Interdisciplinary approaches to advanced cardiovascular tissue engineering: ECM-based biomaterials, 3D bioprinting, and its assessment

As a class of representative intractable diseases, cardiovascular disease (CVD) is the most common cause of global mortality, accounting for approximately 17.9 million deaths each year. At the end of the disease stage, surgery for replacement of cardiovascular (CV) tissue is inevitably required due to the limited regeneration capacity of CV tissue. However, the currently available methods (e.g. autografts, allografts, xenografts, prostheses) have limited therapeutic efficacy because of donor shortage, immunological transplant rejection, anticoagulant therapy, and less durability. To overcome these limitations, CV tissue engineering technology has been extensively explored to develop replaceable tissue and organs for in vivo transplantation. In addition, 3D tissue models are also studied for in vitro mechanistic study and therapeutic screening. To accomplish this, there has been tremendous progress in studying various CV tissue-specific biomaterials and advanced 3D bioprinting techniques to enhance the physiological and anatomical relevance of engineered CV tissues. Moreover, a variety of evaluation methods have been investigated to validate the unique structural properties and electrical activity of the engineered CV tissues towards non- or less-invasive and real-time assessments in 3D volumetric structures. In this review, we systemically present and discuss the advantages and applications of CV tissue-specific biomaterials, 3D bioprinting techniques, and assessment methods that can facilitate real-time monitoring. A thorough understanding of advanced strategies in CV tissue engineering can be utilized to guide work on next-generation therapeutics for CVD.