The opportunity to obviate the risks associated with cardiopulmonary bypass (CPB) while maintaining the long-term survival previously demonstrated with the use of arterial grafts, led us to perform myocardial arterial revascularization without CPB, using a small left thoracotomy as the surgical approach. One patient was operated on with this technique grafting the left anterior descending artery with the left internal mammary artery and grafting sequentially the first diagonal branch and the first marginal branch with a T-graft of radial artery. A small anterolateral thoracotomy was performed and the proximal harvesting of the left internal mammary artery was video-assisted by thoracoscopy. No hemodynamic deterioration occurred during the procedure. The patient was discharged on postoperative day 5 and the postoperative course was uneventful.