Bioprosthetic heart valves with zwitterionic copolymer grafting to improve the properties of endothelialization and anti-calcification

Heart valve replacement surgery has been the most effective treatment for severe valvular heart disease. Bioprosthetic heart valves (BHVs) crosslinked by glutaraldehyde (GA) have non-negligible advantages in clinical applications. However, structural valve degeneration, calcification, insufficient re-endothelialization and other factors lead to a shortened service life of BHVs. In this study, GA-crosslinked decellularized heart valves (GADHVs) were grafted with zwitterionic copolymer (PSBG) of [2-(methacryloyloxy)ethyl]dimethyl-(3-sulfopropyl) ammonium hydroxide and glycidyl methacrylate, and further treated with Arg-Glu-Asp-Val (REDV) peptide to obtain REDV-PSBG-GADHVs with anti-fouling ability and endothelial cell affinity. REDV-PSBG-GADHVs exhibited good collagen stability, reliable mechanical property and excellent hemocompatibility. Moreover,<i>in vitro</i>and<i>in vivo</i>experiments demonstrated that REDV-PSBG-GADHVs exhibited better endothelialization property, lower immune responses and reduced calcification than GADHVs. This modified strategy for heart valve fabrication, which can improve the effect of anti-calcification and endothelialization while maintaining the original advantages of BHVs, shows great potential for application in heart valve replacement.