Surgical ventricular reconstruction for ischaemic heart failure: state of the art

Patients with ischaemic cardiomyopathy and left ventricular (LV) systolic dysfunction represent the highest-risk population with heart failure (HF). The cornerstone of treatment remains guideline-driven medical therapy, which is associated with significant improvement in survival and quality of life. The most commonly considered surgical interventions are coronary artery bypass graft surgery, at times combined with surgical ventricular reconstruction (SVR) and surgery for mitral valve regurgitation. Surgical ventricular reconstruction has been introduced as an optional therapeutic strategy aimed to reduce LV volumes through the exclusion of the scar tissue, thereby restoring the physiological volume and shape and improving cardiac function and clinical status. This review will briefly discuss the rationale to surgically reverse LV remodelling, the technique, and the indications, to the best of our knowledge, coming from the Center with the largest worldwide experience. The evolving data on the role of SVR for the treatment of ischaemic HF will be addressed as well.