Abstract Purpose This scoping review examines strategies to improve adhesion and integration of epicardial patches within the dynamic and wet cardiac environment. It emphasizes mucin-based bioadhesives and auxetic designs as potential solutions for long-term tissue-conformal myocardial repair. Methods Approximately 150 peer-reviewed articles published between 2010 and 2024 were identified through a structured literature search conducted across PubMed, Scopus, and Web of Science. The studies cover adhesive biomaterials, structural patch designs, and epicardial tissue repair approaches were screened and thematically synthesized to map current advances, limitations, and translational gaps. Results Commercially available epicardial patches fail to maintain adhesion under cyclic loading and fluid-rich conditions. Among bioadhesives, mucin demonstrates promising wet adhesion, viscoelasticity, and biocompatibility. Nonetheless, its translation is limited by batch-to-batch variability, purification challenges, and potential immunogenicity. Dopamine-, hyaluronic acid-, and alginate-based adhesives provide alternatives but remain constrained by oxidative instability, limitted long-term durability, or inadequate mechanical performance. Structural innovations such as auxetic geometries improve patch flexibility, strain distribution, and conformability compared with multilayered or microneedle-based strategies. However, challenges related to fabrication, sterilization, scalability and potential interference of cardiac anatomy andphysiology require further investigation. Conclusions The synergistic integration of mucin-based adhesives with auxetic designs presents a compelling pathway toward durable, biocompatible, and tissue-conformal cardiac patches. Addressing manufacturing scalability, reproducibility, and immunological safety will be critical to advancing these concepts toward clinical applications.
Gunasegaran et al. (2026) studied this question.