This invited profile and interview synthesize the clinical, scientific, and organizational contributions of Lorenzo Menicanti to contemporary management of ischemic left-ventricular remodeling, framing surgical ventricular reconstruction (SVR) as a disciplined, outcomes-oriented response that restores geometry to recover function. Building on a programmatic pathway that couples stringent selection thresholds with standardized imaging, intra-operative checkpoints, and longitudinal follow-up, the manuscript details how volumes, sphericity, scar topology, and papillary displacement guide candidacy; how ventricular reshaping integrates mitral strategy in tethering phenotypes; and how success is declared by composite endpoints that align reverse remodeling, functional recovery, and patient-reported outcomes. A Heart Team framework situates SVR alongside, for instance, coronary artery bypass grafting, cardiac resynchronization therapy, transcatheter edge-to-edge repair, and transplant, emphasizing governance, reproducibility, and transparent decision rules that can be audited across institutions. The interview advances a pragmatic ideal: better images and technologies must translate into better decisions for patients and systems, not merely better pictures or procedures. It also appraises emerging roles for four-dimensional flow markers, finite-element stress estimation, and multicenter validation with core-lab adjudication, while outlining an agenda for mechanics-first endpoints, value demonstration, and formal training milestones that operationalize a "Menicanti Method." Together, these elements argue for a mature synthesis of surgical craft, measurement culture, and institutional learning.
