Cell therapy and tissue engineering attract increasing attention as a potential approach for cardiac repair. Adult stem cells from autologous origin are a practically safe and appealing source for cell-based regenerative therapies that may hold realistic clinical potential. A plethora of interesting concepts have been introduced aiming at regenerating ischemic myocardium through adult stem cell-based bioartificial cardiac tissue supplements. Yet, current pre-clinical concepts have not reached translational applicability, and successes are only episodic. This review will provide a brief overview of the latest concepts and breakthroughs in the emerging field of cardiac adult stem cell-based tissue engineering, and discuses the challenges that this field needs to overcome to achieve realistic therapeutic translation into the clinical arena.