Biofilm formation in cardiovascular infection and bioengineering approaches for treatment and prevention

At present, cardiovascular infection such as infective endocarditis (IE) has become a major disease with a high mortality rate. The essence of IE is actually the infection associated with biofilm formation, which can occur not only on native heart valves, but also on prosthetic heart valves and cardiovascular implants such as left heart assist devices, vascular grafts, and pacemakers. Biofilms are bacterial aggregates that are composed of a self-produced extracellular polymeric substance (EPS), which is difficult and challenging for the treatment of cardiovascular infections. Therefore, it is important to explore and develop effective anti-biofilm methods for the treatment of biofilm-associated cardiovascular infection. This review provides comprehension of strategies for degrading EPS in biofilm, the application of nanodrug delivery systems for biofilm-related infections, the strategy for targeting drug resistance genes through gene editing technology and strategy for targeting quorum sensing in biofilm. Furthermore, this review also provides some strategies to optimize the antibacterial properties of cardiovascular implants to prevent biofilm formation. The applications of these strategies will provide novel preventive and therapeutic ways for biofilm-associated cardiovascular infections.