Evolution of Cardiac Models Toward Recreating Biologically Relevant Multiaxial Mechanical Stimuli

Understanding and recreating biomechanical forces in in vitro cultures is integral to regenerating cardiac tissue and finding novel therapies for cardiovascular disease. Mechanical forces influence cardiac physiology from a microscopic cellular scale to the global function of the heart. Here, we will review the mechanical forces within the heart as understood clinically and evaluate in vitro device designs that mimic these mechanical forces at a cellular and tissue level. We will further follow the evolution of bioreactors toward recapitulating multiaxial mechanical forces as they are experienced in vivo and understand the current limitations associated with in vitro systems in the context of recreating in vivo cardiac physiology.