The pathogenesis and treatment strategies of end-stage heart disease, or advanced heart failure (HF), have been a hot topic of research in the field of biology in the last decade. There are 4 million patients with HF in China and the trend is increasing, and HF is the only cardiovascular disease that continues to increase in developed countries. The annual mortality rate is 17-25% and the sudden death rate is 59-64% in patients with HF who have class III to IV cardiac function. An overall analysis of the national multicenter database led by the National Cardiovascular Center Fu Wai Cardiovascular Hospital shows that coronary heart disease is the leading cause of HF in China. Surgical treatment of ischemic HF includes both etiologic treatment i.e. coronary artery bypass grafting (CABG) and treatment of pathologic structural abnormalities (mainly left ventriculoplasty). With today’s emphasis on individualized treatment, the surgical interventions used differ in the different stages of ischemic HF. Left ventriculoplasty, also known as surgical ventricular remodeling (SVR), is primarily aimed at the ventricular wall tumor formation stage of ischemic HF. Left ventricular ventricular wall aneurysm (LVA), defined as reduced, non-existent or paradoxical motion of a portion of the ventricular wall that causes reduced ejection function of the left ventricle. The theoretical basis of surgical ventricular reconstruction: (1) Laplace’s law; the pathological remodeling of the left ventricle after infarction is a very complex physical and neurohumoral regulatory process. Post-infarction myocardial necrosis, fibrosis, scar formation and calcification, compensatory hypertrophy and elongation of the myocardium in the non-diseased region, and eventual dilatation and sphericity of the left ventricle, eventually lead to increased wall tension and myocardial oxygen consumption, and a progressive increase in the burden on the surviving myocardium until it becomes decompensated. The secretion of various neurohumoral regulators in the body plays an early role in maintaining cardiac output, but it also increases myocardial oxygen consumption and cardiac load, leading to an increase in myocardial hypoxia and exacerbating the dilatation of the left ventricle. (2) Myocardial band theory: The “spiral ventricular myocardial band” theory suggests that the ventricular muscle is composed of two layers of deep and shallow muscle, which are arranged in a spiral pattern. SVR aims to restore these distorted normal muscle bundles to their original position and orientation as much as possible in order to reduce the diameter of the ventricular cavity and the shortening of the ventricular cavity during systole, so that the left ventricle can be restored to its post-infarction state before the infarct area is enlarged. SVR, as the primary treatment for ischemic left ventricular insufficiency, was also included in a study led by Fu Wai Cardiovascular Hospital on the surgical management of advanced heart failure in China. The main inclusion criteria were (1) overall LVEF value less than 35%, (2) surviving myocardium ++ (myocardial perfusion imaging), (3) degree of LV pathological remodeling: significant LV enlargement (end-systolic volume index LVESVI greater than 60 ml/m2, end-diastolic volume index LVDSVI greater than 100 ml/m2 or LV end-diastolic diameter LVEDD greater than 60 mm. The mean pulmonary artery pressure is greater than 25 mmHg); (4) the LVA accounts for more than 50% of the left ventricle or the inactive and paradoxically moving ventricular wall accounts for more than 50% of the left ventricular circumference; (5) combined mitral valve insufficiency or mitral annulus diameter is greater than 35-40 mm. SVR starts with LVA resection, the boundary of resection is considered by three aspects, the abnormally moving ventricular wall and the distribution of scar tissue, the geometry of the ventricular cavity and the size of the reconstructed left ventricular cavity. Currently, there are three main types of SVR: standard linear repair, patchplasty, and endocardial annuloplasty, which was first proposed by Cooley in 1958, and the linear suture technique, or “sandwich” suture closure. The representative methods of endoprosthesis are (1) Jatene technique: The operation first folds the distal septum to eliminate its paradoxical motion and restores the normal cone shape of the distal septum; then the base of the LVA is circumferentially reduced in a full layer. To achieve the original size and shape of the left ventricle when LVA has not yet occurred, in the suture closure of the left ventricle, if the incision after annular reduction is less than 2, 5 cm, plus the felt piece is directly linear to the suture incision. If the incision is larger than 2 or 5 cm, the gap is mended with a Dacron patch. (2) Dor technique: In 1984, Dor et al. used EndoventricularCircularpatchplasty to perform left ventricular reconstruction. A Dacron-lined pericardial patch was used to partially open the nonmoving septum and ventricular wall tumor within the ventricle. The periphery of the patch (at the junction of scar tissue and normal tissue) is completely hemostatically closed with continuous 2/0 prolene sutures. In practice, we found that the difficulty of the operation lies in the judgment of the extent and boundary of resection and the choice of the method of performing left ventriculoplasty. The Fu Wai Cardiovascular Hospital has treated more than 700 patients with LVA since 1976. In the early years, linear sutures, extracardiac patches and the classic Jatene technique were mostly used. If the LVA is larger than 30% of the left ventricular volume, especially for huge ventricular wall tumors larger than 50%, direct linear suture may cause the myocardial fiber bundle to change in the longitudinal or transverse direction, destroying the normal myocardial band structure, which will cause severe distortion of the left ventricular cavity, and in some cases will also cause the residual left ventricular cavity to be too small, all of which will directly affect the recovery of the patient’s cardiac function. The patching method has a long aortic block time and extracorporeal circulation time, and is technically demanding. Because the key to restoring the geometry of the left ventricle is the proper patching, too large a patch can leave too much residual left ventricular end-diastolic volume, resulting in a lower EF, which affects left ventricular systolic function and leads to the development of low cardiac output syndrome. In response to the advantages and disadvantages of the traditional procedure, the Fu Wai Cardiovascular Hospital has been improving the endocardiumEncircleSuturingRemodeling (EESR) method for left ventriculoplasty since 1996, which not only minimizes the ventricular wall incision and restores the left ventricular geometry to a certain extent, but also avoids the disadvantages of patch molding. It also avoids the disadvantages of patch molding. The endocardial annuloplasty was performed at the junction with a 2/0 prolene wire, which placed the infarcted myocardial tissue outside the annuloplasty line and tightened the annuloplasty line to minimize the left ventricular incision and make the post-formation cavity close to the normal left ventricular geometry, with the post-annuloplasty incision area less than 5 cm2. The post-annuloplasty incision area is less than 5 cm2, and the post-annuloplasty incision is closed with 1/0 prolene suture and the “sandwich” method. The Cleveland Heart Center performed 102 left ventriculoplasty cases from 1998 to 2000 using this procedure, with an in-hospital mortality rate of 1%. Currently, this procedure is used for almost all patients with large ventricular wall tumors, except for those with severe calcification or small post-annuloplasty left ventricular volumes (requiring patch repair). The main concurrent procedures for SVR are coronary artery revascularization (CABG) and mitral valvuloplasty or valve replacement. We found that for MI with preoperative Doppler ultrasound showing 2+, left ventriculoplasty + CABG significantly improves valve function because, (1) the enlarged annulus can also be reduced after left ventriculoplasty, (2) rearrangement of the papillary muscles after left ventriculoplasty will improve the function of the valve structure, and (3) ischemic papillary muscle function will improve after CABG, which generally does not require special treatment of the mitral valve. The near and long-term outcomes of SVR are satisfactory: 145 patients enrolled in the Left Ventriculoplasty enrolled in the Chinese Surgical Treatment of Advanced Heart Failure Study were followed up for an average of 59 months, with an early mortality rate of 2,8% and a long-term survival rate of 86%. In 59 cases of EESR in a single center at Fu Wai Cardiovascular Hospital, the mortality rate was 1,7% and the 5-year survival rate was 91,6%. The patients’ NYHA cardiac function classification, which changed from (2,5±0,7) grade before surgery to (1,7±0,7) grade at follow-up, showed significant improvement in heart failure symptoms. A group of foreign multicenter reports of 1198 SVR procedures for ventricular wall tumors between 1998 and 2003 showed a mortality rate of 5.3% within 30 days, a 5-year survival rate of 70%, a 5-year readmission-free rate of 78%, and a preoperative cardiac function of grades III and IV in 67% of patients, compared with grades I and II in 85% of patients after surgery. Although results published this year in the second phase of an international multicenter Surgical Treatment of Ischemic Heart Failure (STICH) trial showed no benefit of SVR when performing coronary bypass surgery with systolic heart failure (LVEF 35%) and anterior myocardial apical dysfunction. This was despite a substantial reduction in LV systolic volume index in the SVR group. Enrollment in this randomized prospective study was not defined as LVA patients, and because of selective bias, the population with benefit was not enrolled. Based on the Chinese experience, we should emphasize more rigorously the inclusion criteria, which is the accurate diagnosis of typical capsular LVA, and recommend the use of diagnostic tools such as magnetic resonance imaging (MRI). CABG+SVR is still the main treatment for coronary hypoperfusion, and endocardial annuloplasty is a simplified and effective LV revascularization procedure. Patients with large LVA who have suitable vascular conditions for revascularization, surviving myocardium, LVEF less than 35%, and moderate or above ventricular remodeling have better long-term results with coronary artery bypass grafting combined with LV revascularization for LV insufficiency of ischemic etiology. The results.