Multifunctional Hydrogel Technologies in Cardiovascular Regenerative Medicine: From Material Design to Precision Intervention

Cardiovascular disease (CVD) remains the leading cause of death worldwide. Current therapies mainly control symptoms and compensate function but cannot regenerate myocardial or vascular tissue. Hydrogels possess ECM-mimetic hydrated networks, tunable viscoelasticity and degradation, in situ gelation, and customizable bioactivity, enabling synergistic local retention, mechanical support, electrical/ionic conduction, controlled release, and microenvironment modulation. They therefore hold translational value for cardiovascular repair, but current evidence remains fragmented and lacks systematic integration. Unlike reviews focused on a single material, function, or disease, this review uses cascade matching as its central framework to critically evaluate the relationships among multifunctional hydrogel design, functional attributes, biological mechanisms, cardiovascular outcomes, and clinical translation, and to distill translational design principles and evaluation requirements. Following PRISMA guidelines, 5t6 original research studies were included in this review. Hydrogels exhibit multidimensional repair potential in cardiomyopathy, coronary atherosclerosis, and arrhythmia through four overlapping functional domains: mechanical support, electrical repair, therapeutic delivery, and microenvironment modulation. Current evidence remains predominantly preclinical and is limited by insufficient dynamic mechanical adaptation, interfacial fatigue, lack of standardized electrical evaluation, mismatched degradation timing, unclear mechanistic causal chains, and inconsistent evaluation systems. This review integrates preclinical evidence, clarifies the associations among hydrogel design, functional mechanisms, and cardiovascular outcomes, and distills translational design principles and evaluation requirements to inform future research.