The cardioreduction (Batista) procedure is a new surgical procedure being clinically performed for end-stage heart failure. It is the most recent of operations based on the concept of ventricular remodeling, among which dynamic cardiomyoplasty and temporary left ventricular assist device support are alternatives. Since the initial published report in 1996,cardioreduction has quickly been embraced by the public and many medical institutions throughout the world as an option to cardiac transplantation. There is very little scientific evidence regarding the beneficial effect and physiological principles behind cardioreduction. Since several clinical series are beginning to appear on the short-term results of cardioreduction, it is important to delineate the theoretical basis for the procedure. Cardioreduction is purported to be beneficial because it normalizes the cardiac ventricular mass-to-volume ratio. This review attempts to present the literature evidence of a universal ventricular mass-to-volume ratio and the physiological principle for cardioreduction.