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Symptomatic congestive heart failure causes great suffering and associated with high rates of morbidity and mortality. It is now a widespread epidemic and one of the most important public health problems in cardiovascular medicine. Great insight has occurred with respects to pharmacotherapeutic approaches to heart failure yet symptomatic patient can still anticipate 5-year mortality rates of between 50% and 80% Increases understanding of the pathophysiology of heart failure has resulted in clinicians focusing on the importance of revascularization strategies in patients with ischemic syndromes causing ventricular dysfunction. In patients without overt coronary artery disease, operative interventions can also play a significant role. Obviously, cardiac transplantation is the ultimate surgical intervention for treatment of any end stage cardiomyopathy, but this procedure, although extremely successful, still has limitations of immunosuppressive drug morbidity and inadequate donot organ availability. Several alternative procedures have been proposed and include mitral valve reconstruction for cardiomyopathy-induced mitral regurgitation, partial left ventriculectomy or volume reduction surgery (sometimes called the Batista Procedure), and dynamic cardiomyoplasty. It is important to consider pathophysiologic concepts underlying these surgical procedures and study emerging experience to determine if these operative interventions subsequently can play a significant role in managing patients with dilated cardiomyopathy.