Engineering Angiogenesis for Myocardial Infarction Repair: Recent Developments, Challenges, and Future Directions

Myocardial infarction is a cardiovascular disorder that remains a critical health issue worldwide. Because of its intrinsic inability to regenerate, cardiac tissue fails to repair itself after myocardial infarction. Cardiovascular engineering is a promising approach to regenerating myocardium for myocardial infarction repair. Despite explosive growth in research and interest in this field, cardiovascular regenerative medicine faces many challenges, with the need for rapid vascularization being the most pressing. Due to the high metabolic demand of cardiac cells, myocytes transplanted or implanted via cardiac scaffolds in the infarcted region do not survive without the timely formation of a microvascular network in the infarcted area or within the scaffolds. To address this issue, various strategies have been developed based on angiogenesis stimulation, prevascularization, and inosculation to promote microvascular network formation within the cardiac scaffolds. This paper describes cardiac tissue engineering strategies, key challenges in cardiovascular regenerative medicine, and various vascularization strategies, with an aim to review recent advances and developments in engineering vascularization and inosculation approaches towards the rapid integration of cardiac scaffolds, once implanted, with the host tissue. Challenges in engineering angiogenesis and future directions to address the issue of rapid inosculation are also discussed.