The increase in left ventricular volume after a myocardial infarction is a component of the remodelling process leading to heart failure and it is associated with poor clinical outcomes. Hence, the current management strategy for ischaemic left ventricular dysfunction has been aimed to reverse the remodelling process by medical therapy, devices and/or surgical strategies. Surgical ventricular reconstruction, usually combined with myocardial revascularization, has been introduced as an optional therapeutic strategy aimed to reduce the left ventricle through the exclusion of the scar tissue. Surgical ventricular reconstruction is recommended in selected heart failure patients, especially if a postoperative left ventricular end-systolic volume index less than 70 mL/m2 can be predictably achieved, because a smaller residual volume is associated with improved survival. This chapter briefly discusses the rationale to surgically reverse left ventricular remodelling, the technique, and the indications to the best of the authors’ knowledge, coming from one of the centres with the most experience in SVR worldwide.