# The Long and Winding Road to Cardiac Regeneration
###### Abstract  
Cardiac regeneration is a critical endeavor in the treatment of heart diseases, aimed at repairing and enhancing the structure and function of damaged myocardium. This review offers a comprehensive overview of current advancements and strategies in cardiac regeneration, with a specific focus on regenerative medicine and tissue engineering-based approaches. Stem cell-based therapies, which involve the utilization of adult stem cells and pluripotent stem cells hold immense potential for replenishing lost cardiomyocytes and facilitating cardiac tissue repair and regeneration. Tissue engineering also plays a prominent role employing synthetic or natural biomaterials, engineering cardiac patches and grafts with suitable properties, and fabricating upscale bioreactors to create functional constructs for cardiac recovery. These constructs can be transplanted into the heart to provide mechanical support and facilitate tissue healing. Additionally, the production of organoids and chips that accurately replicate the structure and function of the whole organ is an area of extensive research. Despite significant progress, several challenges persist in the field of cardiac regeneration. These include enhancing cell survival and engraftment, achieving proper vascularization, and ensuring the long-term functionality of engineered constructs. Overcoming these obstacles and offering effective therapies to restore cardiac function could improve the quality of life for individuals with heart diseases. cardiac regeneration; stem cell therapy; decellularized extracellular matrix; bioreactor; biomaterials; organoids; chips +
Footnote †: journal: Medical Imaging  
**Citation:** [PERSON]; [PERSON]; [PERSON] [PERSON]; [PERSON] [PERSON]; [PERSON]; [PERSON], [PERSON], [PERSON], [PERSON]. Within the panorama of cardiac regeneration, cell-based approaches have garnered considerable attention for their potential to introduce new therapeutic strategies [10,11]. One such approach is cardiac tissue engineering, a budding and rapidly evolving field in regenerative medicine [12]. Its primary objective is to restore the function of damaged heart tissue by leveraging the power of stem cells, biomaterials, and other innovative tissue-engineering techniques [13, 14, 15]. Recent years have witnessed substantial advancements in both research and clinical applications of cardiac tissue engineering, offering promising avenues for the treatment of heart disease and related cardiovascular conditions [16, 17, 18]. Presently, researchers are actively exploring two main methods of cardiac regeneration: stem cells and bioengineering [19]. Stem cell therapy involves isolating stem cells from the patient, reprogramming them in vitro, and injecting them into the damaged areas of the heart tissue [20, 21]. This process holds the potential to stimulate the heart's intrinsic repair mechanisms and facilitate the restoration of damaged tissue. On the other hand, bioengineering entails the creation of artificial heart tissue utilizing a combination of proteins, growth factors, and living cells [22, 23, 24]. By employing an appropriate scaffold and incorporating growth factors, this approach can lead to the development of fully functional heart cells. Once these cells integrate with the patient's existing heart tissue, they offer the possibility of a more permanent and comprehensive solution for repairing and regenerating cardiac tissue [25, 26, 27]. Exciting breakthroughs have also been witnessed in the clinical applications of tissue engineering for heart disease. For instance, cardiac patches have emerged as a valuable tool for repairing damaged heart tissue [28, 29], while the development of replacement heart valves aims to address issues related to damaged or defective valves [30, 31, 32]. These innovative valves boost significantly prolonged lifespans compared to their traditional counterparts and feature implantable designs, making them highly suitable for individuals in need of long-term treatments [33, 34].