ABSTRACT Backgrounds Over decades median sternotomy has a been a gold standard approach for treatment of isolated multivessel coronary artery disease but this traditional approach has been associated with sternal wound healing complications leading to remarkable morbidity and mortality. Our aim was to describe our technique of left anterior minithoracotomy through fourth intercostal space for treatment of patients with multivessel coronary lesions . Methods Our experience includes 62 consecutive patients who were operated with the same surgical team. Left internal thoracic artery was harvested in all patients by the aid of rib retractor. All patients were operated under cardiopulmonary bypass (CPB) with blood cardioplegia through left minianterior thoracotomy of 5cm-7cm. All saphenous vein grafts were harvested endoscopically. Results We had no mortality, no early postoperative myocardial infarction was observed . Only one patient was converted to sternotomy(1.6 %). Two patients had postoperative atrial fiblillation(3.2%), 1 patient suffered postoperative stroke(resolved without neurologic deficit)(1.6%), 4 patients had revision due to postoperative bleeding(6.4%) perfomed through the same incision(no sternotomy was required). The mean number of bypass was 3.6 ±0.8, cross clamping time was 95.7 ± 41.0 minutes, cardiopulmonary bypass time was 159.2 ± 46.5 minutes,entubation time was 6.7± 1.9 hours, intensive care unit(ICU) stay was 1.2± 0.6 days, hospital stay was 5.3± 2.7 days. Conclusion CABG via left anterior thoracotomy is equally effective as traditional sternotomy but less invasive,quick recovery and is so promising in terms of less morbidity and mortality. It might be an alternative to sternotomy incision and percutaneous techniques