The last five years have witnessed an increasing interest in the subject of transmyocardial laser revascularization (TMR) as illustrated by the number of abstracts presented at the meetings of the American Heart Association and the American College of Cardiology (Figure). The ideas and concepts associated with this particular method of myocardial revascularization have changed dramatically over even this short period of time. The original premise of "de-evolving" mammalian hearts to recreate a reptilian-like myocardial circulation by making multiple channels through the myocardium has been...