Severe heart failure refractory to medical treatment necessitates the use of other modalities of treatment. Surgical ventricular restoration (SVR) surgery can provide relief until donour hearts are available or when transplantation is contraindicated. In this review we look at the physiological basis for improvement in cardiac function and cardiac and haemodynamic changes that occur after SVR. We also compile the reported factors affecting surgical outcome, criteria for patient selection and predictors of postoperative mortality. NYHA class, presence of diastolic failure, severe impairment of contractile function and presence of mitral regurgitation were the most important determinants. Various different procedures for achieving SVR are briefl y discussed. Importance of mitral valve repair/replacement, coronary artery bypass grafting and intraoperative echocardiography in improving postoperative result is highlighted. Role of perioperative medication (anti-arrhythmics, ACE inhibitors and β-blockers) is briefl y studied at the end of the review.