The results of combined surgery for ischemic cardiomyopathy were reviewed focusing on the selection of operative procedures. Left ventricular volume reduction was performed in 33 patients. Hospital mortality was 17% in Dor procedure (n=24), 20% in Batista operation (n=5) and 0% in over-lapping method (n=4). Procedures should be selected according to left ventricular wall area to be excluded. Mitral valve plasty was performed in 50 patients, and early and late results of our original "papillary muscle sandwich plasty" (n=27) was superior to those of other conventional procedures (n=23). In "sandwich plasty", the papillary muscle heads of the anterior and the posterior mitral valve leaflets are approximated using tefron-pledgeted 3-0 ticron suture at the anterolateral and posteromedian commissural portions, respectively. In conclusion, active combined surgery is necessary for the treatment of ischemic cardiomyopathy.