A 45-year-old male presented to our hospital with worsening heart failure. Computed tomography coronary angiography revealed total occulusion of the proximal left anterior descending artery (LAD). The patient had a history of acute type A dissection,and had undergone aortic root replacement. Avoiding prosthetic graft injury and bleeding,coronary revasculizaion was accomplished by left anterior thoracotomy using the left internal thoracic artery without cardiopulmonary bypass. The postoperative course was uneventful.