Background, objectives and methods: For severer ischemic cardiomyopathy (ICM), the ventricular assist device (VAD) can be applied as well as conventional surgery such as coronary artery bypass grafting (CABG), mitral valve procedures and surgical ventricular restoration (SVR). ICM patients with left ventricular ejection fraction less than 30 % who underwent surgery including SVR and VAD implantation were selected, and their contemporary results of surgical treatment were retrospectively analyzed. Results: In-hospital mortality of CABG group, SVR group, and VAD group were 10 %, 10.5 % and 75 %, respectively. Preoperative renal dysfunction, mitral regurgitation≧3, and concomitant mitral valve procedure were identified as risk factors for in-hospital mortality in this patients cohort. Kaplan-Meier analysis revealed that overall survival rates at 1 year and 5 year were 85 %, 80 % in CABG group; 89.7 %, 89.7 % in SVR group; 50 %, 0 % in LVAD group, respectively (p=0.028). Conclusions: Although long-term results after surgical treatment of ICM patients were acceptable, operative mortality was still high for these cohorts, and further improvement has been required.

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A 72 year-old man presented with aortic pseudoaneurysm and aortopulmonary fistula,due to dehiscence of the both coronary button anastomosis, at 15 years after Aortic root replacement with Carrel patch procedure for annuloaortic ectacia. At reoperation, a fistula was found on the pulmonary trunk. The pulmonary artery defect was closed with interrupted 3-0 polypropylene sutures placed through strips of Teflon felt. The left and right coronary button had completely detached from the graft. The coronary ostial hole of composite valve graft was closed using a new prosthetic patch. Two coronary artery bypass were placed on LAD and RCA using saphenous vein grafts.
Coronary pseudoaneurysm with fistulization to the pulmonary artery after a modified Bentall operation is a rare complication, only a few cases has been previously reported.

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