Novel non-glutaraldehyde bioprosthetic heart valve construction strategy based on ATRP with enhanced anticoagulant and anti-calcification properties

This study presents a new non-glutaraldehyde crosslinking and surface-functionalization strategy for constructing next-generation bioprosthetic heart valve leaflets. Decellularized porcine pericardium (D-PP) was chemically modified using an ATRP-initiated grafting approach, first introducing alkyl bromine groups (Br-PP) and subsequently applying in situ crosslinking using a four-arm double-bond crosslinker to generate mechanically reinforced PT-PP. A second ATRP reaction added sulfonic acid groups, creating PT-BS-PP with enhanced hydrophilicity and biofunctionality. Comprehensive in vitro and in vivo analyses demonstrated that PT-BS-PP exhibited improved biocompatibility, reduced immune activation, superior anticoagulation behavior, increased endothelialization potential, and sharply reduced calcification relative to glutaraldehyde-crosslinked controls. The findings support PT-BS-PP as a promising leaflet candidate for transcatheter bioprosthetic heart valves where durability, anti-calcification, and hemocompatibility are essential.