MIDCAB stands for “Minimally Invasive Direct Coronary Artery Bypass.”

In traditional open-heart surgery or bypass surgeries on a beating heart, it is necessary to cut the sternum, also known as the breastbone, to reach the heart. This method requires a large incision, and the postoperative recovery period is extended. Patients cannot lie on their side for at least 1 month, and they need to be very cautious in their movements while sitting, standing, or lying down, often requiring support. This condition significantly prolongs the patient’s return to social life before the surgery and reduces the comfort level. With the MIDCAB technique:

  • The procedure is performed by making an approximately 6 cm incision under the left breast, opening the ribs.
  • The artery, called LIMA, which is essential for bypass surgery, is prepared from this area.
  • Bypass surgery can be performed through this small keyhole-like space by stopping the beating heart or the heart, with the assistance of a heart-lung machine. This technique does not impose any restriction on the number of bypass vessels to be performed, allowing complete revascularization. In other words, all surgical interventions performed with large incisions in traditional surgery can also be performed through this small incision.

Advantages of MIDCAB include:

  1. Faster recovery (1,2,5,6)
  2. Quicker discharge from the hospital (1,2,5,6)
  3. Reduced need for blood and blood products (2,4,5)
  4. Fewer neurological complications (in cases without ascending aorta intervention or in off-pump cases) (1-3,5)

As the average life expectancy continues to rise in our era, and our lifestyles tend to become more sedentary, coronary artery disease is increasing day by day. Consequently, in the coming years, the need for repeat bypass surgeries, 2nd, 3rd, or even 4th times, may arise. When MIDCAB is preferred in the first surgery, it is believed that there will be significantly fewer adhesions, resulting in reduced surgical complications in subsequent heart surgeries.

MIDCAB Advantages: In addition to smaller incisions and wounds

Who Can Undergo MIDCAB? Any patient who is a candidate for bypass surgery can undergo MIDCAB. There are rare exceptions:

  • If there has been a previous treatment similar to radiotherapy
  • If there has been a previous heart surgery due to adhesions
  • If there have been lung surgeries (on the left side)
  • If there is severe calcification in the aorta



1. Al-Ruzzeh S, Mazrani W, Wray J, Modine T, Nakamura K, George S, Ilsley C, Amrani M. The clinical outcome and quality of life following minimally invasive direct coronary artery bypass surgery. J Card Surg. 2004 Jan-Feb;19(1):12-6. doi: 10.1111/j.0886-0440.2004.04003.x. PMID: 15108783.

2. Kettering K, Dapunt O, Baer FM. Minimally invasive direct coronary artery bypass grafting: a systematic review. J Cardiovasc Surg (Torino). 2004 Jun;45(3):255-64. PMID: 15179338.

3. Piątek J, Konstanty-Kalandyk J, Kędziora A, Hyochan Song B, Wierzbicki K, Darocha T, Sobczyk D, Kapelak B. Minimally invasive direct coronary artery bypass (MIDCAB) – safety assessment in own material. Przegl Lek. 2017;74(2):62-5. PMID: 29694007.

4. Zhang L, Cui Z, Song Z, Yang H, Fu Y, Gong Y, Ling Y. Minimally invasive direct coronary artery bypass for left anterior descending artery revascularization – analysis of 300 cases. Wideochir Inne Tech Maloinwazyjne. 2016 Jan;10(4):548-54. doi: 10.5114/wiitm.2015.55842. Epub 2015 Nov 30. PMID: 26865891; PMCID: PMC4729728.

5. Xu Y, Li Y, Bao W, Qiu S. MIDCAB versus off-pump CABG: Comparative study. Hellenic J Cardiol. 2020 Mar-Apr;61(2):120-124. doi: 10.1016/j.hjc.2018.12.004. Epub 2019 Jan 25. PMID: 30685419.

6. Subramanian VA, Patel NU. Current status of MIDCAB procedure. Curr Opin Cardiol. 2001 Sep;16(5):268-70. doi: 10.1097/00001573-200109000-00002. PMID: 11584163.