A 71-year-old man who had undergone coronary artery bypass grafting with left internal thoracic artery (LITA) and saphenous vein graft (SVG) 7 years previously was referred to our hospital for dyspnea on exertion. Transthoracic echocardiography (TTE) showed severe aortic stenosis and regurgitation. Contrast-enhanced computed tomography revealed patent LITA anastomosed to the left anterior descending (LAD) coronary artery and SVG to the left circumflex artery near the ascending aorta. Re-operative aortic valve replacement (AVR) was performed via upper partial re-sternotomy through an inverted T-shaped incision. The patent LITA was dissected and clamped successfully with minimal adhesion detachment. Postoperative TTE revealed a patent LITA anastomosed to LAD. No complications occurred, and the patient was discharged on postoperative day 17.