A severely calcified coronary artery demands a special technique in coronary artery bypass surgery. We have successfully developed a "punch-out" technique for a calcified right coronary artery in a dialysis patient. After an incision into the target coronary artery, the calcified arterial wall was resected using a punch to make an oval hole for anastomosis. Limited endarterectomy, which consisted of dissection and removal of the calcified endothelium and media around this hole, preserving the adventitia, enabled the anastomosis. This technique can be used for a severely calcified coronary artery that is unamendable to conventional coronary artery bypass grafting.