Table 2.

Different types of bioreactors for cardiac tissue engineering.

Bioreactors	Culture type	Advantages	Examples	Ref.
Perfusion	Scaffolds	Enhances mass transfer of oxygen through the engineered patch	Vascular cells reveal changes in their metabolic and functional properties after exposure to increased levels of shear stress, as well as increased cell distribution and lower diffusion gradients	[120,143]
		Creates frictional shear stress on the cells which enhances cell proliferation
Multi-shear perfusion	Scaffolds	Delivers different shear stresses at the same time	DNA content of cultured cells increases by 91% after exposure to the bioreactor	[120]
		Can be used on 3D tissues
Pulsatile fow	Cell-Sheets	Enhances vascularization of stacked cell sheets	Stacking of six layers of rat cardiac cell sheets resulted in a thicker and denser grafts, which contracts regularly after implantation into host rat	[120]
Uniaxial cyclic stress	Scaffolds	Increases cardiomyocyte size	Human cardiac constructs implanted into rats after exposure to uniaxial loading displayed increased active force and enhanced graft perfusion into host tissue	[120]
		Aligns fibers in the ECM
		Increases angiogenesis
Rotational wall vessel	Cell-culture vessels	Creates laminar fluid flow	Cardiomyocytes cultured in these bioreactors have a constant pH, %CO2, and %O2, compared to an increasing amount of DNA in the culture.	[143]
		Enhances mass transfer rate
Electrical stimulation	Scaffolds and hydrogels	Ensures impulse propagation	Cardiac constructs propagate continuous pulses and a rate of 400 beats min−1 after inserting in an electrical stimulation bioreactor	[144]
		Increased conduction velocities to mimic in vitro conditions
		Caused synchronous macroscopic pulses