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Surface Biofunctionalization of Tissue Engineered for the Development of Biological Heart Valves: A Review

Valve replacement is the mainstay of treatment for end-stage valvular heart disease, but varying degrees of defects exist in clinically applied valve implants. A mechanical heart valve requires long-term anti-coagulation, but the formation of blood clots is still inevitable. A biological heart valve eventually decays following calcification due to glutaraldehyde cross-linking toxicity and a lack of regenerative capacity. The goal of tissue-engineered heart valves is to replace normal heart valves and overcome the shortcomings of heart valve replacement commonly used in clinical practice. Surface biofunctionalization has been widely used in various fields of research to achieve functionalization and optimize mechanical properties. It has been applied to the study of tissue engineering in recent years. It is proposed to improve the shortcomings of the current commercial valve, but it still faces many challenges. This review aimed to summarize the modification strategies of biofunctionalization of biological heart valve surfaces based on tissue engineering to eliminate adverse reactions that occur clinically after implantation. Finally, we also proposed the current challenges and possible directions for future research.