Nanostructured Surface Modifications for Cardiac Implants: From Bench to Bedside

The growing demand for cardiovascular medical devices (CMDs) has significantly improved the quality of life for patients with heart disease. Despite major technological advances, long-term performance is still hindered by complications arising from interactions between blood and material, such as thrombosis, chronic inflammation, endothelial dysfunction, infection, and fibrotic encapsulation. But issues such as thrombosis, inflammation, cytotoxicity, and infection, primarily brought about by poor surface compatibility with biological fluids and tissues, are often the reasons for the inability of these devices to achieve long-term success.

A structured literature review was conducted following PRISMA 2020 guidelines using PubMed, Scopus, Web of Science, and Google Scholar (2020-2025). Studies on surfacemodified cardiac implants (stents, valves, pacemaker leads, and LVADs) evaluating biocompatibility, hemocompatibility, or infection resistance were included, while non-cardiac and unrelated nanocarrier studies were excluded. Extracted data were narratively synthesised to compare coating mechanisms, durability, and translational potential.

Heart valves, stents, pacemakers, and ventricular assist devices, among other CMDs, have seen surface modification and coating technologies evolve as critical instruments to enhance the biocompatibility, hemocompatibility, and functionality of CMDs. A total of 115 screened reference records demonstrated significant evidence of CMD-related bioactive strategies.

In this paper, a systematic review of a wide range of surface engineering strategies, such as passive and bioactive coatings, proven techniques like heparin immobilisation, albumin functionalization, nitric oxide release systems, and zwitterionic polymers, is provided with specific emphasis. The review also addresses challenges related to device-associated infections, complement activation, and immune responses.

Ultimately, this review aims to be a comprehensive guide for selecting appropriate surface modifications for CMDs and highlights future directions to enhance clinical outcomes through the use of next-generation multifunctional coatings.