Advanced strategies for biofunctionalizing cardiovascular implants using cell-derived materials.

Functionalization of cardiovascular implants is advancing to improve hemocompatibility, endothelialization, anti-inflammatory effects, and long-term patency. Conventional materials, including polymers, chemical grafts, and bioactive molecules, provide important biological benefits but do not fully replicate the complex biochemical and physiological cues of the native vascular microenvironment. Cell-derived materials, including decellularized extracellular matrix (dECM), cell membranes, extracellular vesicles (EVs), and secretomes, offer significant opportunities by preserving native structural proteins, adhesion molecules, lipid interfaces, and paracrine signaling factors. These biologically derived materials enhance endothelial repair, modulate inflammation, reduce neointimal hyperplasia, and promote vascular remodeling. Despite these advantages, substantial translational challenges remain, as many biofunctionalized implants exhibit inadequate coating adhesion, limited shear resistance, poor durability under pulsatile flow, and susceptibility to fatigue, delamination, or structural failure. This review summarizes recent advances in the functionalization and fabrication of cardiovascular implants using cell-derived materials, providing a systematic analysis of fabrication strategies, biological performance, mechanical properties, and device-specific challenges. Finally, we discuss common failure mechanisms, translational barriers, and future directions for developing scalable, mechanically robust, and clinically translatable cell-derived biomaterials for next-generation cardiovascular implants.