Evolution of Cardiac Models Toward Recreating Biologically Relevant Multiaxial Mechanical Stimuli

Understanding and recreating biomechanical forces in <i>in vitro</i> 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 <i>in vitro</i> 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 <i>in vivo</i> and understand the current limitations associated with <i>in vitro</i> systems in the context of recreating <i>in vivo</i> cardiac physiology.