Myocardial infarction is one of the leading causes of death in industrialized nations. Recent advances in tissue engineering and cell biology have changed our understanding of regenerative activities in the infarcted heart and have raised considerable hopes for novel therapeutic approaches to treat patients. Studies have shown that cell transplantation results in small improvements in the infarct area and while these therapies hold promise, significant challenges remain in order to increase both cellular engraftment efficiencies and transplanted cell function. Robust cardiac healing will require appropriate revascularization of the infarct site, mechanical recovery of damaged tissue and electrophysiological coupling with native tissue. Embryonic stem cells, uniquely, have the potential to generate bonafide cardiomyocytes and other derivatives which should contribute toward these multifaceted requirements. Guiding embryonic stem derived cells to support healing and regeneration of heart tissue using tissue engineered constructs may provide advantages over direct cell transplantation, including replacement of damaged infrastructure, temporary support for transplanted cells, and control of size, shape, strength and composition of the graft.