Cardiovascular diseases remain the leading cause of global mortality, driving an urgent demand for advanced therapeutic strategies beyond conventional pharmacological and surgical interventions. Three-dimensional (3D) bioprinting has emerged as a transformative technology in cardiovascular medicine, offering the unprecedented capability to fabricate living, patient-specific tissues with complex architectures. However, the transition from structural mimicry to functional regeneration is hindered by critical challenges, including vascularization bottlenecks, electromechanical mismatch, and the lack of mature biomimetic microenvironments. This review systematically summarizes recent breakthroughs in cardiovascular bioprinting, covering advanced biofabrication modalities, smart bioink formulations with tunable mechanics and electroactivity, and hierarchical vascularization strategies. We critically evaluate the translational progress of bioprinted constructs in myocardial patches, heart valves, and conduction system reconstruction, alongside their utility in disease modeling and drug screening. Furthermore, we explore the synergistic integration of emerging frontiers—Artificial Intelligence (AI), nanotechnology, and gene editing—highlighting their collective potential to engineer intelligent, adaptive cardiac tissues. Finally, we discuss the remaining hurdles in clinical translation and propose a roadmap for realizing the next generation of functional cardiovascular regenerative therapies.