatibility. Endothelialization of their luminal surface is a promising strategy to increase their hemocompatibility. In this review, we provide a collection of research studies and review articles aiming to summarize the recent efforts on surface modifications of CV implants, including stents, grafts, valves, and ventricular assist devises. We focus in particular on the implementation of micrometer or nanoscale surface modifications, physical characteristics of known biomaterials (such as wetness and stiffness), and surface morphological features (such as gratings, fibers, pores, and pits). We also review how biomechanical signals originating from the endothelial cell for surface interaction can be directed by topography engineering approaches toward the survival of the endothelium and its long-term adaptation. Finally, we summarize the regulatory and economic challenges that may prevent clinical implementation of endothelialized CV implants.