Implantable Systems for Cardiovascular Treatment and Monitoring: Comparative Insights From Intracardiovascular and Extracardiovascular Technologies

Cardiovascular diseases remain the leading cause of mortality worldwide, driving the need for implantable technologies capable of repairing, supporting, replacing, and monitoring cardiovascular functions. Current cardiovascular technologies are commonly classified according to anatomical target or invasiveness, limiting direct comparison of how different systems interact with blood and tissues. We present a comparative review based on the distinction between intracardiovascular systems, directly exposed to blood flow, and extracardiovascular systems, primarily interacting with surrounding tissues. A total of 107 devices (77 actuation and 30 sensing technologies) across myocardial, vascular, and valvular domains were analyzed through a semiquantitative framework considering blood contact burden, biomimicry, invasiveness, bulkiness, softness, and clinical maturity. Our analysis reveals that clinically established actuation systems remain predominantly rigid and optimized for reliability and high hemodynamic support, whereas emerging soft technologies aim to improve mechanical compatibility with cardiovascular tissues and reduce physiological burden, although they largely remain preclinical. Blood‐contacting devices provide direct hemodynamic control but face major hemocompatibility constraints, while extracardiovascular approaches reduce blood exposure with more complex tissue coupling. Sensing technologies are generally less mature with the preference for minimally invasive monitoring whenever external acquisition is feasible. This review identifies interface‐dependent design trade‐offs and highlights key translational challenges toward adaptive, patient‐specific cardiovascular therapies.