One of the problems of the surgical treatment for ischemic heart failure (STICH) trial was that they did not clearly show how they assessed preoperative myocardial viability. We have been stressing on the importance of accurate preoperative evaluation of myocardial viability to determine the indication of surgical ventricular restoration (SVR), and the location of the exclusion area, if indicated. To this end, we have been using late enhancement of magnetic resonance imaging (MRI), and the surgical strategy for patients with left ventricular ejection fraction (LVEF) less than 35% was constructed based on the findings of MRI. When the ventricle had the extent of hyperenhancement of less than 50% of its wall thickness in any region, complete revascularization with coronary artery bypass grafting (CABG) was performed without SVR. When the ventricle had extensive area of hyperenhancement of 50% or more of its wall thickness, the area was surgically excluded. The early and mid-term surgical outcomes were satisfactory in both the CABG only group and the CABG + SVR group. However, the patients who had residual myocardium with low viability were likely to show higher incidences of cardiac death and readmission for heart failure after SVR in the mid-term. Regeneration therapy of myocardium need to be developed to improve myocardial contractility of residual myocardium after SVR to obtain further better long-term surgical outcomes.