Transmyocardial laser revascularization--a technique in evolution.

Transmyocardial laser revascularization (TMLR) is a rapidly evolving technique that represents the recent rediscovery of an old therapy. A growing clinical experience is being assimilated into clear indications and contraindications for and the appropriate performance of this procedure. This technique can be judged to improve patient quality of life and survival in appropriately selected patients. The therapy should still be applied cautiously, in that a full understanding of its indications and mechanism of action remains in a state of evolution.