Vascularized Cardiac Tissue Engineering: From Advances in Biofabrication to Translational Applications

The in vitro engineering of vascularized cardiac tissues holds transformative potential for disease modeling, drug screening, and regenerative therapy. However, despite rapid advances in stem cell biology, biomaterials, and biofabrication technologies, the reconstruction of functional, perfusable vasculature within engineered myocardial tissues remains a central and unresolved challenge. In this review, we move beyond a descriptive catalog of available techniques and instead present a process-oriented framework for understanding vascularized cardiac tissue engineering. By systematically analyzing how cellular components, biomaterial design, and biofabrication strategies collectively govern vascular formation, perfusion stability, and myocardial function, we examine self-assembly, mold-casting, 3D bioprinting, and microfluidic approaches, to critically evaluate their respective advantages and trade-offs under cardiac-specific physiological constraints. Finally, application prospects of vascularized cardiac tissues in disease modeling and drug testing are discussed, and current limitations and future directions are proposed to accelerate translational impact. By reframing vascularized cardiac tissue engineering as an integrated manufacturing challenge rather than a collection of isolated technologies, this review aims to provide a coherent conceptual guide for advancing functional human cardiac models.