Myocardial infarction is the leading cause of death in developed countries. Cardiac cell therapy has been introduced to clinical trials for more than ten years but its results are still controversial. Tissue engineering has addressed some limitations of cell therapy and appears to be a promising solution for cardiac regeneration. In this review, we would like to summarize the current understanding about the therapeutic effect of cell therapy and tissue engineering under purview of functional and structural aspects, highlighting actual roles of each therapy towards clinical application. 1. Introduction Ischemic heart disease is the principal cause of chronic heart failure in developed countries. In the USA alone, it causes 400,000 deaths annually [1]. The currently available therapies (i.e., pharmacological, interventional, and surgical methods) are unable to revitalize dead myocardium. Therefore, they cannot halt or reverse the development of congestive heart failure (CHF). Though cardiomyocytes in nonmammalian vertebrate species, like zebrafish, can restore the injured myocardium through proliferation and differentiation, this mechanism is not significant in humans [2]. Cardiac transplantation, the sole definitive therapy with long-term effect for end-stage HF so far, remains limited due to the scarcity of heart donors [3]. Myocardial restoration therapies, including cardiac cell therapy and cardiac tissue engineering, sound promising for a failing heart [4] as their ultimate goals are to regenerate the injured myocardium by robust and viable cells or artificial tissues. Although 10 years passed since Menasche et al. launched the first clinical trial [5], cardiac cell therapy has not become a well-established medical treatment for postmyocardial infarction (MI) patients. Delivery of cell suspensions to the myocardium is limited by various factors, such as insufficient cell retention and survival [6]. The introduction of cell-cell mechanical interaction systems, in the form of either cell sheets or biomaterial scaffolds [7] has addressed the issues related to poor cell retention and survival. Moreover, this strategy may offer a three-dimensional homogeneous cell delivery plus structural support (scaffold) to the myocardial area of ischemic injury [7]. Yet, there are no clinical studies of this approach. Though both cardiac cell therapy and tissue engineering have resulted in some improvement of function and structure of the injured heart, it would still be a laborious mission to reproduce the “real” myocardium. In this review, we would like to summarize
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