PURPOSE OF REVIEW: The rising global prevalence of cardiovascular disease is driving the need for innovative biotherapeutics. Recently, exosomes-extracellular vesicles involved in paracrine signaling have shown promise in aiding heart repair associated with cardiovascular conditions. Their therapeutic potential encompasses several beneficial mechanisms, including anti-fibrosis, anti-inflammation, pro-angiogenesis, anti-oxidation, and anti-apoptosis, all contributing to improved cardiac function. This review provides a comprehensive overview of exosomes and highlights the latest research on their effectiveness in addressing current challenges in regenerative cardiac medicine. RECENT FINDINGS: Current approaches revolve around elucidating and enhancing how different cell types, cargo, and delivery methods impact healing in a pathological cardiovascular environment. The emerging field of therapeutic exosome research is promising for cardiac regeneration due to the beneficial effects of exosomal cargo. The expansion of mechanistic knowledge and the optimization of techniques are required before standard clinical application.