Until recently refractory congestive heart failure under optimal medical treatment could only be treated surgically by heart transplantation. Many factors, such as a lack of donors, an operative mortality rate of 10–20%, and side effects associated with immunosuppression, have prompted heart surgeons to find alternative treatments. Moreover the number of heart failure patients is steadily growing. Although medical treatment has changed the course of the disease, it has only helped to slow the process of deterioration. Patients referred for surgery show a longer evolution than in the past and are probably more sick. Since the early '90s many surgical options have appeared and, like medical treatment, should allow a tailored surgical approach. Ischaemic cardiomyopathies can benefit from myocardial revascularisation even in patients without angina and an ejection fraction below 20%.1 ,2 Such patients could already have some kind of ventricular reduction with use of the Dor procedure in dyskinetic and akinetic areas.3 More recently, Bolling has called our attention to the deleterious effect of mitral regurgitation in such failing ventricles and advocated a simple annuloplasty to make the mitral valve competent again.4 All these options can be used either in isolation or in combination in any given patient. On the other hand, dilated cardiomyopathy has lacked alternative solutions to heart transplantation. Recently, two surgical options became available at the same time: isolated mitral valve repair, and left ventricular reduction with correction of mitral regurgitation—the Batista procedure.

Mitral valve repair was pioneered by Bolling and represents probably the easiest and most elegant way to treat a key factor of congestive heart failure.4 In a series of more than 60 patients evenly distributed among ischaemic and dilated cardiomyopathies, Bolling's operative mortality is extremely low (< 2%). Actuarial survival reaches 82% at one year and 72% at two years. …