Minimally invasive direct coronary artery bypass (MIDCAB) is a minimally invasive version of the traditional coronary artery bypass graft (CABG). Like CABG, MIDCAB creates a detour for blood to flow around a blocked coronary artery. Unlike conventional CABG surgery, however, the patient’s chest is not fully opened. Instead, the surgeon works through a smaller incision in the side of the chest. MIDCAB surgery may be performed with or without the use of the heart-lung machine.

MIDCAB surgery is used to treat the symptoms of coronary artery disease. By bypassing blockages in diseased coronary arteries, surgeons are able to reestablish blood flow to the heart. This will relieve such symptoms as angina (chest pain, pressure or discomfort) and lower the risk of heart attack or other potentially fatal events.

MIDCAB was developed as a less-invasive approach toward bypass surgery. Because a smaller incision is used, patients recover more quickly, with less trauma and lost time as compared to conventional CABG. Recovery time after MIDCAB is comparable to the recovery time after balloon angioplasty (3 to 7 days) versus the two weeks that are common after conventional CABG. Within two weeks, many MIDCAB patients can return to normal activities.

However, there are a number of drawbacks to MIDCAB. Because the surgeon is working through a smaller incision, the technique is only available for coronary artery disease that occurs in one artery. Multi-vessel disease cannot usually be treated with MIDCAB alone. This shortcoming has been addressed to some extent by the development of hybrid techniques that use MIDCAB surgery in conjunction with balloon angioplasty. In addition, MIDCAB is more technically demanding.