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Cardiology and Angiology

Cite as: Archiv EuroMedica. 2026. 16; 4. DOI 10.35630/2026/16/Iss.4.11

Received 09 July 2026;
Accepted 07 August 2026;
Published 10 August 2026

THE POTENTIAL OF 3D PRINTING AND BIOPRINTING IN CARDIOLOGY AND VASCULAR SURGERY: A NARRATIVE REVIEW OF DIAGNOSTIC, THERAPEUTIC, AND EDUCATIONAL APPLICATIONS

Agnieszka Sawina¹ , Sara Rakotoarison¹ ,
Kaja Hanys¹ , Gabriela Najdek¹ , Patryk Mroczka¹

¹ Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland

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  sawina.agnieszka13@gmail.com

ABSTRACT

Background

Three-dimensional printing and bioprinting are increasingly being investigated in cardiology and vascular surgery. Their applications include patient-specific anatomical modeling, diagnostic support, preoperative planning, procedural simulation, medical education, tissue engineering, and the development of vascular grafts. However, these applications differ substantially in their level of clinical readiness.

Aim

This narrative review aimed to assess the diagnostic, therapeutic, educational, and regenerative applications of 3D printing and bioprinting in cardiology and vascular surgery and to distinguish applications closer to routine clinical use from technologies that remain experimental.

Materials and Methods

A literature search was conducted in PubMed and Google Scholar for English-language publications published between 2016 and 2026. The search terms included “3D Bioprinting,” “Three-Dimensional Printing,” “Blood Vessels,” “Bioprinted Vessels,” “Vascular System,” “Vascular Grafts,” “Cardiovascular Disease,” “Tissue Engineering,” and “Biomaterials.” The search was completed on March 26, 2026. After assessment for thematic relevance, 46 sources were included.

Results

Three-dimensional printing is increasingly used for cardiovascular anatomical modeling, preoperative planning, procedural simulation, medical education, and patient communication and may also support selected diagnostic applications. Patient-specific models can reproduce complex cardiac and vascular anatomy using computed tomography, magnetic resonance imaging, and echocardiographic data. In contrast, vascular bioprinting remains largely experimental. Progress has been reported in bioink design, the fabrication of multilayer vascular structures, endothelialization, perfusion, and the reproduction of selected mechanical properties of native vessels. Major limitations include insufficient mechanical durability, difficulties in maintaining long-term patency and endothelial function, thrombogenicity, biological instability, and the fabrication of small-diameter vessels and microvascular networks. An acellular tissue-engineered vascular graft has received clinical approval, but this should not be regarded as evidence that directly 3D-bioprinted vessels are ready for routine use.

Conclusions

Three-dimensional printing is currently closer to routine clinical use than vascular bioprinting, particularly in anatomical modeling, treatment planning, procedural simulation, education, and patient communication. Vascular bioprinting has substantial potential for regenerative medicine, but routine clinical implementation requires further standardized preclinical testing, well-designed clinical studies, regulatory oversight, and long-term patient registries.

Keywords: Three-Dimensional Printing, Tissue Engineering, Biomaterials, Blood Vessels, Vascular System

INTRODUCTION

Vascular grafts created using 3D bioprinting could become a new alternative for treating cardiovascular diseases (CVD) [1]. According to data from the Central Statistical Office, CVD remains the leading cause of death in Poland. In 2023, they accounted for 37% of all deaths [2]. CVD contributes to a significant decline in the quality of life of patients worldwide through the development of heart failure and coronary artery disease. Patients most commonly report symptoms such as shortness of breath, reduced exercise tolerance, and chest pain. In advanced stages of the disease, transplantation may be necessary [3,4]. According to a Poltransplant report, in 2023, the average waiting time for a planned heart transplant was 687 days, while for an urgent one, 69 days. In Poland, the presumed consent (opt-out) model is in effect, meaning that the collection of cells, tissues, or organs from a deceased patient is permissible unless an objection is raised during the patient's lifetime, either verbally (in the presence of witnesses), in writing, or through entry in the Central Register of Objections [5].

Long wait times for transplantation and rising costs of care are prompting scientists to explore alternative treatments for CVD patients. One promising technology in this area is three-dimensional bioprinting (3DBP).

The first 3D printer was built in the 1980s by Charles Hull. The technology involved curing polymer layers using UV light based on a computer design—the beginning of the stereolithography method. The company "3D Systems," founded by the aforementioned American engineer, continues to support this industry to this day, among others: surgeons, orthodontists, orthopedists.

The first attempts to use biological components, collagen and fibronectin, took place in 1988. That same year, Robert J. Klebe used a standard inkjet printer to cytoscribe adhesive proteins and monoclonal antibodies onto a Petri dish. This event is considered the initiation of bioprinting. In 1999, Odde and Renn used living cells and a laser to create anatomical models. In the 1990s, the printing of dental implants and prostheses began. The first bioprinter was developed by Wilson and Boland in 2003, using an inkjet printer as a base. The researchers modified the device to administer cellular solutions. The first vascular models appeared in 2009. The method developed by Norotte does not use a scaffold for fibroblasts and muscle cells, allowing for better biological integration of the materials. Bioprinted cartilage and liver models were tested in mice in 2012 [3,4]. In the years 2014-2016, 3D tissue integration with the circulatory system was scanned, and heart valves were created [6].

The modern use of this technology covers a wide range of medical procedures, including pre-operative planning using anatomical models created based on patient data, designing and manufacturing surgical guides and implants tailored to individual needs, as well as the production of tools and personalized medical products such as prostheses and dedicated devices [7].

3DBP technology uses bioinks to stabilize cells during printing. The layered structure of the grafts allows for precise mapping of anatomical structures based on computed tomography (CT) or magnetic resonance imaging (MRI) data [8,9]. A personalized approach could improve treatment effectiveness. Although bioprinting of blood vessels is not currently used clinically on a large scale, 3D bioprinters have previously been tested in orthopedics, including for bone and cartilage reconstruction. Currently, orthopedic surgeons use handheld bioprinters and so-called biopens to rebuild various types of tissue [10]. However, the use of this technology in the creation of vascular grafts is associated with numerous limitations. A key challenge remains the lack of suitable bioinks and printing devices capable of accurately replicating the complex structure of a blood vessel. Materials used in printing should be characterized by high mechanical strength and adapted to the physiological stresses occurring in the circulatory system.

In vivo experiments, the number of which is constantly growing, are also an extremely important area of research. Such solutions not only increase the accuracy of procedure planning but also open up the possibility of performing procedures that were previously technically unattainable or associated with significant risk.

Previous reviews have often examined individual aspects of 3D printing or bioprinting, such as cardiovascular anatomical models, tissue engineering, bioinks, or vascular graft fabrication. However, an integrated assessment of diagnostic, therapeutic, educational, and regenerative applications in cardiology and vascular surgery, together with recent technological and clinical developments, remains limited. This narrative review addresses this gap by examining these areas within a single cardiovascular framework and distinguishing established clinical applications from technologies that remain experimental.

AIM

The aim of this narrative review is to summarize the current applications of 3D printing and bioprinting in cardiology and vascular surgery and to assess their diagnostic, therapeutic, educational, and regenerative potential.

Objectives

The objectives of this review are to:

1. describe the main 3D printing and bioprinting technologies used in cardiovascular medicine;
2. assess the use of 3D-printed models in diagnosis, preoperative planning, procedural simulation, medical education, and patient communication;
3. review current advances in bioinks, vascular tissue engineering, and vascular graft development;
4. identify the main technological, biological, clinical, regulatory, ethical, and economic limitations of these technologies.

MATERIAL AND METHODS

This narrative review summarizes the current state of knowledge on 3D printing, bioprinting techniques, bioinks, vascular graft development, clinical applications, educational use, technological limitations, and future perspectives in cardiovascular medicine.

The literature search was conducted in PubMed and Google Scholar and covered English-language publications published between 2016 and 2026. The analyzed sources included review articles, engineering studies, original research papers, an academic textbook, and statistical reports. The following search terms were used: “3D Bioprinting,” “Three-Dimensional Printing,” “Blood Vessels,” “Bioprinted Vessels,” “Vascular System,” “Vascular Grafts,” “Cardiovascular Disease,” “Tissue Engineering,” and “Biomaterials.”

Publications were included if they were published in English between 2016 and 2026 and were directly relevant to the scope of the review. Publications were excluded if they fell outside the specified date range, were not available in English, did not directly address 3D printing or bioprinting in cardiovascular medicine, or did not provide information relevant to the diagnostic, therapeutic, educational, or vascular tissue-engineering applications covered by this review.

The literature search was completed on March 26, 2026. After assessment for thematic relevance, 46 sources were included in the final review.

RESULTS

The main applications of 3D printing and bioprinting in cardiovascular medicine are summarized in Table 1.

Potential applications of 3D printing in the diagnosis of cardiovascular diseases

3D printing may find significant applications in the management of cardiovascular diseases. Anatomical models created from imaging data such as echocardiography, computed tomography, or magnetic resonance imaging can enable precise analysis of the anatomy of the heart and blood vessels. Detailed visualization of valve defects or coronary artery damage can significantly improve the planning of cardiac surgery. Available research indicates that the preoperative use of 3D models can influence clinical decision-making by the surgical team, enabling more effective preparation for surgery [11,12]. Additionally, printed grafts can be used as a tool for simulating selected pathophysiological phenomena, such as blood flow, the mechanism of pulmonary embolism, arrhythmias, and vascular stenosis. This approach not only facilitates treatment planning but also strengthens the doctor-patient relationship. Visualization and detailed explanation of pathology using 3D models can positively impact the patient's understanding of the disease, increasing their engagement in the therapeutic process. Another significant advantage of using 3D technology in diagnostics is the ability to optimize imaging techniques; the models can be used to select the optimal patient positioning angle, which translates into increased diagnostic precision and reduced exposure to ionizing radiation. [13].

3D models of the heart and vessels have the potential to play a significant role in the management of patients with cardiovascular disease. However, it should be noted that the high cost of production and limited availability of this technology remain limitations. Reconstructing small-diameter vessels (1–3 mm) and microvascular structures (<1 mm) remains a significant clinical challenge, particularly in the context of complex, multi-level vascular systems [10].

3DBP techniques and the basics of bioprinting

The goal of bioprinting is to recreate functional and structural equivalents of natural tissues and organs that can regenerate and differentiate on their own after implantation. [14]. Currently, there are four main techniques in 3D bioprinting: laser, stereolithography, inkjet, and extrusion-based.

In the laser technique, the bioink takes on a liquid form, and the pulsed laser beam enables non-contact material deposition. The advantage of this method is high cell survival (~95%) and their ability to proliferate without changing their phenotype, which results from the lack of direct contact between the biomaterial and the bioink dispensing elements. Additionally, precise deposition of materials with varying viscosities is possible. However, the main limitations are the high cost and technological complexity of the devices. The method is used for research on the creation of, among others, bone tissue [15,16,17]. Stereolithographic bioprinting is based on layered curing of hydrogels with UV light. Exposure time and light penetration depth directly impact cell survival, which is approximately 80% in this method. This method is used to create complex vascular models capable of ensuring perfusion in deep structures, but it is associated with high investment costs, and one of the research subjects is the structure of the cornea [18,19]. Inkjet bioprinting, one of the first techniques developed, provides high spatial control over cell distribution and a high survival rate (~90%). This technology is relatively inexpensive and quick to implement. However, its limitations include the need to use liquid bioinks with low viscosity and low cell concentration, which results from the design requirements of the fine-grained printing nozzles. Furthermore, the mechanical strength of structures printed this way remains limited and requires further improvement. Research on this method includes, among others, the formation of joint cartilage that is capable of growth in incubation [15,16,20].

The most common method in tissue engineering is extrusion-based bioprinting. This technique combines a robotic system with mechanical material dispensing, enabling the use of a wide range of bioinks with varying viscosities. Although its significant advantage is the stability and integrity of the created structures, it is characterized by low cell viability. This is a consequence of shear forces and mechanical stresses, which limit cell functionality. Recent advancements in this technique include layered bioprinting using UV light. This method produces flexible and durable tubular structures, particularly useful for modeling small arteries and veins. The layered arrangement allows for the replication of natural vascular architecture, making this method promising for the creation of vascular grafts and vessel fabrication [10,15,21,22].

Additionally, this technique is used for research on the creation of human skin tissues [10,16]. The methods discussed above are described in the table below (Table 2).

Current barriers to implementing 3D printing in clinical practice include regulatory issues, the need for harmonized quality standards, and technological limitations. Despite these challenges, market forecasts predict dynamic growth for the sector, with the global 3D printing market in healthcare estimated at billions of dollars, with annual growth expected [23].

Bioinks - materials used for bioprinting of blood vessels

Materials used in 3D bioprinting of blood vessels must replicate the properties of natural tissue as faithfully as possible. In particular, they must be biologically compatible with the surrounding cellular environment, enabling cell adhesion, proliferation, and growth. Maintaining the vessels' physical properties, such as elasticity and resistance to blood pressure, is also crucial. For this reason, the bioinks used for this purpose consist of biomaterials in which living cells are suspended. They can be divided into natural and synthetic. Natural components include collagen, fibronectin, alginate, gelatin, and hyaluronic acid. Synthetic components include polyethylene glycol (PEG), polylactic acid (PLA), polylactide (PLLA), and other polymers. The advantages of natural bioinks include their biological compatibility and the creation of a physiological environment for cells. However, their limitations include shorter shelf life and relatively low mechanical stability. Synthetic bioinks, on the other hand, offer greater control over physicochemical properties and greater durability, but exhibit lower compatibility compared to natural bioinks. Therefore, attempts to create hybrid bioinks, combining natural and synthetic components, are becoming increasingly popular [15,24]. The use of endothelial cells in combination with mesenchymal stem cells is gaining increasing interest. Such configurations may enable the formation of blood vessels and enable adaptation to physiological conditions. The patient's own pluripotent stem cells can be used in the printing process, reducing the risk of rejection. Studies demonstrate the potential use of cardiomyocytes derived from induced pluripotent stem cells and human umbilical vein endothelial cells for the creation of vascularized myocardial tissue. However, this technology is limited by the insufficient viability of the cells, which can be degraded at various stages of the process [10,24].

An innovative solution is ECM bioinks (Enhanced Cellular Modification Inks). Extracellular Matrix (ECM), i.e., inks containing an extracellular matrix derived from tissues corresponding to those to be reconstructed. Their main advantage is their biomimetic nature, which promotes cell function and limits the body's immune response. However, the process of ECM isolation and replication poses significant technological challenges, and the cell viability in such inks is lower compared to synthetic inks [24]. Growth factors, vascular cells, and anticoagulants are also used to improve the functionality of printed vessels. These are intended to support angiogenesis, anti-inflammatory effects, and antithrombotic properties. The most commonly used factors include VEGF (vascular endothelial growth factor), FGF (fibroblast growth factor), and TGF-β (transforming growth factor-β), which support cell proliferation and differentiation. Heparin, bioactive glasses, and trace elements (including Cu, Zn, Si) stimulate angiogenesis and support cell proliferation. In order to precisely control the release of growth factors and limit potential side effects, encapsulation or functionalization strategies using aptamers are used [10].

However, the limitation of their application is low biological stability; a solution may be cross-linking of growth factors in the hydrogel structure, which allows for their gradual and controlled release [25].

It should be noted that most bioprinting methods are currently at the stage of basic research or early preclinical studies.

Educational and Clinical Applications of 3D Printing in Vascular Surgery

Spatial-visual abilities play a key role in the training of surgeons. The constant transformation of two-dimensional diagnostic images (e.g., computed tomography, magnetic resonance imaging, angiography) into three-dimensional representations of anatomical structures is a routine element of their work. This skill is fundamental to the effective planning and execution of surgical procedures, but its development requires intensive training and clinical experience [26]. 3D printing technology opens new perspectives in surgical education, enabling the creation of precise models of blood vessels and cardiac structures. These models are used both for learning surgical techniques and for planning procedures and improving manual skills. The use of 3D printing technology in healthcare facilities has evolved from single, pilot projects implemented in leading academic centers to a mature and rapidly developing field, characterized by clearly defined procedures and support from scientific communities and organizations [27].

Surgical simulations using 3D models support the development of procedural competencies in a controlled and safe environment, without risk to the patient. In the case of vascular surgery, this allows for the practice of both classical procedures (e.g., endarterectomy, bypass grafting) and endovascular procedures (e.g., endovascular aneurysm repair - EVAR), including the selection and fitting of implants to the anatomical dimensions of a specific patient [28]. The use of 3D models contributes to: increased engagement of training participants thanks to the interactive nature of learning, better memory and understanding of the complex anatomy of vessels and organs, acceleration of learning of manual skills in doctors with limited access to real procedures, and development of interpersonal and decision-making competencies through participation in team simulations [26]. 3D printing is used for these purposes at the University Hospital in Szczecin, other European countries, the USA, and China [29].

Studies have also shown that these models can be effectively used in educating patients and their families, facilitating their understanding of the disease [30]. Unlike commercial simulators, which are expensive and often limited to a single clinical scenario, 3D models are characterized by low production costs and high repeatability. Rapid prototyping technology allows for its effective implementation in residency programs and specialization courses at institutions with various levels of reference. Despite significant advantages, 3D printing technology has its limitations, including the reproduction of dynamic structures such as heart valves or atrial myocardium. However, their effectiveness can be increased through integration with virtual reality (VR) and augmented reality (AR), which enables interactive exploration of the interior of the heart and vascular system and supports advanced surgical training and procedure planning [30].

Key audiences for this training include vascular surgeons, cardiac surgeons, biomedical engineers responsible for model design, 3D technicians, sterilization personnel, infection control teams, and anesthesiologists. The required competencies would include, among others, use of specialized CAD (Computer Aided Design) software (e.g., Mimics, 3D Slicer, Fusion 360), selection of appropriate medical materials, taking into account biocompatibility and sterilization options, knowledge of the Medical Devices Regulation (MDR) and European Conformity Marking principles, and preoperative planning using 3D printing. Training should also address occupational safety issues, including control of volatile organic compounds (VOC) emissions, waste management, compliance with occupational health and safety regulations, and quality validation in accordance with ISO 13485 and GMP (Good Manufacturing Practice) standards. Practical implementations of training include hybrid programs combining e-learning with hands-on workshops. Many centers are establishing interdisciplinary 3D-Lab teams consisting of physicians, engineers, and technicians [31]. The implementation of this technology requires a properly organized infrastructure, including qualified personnel in the field of imaging diagnostics and biomedical engineering, dedicated software for image data segmentation, quality assurance systems, and the use of materials with the required certificates [27].

From an ethical perspective, the use of 3D printing in medicine requires informed consent from the patient for the implantation of personalized (custom-made) devices, as well as for the processing of their imaging data (e.g., CT, MRI). Appropriate management of the storage of anatomical models and digital files is crucial while respecting patient privacy. Particular ethical challenges arise in the context of bioprinting using stem cells and tissues, as well as testing grafts on laboratory animals, in accordance with the provisions of Directive 2010/63/EU [32].

Each use of a personalized device requires approval by a bioethics committee and detailed clinical documentation, including a description of the device and materials, sterilization method, justification for customization (e.g., lack of available commercial alternatives), and a clinical outcome monitoring plan. Patient consent should be expanded to include information regarding the device's status (e.g., lack of CE marking), potential unknown long-term effects, as well as procedures for reporting complications and participating in a clinical registry [33,34].

In the case of the use of stem cells and biotissues, additional consents, ethical supervision, and compliance with the principles of Good Clinical Practice (GCP) are required. GCP and reporting each clinical trial to the Office for Registration of Medicinal Products (URPL) [35]. Currently, 3D printing not only supports surgery and personalized medicine, but also constitutes an important component of the development of a modern, innovative healthcare ecosystem in the future [27].

Technological and clinical innovations in the use of printed blood vessels

In recent years, vascular bioengineering has advanced rapidly, with both cellular and acellular technologies contributing to the development of personalized vascular therapies. A major clinical milestone was reached in December 2024, when the U.S. Food and Drug Administration (FDA) approved Symvess™, the first acellular tissue-engineered vessel for the treatment of extremity arterial injuries when a suitable autologous vessel is unavailable [36]. The most frequently observed adverse events were thrombosis, anastomotic stenosis, fever, and pain [36].

Concurrently, Humacyte is conducting Phase III clinical trials of the Human Acellular Vessel (HAV), which has received Regenerative Medicine Advanced Therapy designation from the FDA. HAV has been investigated in peripheral arterial disease, vascular trauma, and hemodialysis access. Preliminary findings suggest favorable patency, infection rates, and mechanical properties compared with synthetic grafts. A key advantage of Symvess™ is its off-the-shelf availability. Because donor cells and genetic material are removed during decellularization, the product has reduced immunogenic potential and does not require patient-specific tissue preparation. Refrigerated storage allows rapid use in urgent cases of limb-threatening vascular injury [37,38].

From the perspective of implant durability and functionality, maintaining mechanical properties similar to native vessels is crucial. 3D-printed vessels should demonstrate resistance to appropriate burst pressure and flexibility, ensuring physiological deformability [40]. In tensile tests (Young's modulus), they were initially found to be stiffer than native vessels, but after 12 weeks these values became equal (ATEV: 1.1 ± 0.2; native: 2.4 ± 0.7), as was the tensile strength (ATEV: 2.21 ± 0.5; native: 1.5 ± 0.3) [40]. Additionally, the graft structure provided a barrier on the intraluminal side of the vessel and contractile properties on the external side. Selective permeability and proper perfusion were also demonstrated [41,42].

In addition to classic 3D printing, advanced technologies such as 4D bioprinting are being developed, enabling the creation of dynamically changing vascular structures. This process involves the use of materials that respond to external stimuli (e.g., temperature, light, pH, mechanical forces) and enables the creation of implants that adapt to changing in vivo conditions. Polymers, shape-remembering hydrogels, and photopolymers, as well as living cells, are used for this purpose. In the context of vascular surgery, this technology allows for the production of grafts with variable diameters and elasticity that adapt to local hemodynamic conditions. The mechanical stability of the bioink plays a key role here, as it must be maintained despite the changing functional properties. The results of preclinical studies to date are also promising in the context of other tissues, such as bone, cartilage, skin, and muscle [43]. A stable endothelial layer was obtained under conditions similar to native shear stress (>10 dynes/cm²). Improved cell adhesion to the biomaterial, increased nitric oxide production, and modulation of the inflammatory and anti-inflammatory response were observed. Importantly, dynamic perfusion allows for testing the grafts' behavior under both physiological and pathological conditions, which increases their clinical potential, especially in patients at high risk of thrombosis [44,45].

In light of the above data, 3D printing and its advanced forms, such as 4D-bioprinting, are key technologies in the development of modern, functional, and biocompatible vascular implants, opening new perspectives for regenerative medicine [7].

Monitoring population effects

To effectively implement 3D printing technology for the production of personalized vascular implants, it is essential to create a system for monitoring its impact on public health. Maintaining patient registries and analyzing clinical parameters and quality of life are crucial. Monitoring includes, among others: graft survival rates, vessel patency, frequency of complications (e.g. infections, thromboses, pseudoaneurysms), need for revascularization, as well as periprocedural and long-term deaths [46]. Indicators such as quality of life (measured, for example, using the EQ-5D-5L and SF-36 tools), level of independence, return to professional activity, and patient-reported side effects should be assessed simultaneously. One current international initiative in this area is the Symvess™ registry, which includes patients with peripheral vascular injuries. Inter-center comparisons and long-term registries are essential for validating this technology and informing reimbursement decisions. Only through systematic data collection can the cost-effectiveness of 3D-printed implants be verified.

DISCUSSION

The results of this narrative review show that 3D printing and bioprinting are at different levels of readiness for use in cardiology and vascular surgery.

The most clinically developed application is the use of patient-specific anatomical models. They are used for visualization, preoperative planning, procedural simulation, medical education, and patient information. Such models allow the complex anatomy of the heart and blood vessels to be reproduced. They are created on the basis of computed tomography, magnetic resonance imaging, and echocardiographic data. These models may support clinical decision-making and preparation for selected procedures. Anatomical modeling and clinical planning are described in References [11–13], while educational and simulation applications are addressed in References [26,28–30]. However, wider implementation of these technologies is limited by production costs. Other important barriers include access to appropriate equipment and software, the need for trained interdisciplinary teams, and difficulties in reproducing dynamic cardiovascular structures.

In contrast, vascular bioprinting and the development of functional vascular grafts remain largely experimental. Recent studies have reported advances in bioink design and vascular tissue engineering [9,10,18,24,25]. Progress has also been made in the fabrication of multilayer vascular structures [21,22], small-diameter vessels [39], endothelialization and perfusion [41,44,45], and the reproduction of selected mechanical properties of native vessels [40–42]. However, a clinically functional vascular graft must combine adequate mechanical strength, elasticity, resistance to rupture, endothelial activity, selective permeability, and long-term biological stability. Achieving all of these properties remains particularly difficult in small-diameter vessels and microvascular networks.

The reviewed data also show that no bioprinting method is optimal for all cardiovascular applications. Laser-based methods may provide high cell viability and spatial precision [15,16]. Inkjet bioprinting is also characterized by relatively high cell viability and printing speed. However, it requires low-viscosity bioinks and limited cell concentrations [15,16,20]. Stereolithography enables the production of complex structures with high precision. However, exposure to ultraviolet light may reduce cell viability [18,19]. Extrusion-based printing allows a wider range of bioinks to be used. It is also suitable for producing stable multilayer structures. However, mechanical stress during printing may damage cells [15,16,21,22]. Thus, each method has important limitations. These relate to cost, printing speed, material viscosity, cell density, mechanical stress, and reduced cell viability. Therefore, the choice of printing technology and bioink composition should depend on the intended anatomical structure. The required mechanical properties, cell type, and clinical or experimental purpose should also be considered.

Bioink composition remains one of the key factors determining the properties of a vascular graft. Natural materials provide a favorable biological environment. However, they usually have limited mechanical stability. Synthetic polymers allow more precise control of physicochemical properties. At the same time, they may have lower biocompatibility. Hybrid bioinks and extracellular matrix-based materials may partially overcome these limitations. However, problems related to reproducibility, cell viability, stability, and the controlled release of bioactive factors remain unresolved [15,18,24,25].

The clinical status of tissue-engineered vascular products should be distinguished from that of directly 3D-bioprinted vessels. The approval and clinical investigation of acellular tissue-engineered vascular grafts demonstrate progress in vascular regenerative medicine [36–38]. This is particularly important when suitable autologous vessels are unavailable. However, these advances do not confirm that 3D-bioprinted vascular grafts are ready for routine clinical use. Most bioprinting approaches described in the reviewed literature remain at the stage of laboratory development or preclinical evaluation. Therefore, data on anatomical modeling, acellular grafts, and experimental bioprinted vessels should not be interpreted as evidence of the same level of clinical implementation.

Further development requires standardized assessment of mechanical durability and vessel patency. Thrombogenicity, endothelial function, immune response, fibrosis, degradation, and long-term safety must also be evaluated. Prospective clinical studies and patient registries are needed. They should assess graft survival, complications, repeat interventions, quality of life, and cost-effectiveness. Regulatory and quality-control issues must be addressed before widespread clinical implementation. Data protection for medical imaging and ethical issues related to the use of cells, tissues, and personalized medical devices must also be resolved.

Limitations

This review has several limitations. The literature search was limited to PubMed and Google Scholar, and only English-language sources were included. Therefore, relevant publications indexed in other databases or published in other languages may have been missed.

Heterogeneous source types were included in the review, including original studies, review articles, engineering studies, statistical reports, an academic textbook, and institutional websites. Therefore, the included evidence differed substantially in methodological quality, clinical relevance, and level of technological readiness.

Study quality and risk of bias were not assessed using a formal standardized tool. Sources were selected according to thematic relevance. A formal systematic review protocol was not used, and quantitative data synthesis was not performed.

The reviewed evidence included laboratory and preclinical studies, educational applications, regulatory information, and limited clinical experience. Therefore, direct comparison of findings was not always possible. The conclusions should be interpreted as a narrative overview of current applications, limitations, and research directions and should not be regarded as a definitive assessment of clinical effectiveness.

CONCLUSIONS

Three-dimensional printing is increasingly used for cardiovascular anatomical modeling, preoperative planning, procedural simulation, medical education, and patient communication, and may also support selected diagnostic applications. These applications are currently closer to routine clinical use than vascular bioprinting.

Vascular bioprinting remains largely experimental. Progress has been made in bioink design, the fabrication of multilayer vascular structures, endothelialization, perfusion, and the reproduction of selected mechanical properties of native blood vessels. However, the development of clinically functional vascular grafts remains limited by insufficient mechanical durability, difficulties in maintaining long-term patency and endothelial function, thrombogenicity, biological instability, and the challenge of creating small-diameter vessels and microvascular networks.

The clinical use of acellular tissue-engineered vascular grafts demonstrates progress in regenerative vascular medicine. However, it should not be interpreted as evidence that directly 3D-bioprinted vessels are ready for routine clinical use. Further development requires standardized preclinical testing, well-designed clinical studies, regulatory oversight, and long-term patient registries. These measures are necessary before vascular bioprinting can be widely implemented in cardiology and vascular surgery.

DISCLOSURE

Author Contributions

Conceptualization: Agnieszka Sawina, Sara Rakotoarison, Kaja Hanys, Gabriela Najdek, Patryk Mroczka. Methodology: Kaja Hanys, Gabriela Najdek, Agnieszka Sawina, Sara Rakotoarison, Patryk Mroczka. Formal analysis: Sara Rakotoarison, Agnieszka Sawina, Kaja Hanys, Patryk Mroczka, Gabriela Najdek. Investigation: Patryk Mroczka, Sara Rakotoarison, Agnieszka Sawina, Kaja Hanys, Gabriela Najdek. Supervision: Gabriela Najdek, Sara Rakotoarison, Kaja Hanys, Patryk Mroczka, Agnieszka Sawina. Writing – original draft: Sara Rakotoarison, Gabriela Najdek, Agnieszka Sawina, Kaja Hanys, Patryk Mroczka. Writing – review and editing: Agnieszka Sawina, Kaja Hanys, Sara Rakotoarison, Patryk Mroczka, Gabriela Najdek.

All authors have read and approved the final version of the manuscript.

Funding

The article received no external funding.

Conflict of Interest

The authors declare no conflicts of interest.

Use of Artificial Intelligence

The authors used ChatGPT (OpenAI) solely for language editing, grammar correction, and refinement of scientific terminology. Artificial intelligence tools were not used for data collection, data analysis, interpretation of findings, or development of the scientific content of the manuscript. All AI-assisted text was critically reviewed, edited, and verified by the authors, who take full responsibility for the final version of the manuscript.

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