Surgery for the failing heart after myocardial infarction.

Function follows form and this maxim provides an understanding of the pathophysiology of congestive heart failure following myocardial infarction. The heart fails as it enlarges and becomes more spherical. Surgical methods to treat dilated ischemic cardiomyopathy have evolved and been applied to thousands of patients worldwide. Known as "surgical ventricular restoration", or SVR, the operation reduces left ventricular volume and restores the ventricle towards a more conical normal shape. Global systolic function is improved. Mechanical synchrony is restored. Arrhythmias are largely abated. Neurohumoral mediators that stimulate continued ventricular enlargement are largely reduced. Finally, there is marked and sustained symptomatic improvement of congestive heart failure post-infarction patients after SVR.