Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, and the limited regenerative capacity of myocardial cells poses a significant challenge in repairing cardiac injury. Cardiac tissue engineering (CTE) has emerged as an interdisciplinary approach built on the triad of scaffolds, cells, and bioactive molecules, delivered through translational platforms such as engineered cardiac patches, injectable hydrogels, 3D bioprinting, and heart-on-a-chip systems to replicate native cardiac architecture and physiology. This review critically appraises the preclinical and clinical evidence supporting these platforms, synthesizes emerging frontiers including extracellular vesicle therapy, cardiac organoids, AI-assisted biomaterial design, digital twins, and gene editing and summarizes completed and ongoing clinical trials to assess translational progress to date. Despite meaningful advances, CTE continues to face substantial barriers to clinical application, including vascularization, immunogenicity, cell maturity, scalability, standardization, and regulatory and cost considerations. We outline near-, medium-, and longer-term research priorities needed to address these barriers and propose a realistic timeline toward clinical translation, from narrowly indicated near-term applications to broader use in end-stage heart disease. Continued innovation and cross-disciplinary collaboration between biologists, materials scientists, engineers, clinicians, and regulators will be essential to fully realize the potential of cardiac tissue engineering to transform the therapeutic landscape for heart disease.
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Munjal et al. (2026) studied this question.