Since the last decade, there has been great interest in creating myocardial channels using energy sources and mechanical devices to enhance tissue perfusion as adjunctive therapy for refractory ischemic coronary artery disease. These studies are predicated on the fact that a portion of myocardium in the failing heart is in a state of hibernation. The creation of these channels may lead to neovascularization capable of reviving hibernating myocytes, thus improving cardiac function. This review discusses the pathology after direct myocardial revascularization in animal models and in humans. The fate of the myocardial channels and the potential mechanisms associated with vascular development are emphasized.