Epicardial patches for myocardial repair: circumventing barriers to heal ischemic heart tissue

Ischemic heart disease, which leads to the loss of functional myocardium, remains the leading cause of death in late adulthood. Epicardial patches have emerged as a promising adjunctive strategy for myocardial repair. However, owing to the thick epicardial barrier (epicardial adipose tissue), only a select few approaches have demonstrated reduced scarring and improved heart function in large animal models and early-stage human trials. In this opinion article, we examine the different mechanisms and approaches to overcome the epicardial barrier. We further discuss key design and material considerations to improve safety and efficacy in clinical applications. Finally, we provide a summary of current regulatory and clinical challenges, together with proposed future research directions and foci in the translation of epicardial patches.