Cardiovascular diseases, such as heart valve dysfunction and coronary artery stenosis, are next to cancer the leading cause of death in the US. Treatments involve replacement of the heart valve or bypassing the obstructed coronary artery with a small-diameter vascular graft. The major limitation of currently used replacements is their inability to grow, adapt and repair in the patient. Considering the increasing age of the population and the subsequent increase in cardiovascular disease incidence, efforts to improve existing replacements and unraveling novel types of replacements are of paramount importance. Cardiovascular tissue engineering represents a rapid evolving field of research, providing living heart valve and small-diameter vascular substitutes with the ability to grow, adapt and repair after implantation. Various tissue engineering approaches are being employed, based on in vivo and/or in vitro tissue formation. This review provides an overview of the current heart valve and small-diameter vascular replacements and presents the status and future developments within the various tissue engineering approaches. The potential of tissue engineering for the development of living heart valve and small-diameter vascular substitutes is reflected in the numerous patents related to this emerging field of research.