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The aim of this book is to provide the necessary perspective to stimulate investigators (both clinicians and basic scientists) to ask the appropriate questions in their own experiments and, in time, determine whether direct myocardial revascularization has a place in the treatment of coronary artery disease. The last five years have witnessed an increasing interest in the subject of transmyocardial revascularization (TMR). The ideas and concepts associated with this particular method of myocardial revascularization have changed dramatically over a short period of time. The original premise of de-evolving mammalian hearts to recreate a reptilian-like myocardial circulation by multiple channels through the myocardium has been almost completely dismissed. Now, the most popular notion is that there is an angiogenic response to myocardial channel making. It is this development of new blood vessels that is thought to be responsible for the apparent improvements in symptoms and blood flow. Along the way, the idea that a channel could stay open and allow blood to flow directly from the ventricular chamber has found little support. Rather than directly explore all of these issues and merely duplicate previously published articles, our aim was to take a novel approach: that is, to step back from these arguments and provide perspective from the vantage point of distance.
