Along with angiogenesis and gene therapy, stem cell transplantation is one of the newest treatment modalities proposed to improve the outcome of patients with heart failure or infarction. In this context, much interest has stemmed from experimental studies showing that cardiac transfer of unfractionated or partially purified bone marrow cells, or stem cells and progenitor cells derived from the bone marrow or peripheral blood, can enhance functional recovery after an acute myocardial infarction. On the basis of these data, stem cells and progenitor cells derived from the bone marrow have been proposed for use in the repair of cardiac tissue after acute myocardial infarction in patients. However, the relatively low abundance, small tissue volume, difficult accessibility and disease-related malfunction of bone marrow-derived stem cells make their clinical usefulness difficult in some situations. Recently it has been shown that adipose tissue contains a population of adult multipotent mesenchymal stem cells and endothelial progenitor cells that, in cell culture conditions, have extensive proliferative capacity and are able to differentiate into several lineages, including endothelial cells, smooth muscle cells and cardiomyocytes. The similarities between stem cells extracted from the bone marrow and the adipose tissue suggest the potential for the adipose tissue to act as an alternative, and perhaps preferable, cell source for repairing damaged tissues, such as the ischemic or infarcted heart. In this review we discuss molecular and functional characterization, preclinical results and currently ongoing clinical trials using adipose-derived stem cells in cardiovascular repair.