Transmyocardial laser revascularization is an emerging technique for treatment of patients with coronary artery disease not amenable to standard revascularization by either percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Transmyocardial laser revascularization is typically performed as an isolated procedure on the beating heart, although it has been performed as an adjunct to conventional coronary artery bypass grafting in nongraftable territories. We report the use of transmyocardial laser revascularization in combination with mitral valve replacement via a left lateral thoracotomy for treatment of ischemic mitral regurgitation.