AI-monitored bioadhesive for sutureless microvascular anastomosis.

Microvascular anastomosis, the surgical suturing of small-caliber blood vessels, is technically demanding, time-consuming, and prone to failure from complications such as thrombosis. Existing adhesives are ineffective in the dynamic, wet surgical field, particularly for the limited cross-sectional interface of blood vessels. We present an integrated microneedle-interlocking adhesive system (iMAS) bioinspired by plant root anchoring. This platform combines a hydrophobic polymeric matrix with tetrahedral microneedles, creating robust, three-dimensional bonding for rapid, secure anastomosis. An embedded artificial intelligence (AI)-assisted wireless sensor enables continuous, real-time monitoring of vascular hemodynamics and cardiac graft health, facilitating predictive identification of complications such as stenosis and transplant rejection. In rat models, iMAS reduced procedural time by 78% and suppressed neointimal hyperplasia. iMAS streamlines microvascular anastomosis and enables proactive graft monitoring in transplantation.