We successfully performed coronary artery bypass grafting in a 57-year-old man who had undergone a left pneumonectomy 7 years previously. Because the patient's heart was completely displaced into the left posterior hemithorax, access via a left posterolateral thoracotomy was chosen. Saphenous vein grafts were chosen over the internal mammary artery. The distal anastomoses were performed with use of the off-pump technique; for the proximal anastomosis, 2 venous grafts were implanted into the descending aorta. The patient's postoperative course was uneventful, and postoperative angiography revealed patent grafts. Herein, we discuss the case of this patient, and we present some considerations that can influence surgical approaches in similar circumstances.