Coronary artery bypass surgery (CABG) in dextrocardia with situs inversus patients is comparatively rare in literature. Abnormalities in the embryonic cardiac loop and other associated congenital anomalies pose challenges in both anaesthesia and surgery. We describe, a successful elective off pump total arterial revascularization coronary artery bypass surgery with RIMA-LIMA en Y configuration with 5 distal anastomosis were performed in a 64-year-old patient with dextrocardia, situs inversus and triple vessel coronary artery disease. The peri-operative periods were uneventful. This report highlights the feasibility, benefits and relative ease of Off-pump RIMA-LIMA en Y graft in such patients