Transmyocardial laser revascularization is an alternative treatment option for patients with refractory angina who are not suitable candidates for more conventional coronary intervention or surgery. The laser creates channels that provide blood flow from the left ventricular chamber to areas of ischemic myocardium. Results have been impressive with patients reporting a reduction in angina of two classes according to the Canadian Heart Association Angina Classification. Care of the patient post transmyocardial laser revascularization procedure is comparable to that of other cardiac surgery patients. Innovations in this relatively new procedure include less invasive approaches and using it as an adjunctive or delivery modality for gene therapy.