method using a circular patch stitched to the inside of the ventricle (the endoventricular circular patch plasty or dor procedure) to close the defect after excision. dor's approach has been modified by others and is today the preferred method for surgical treatment of incorrectly contracting (dyskinetic) left ventricle tissue, although a linear closure technique combined with septoplasty might be equally effective. the multicenter restore trial of 1198 participants demonstrated an increase in ejection fraction from about 30% to 40% with a concomitant shift in nyha classes, with an early mortality of 5% and a 5-year survival of 70%. it remains unknown if surgery is superior to optimal medical therapy. the stich trial (surgical treatment for ischemic heart failure) will examine the role of medical treatment, coronary artery bypass surgery and left ventricle remodeling surgery in heart failure patients. results are expected to be published in 2009 and 2011. the batista procedure was invented by brazilian surgeon randas batista in 1994 for use in patients with non-ischemic dilated cardiomyopathy. it involves removal of a portion of viable tissue from the left ventricle to reduce its size (partial left ventriculectomy), with or without repair or replacement of the mitral valve. although several studies showed benefits from this surgery, studies at the cleveland clinic concluded that this procedure was associated with a high early and late failure rate. at 3 years only 26 percent were event-free and survival rate was only 60 percent. most hospitals have abandoned this operation and it is no longer included in heart failure guidelines. newer procedures under examination are based on the observation that the spherical configuration of the dilated heart reduces ejection fraction compared to the elliptical form. mesh-like constraint devices such as the acorn corcap aim to improve contraction efficacy and prevent further remodeling. clinical trials are underway. another technique which aims to divide the spherical ventricle into two elliptical halves is used with the myosplint device.