Mediastinal wound infection following sternotomy is a serious post-operative complication. Therefore a median sternotomy must be avoided for the patient having a low cervical terminal tracheostomy. A 64-year-old man, who had undergone a low cervical terminal tracheostomy after total laryngectomy, complained of an anterior chest oppression. His coronary angiography revealed 75% stenosis of the left main coronary ostium. He underwent coronary artery bypass grafting through left thoracotomy. Extracorporeal circulation with femoral cannulation was performed, and the left internal thoracic artery and right saphenous vein were used as grafts under hypothermic fibrillatory arrest without aortic cross-clamping. The left thoracotomy approach is a safe and advantegeous method in selected patients.