It is still a highly difficult choice with no definitive answer whether to perform cardiac surgery on cardioplegically arrested heart or to operate on a beating heart, especially for patients with dilated cardiomyopathy (DCM). A 73-year-old man, who had ascending aortic aneurysm and DCM with ejection fraction (EF) of 16.5% and the left ventricle (LV) dyssynchrony, underwent graft replacement of the ascending aorta and implantation of the LV lead for cardiac resynchronization. The operation was carried out on a beating heart using tepid hypothermic cardiopulmonary bypass under antegrade/retrograde coronary blood perfusion during graft-aorta proximal anastomosis. Postoperative course was uneventful, though brain natriuretic peptide (BNP) showed transient elevation.