The need for replacement cardiovascular tissues is great, in particular for pediatric patients suffering from complex congenital heart defects where major portions of their valves and great vessels need to be reconstructed. We have pioneered the use of 3D tissue printing to fabricate complex anatomical shapes. We continue to build on our clinical image processing, deposition algorithm, and biofabrication technology to enable broader classes of material components to be deposited with higher spatial resolution without compromising clinically relevant sizing or cell viability. We are developing technology to parse this structural heterogeneity directly from the clinical imaging data and automatically deposit it in 3D. We are further developing quantitative analysis tools to define the quality and repeatability of 3D biofabrication of heart valves, which are essential for downstream high-throughput biomanufacturing. We are also applying these innovations to print other soft tissues requiring complex macroscale anatomy with intrinsic material heterogeneity such as patient specific vascularized tissue beds for reconstructive surgery.