Recently, a variety of novel approaches and ingenious techniques have been developed in an attempt to make cardiac surgical procedures less invasive.1 Many of these methods remain largely experimental, yet one procedure seems to have been rapidly accepted by cardiac surgeons. In minimally invasive direct coronary artery bypass (MIDCAB) the heart is approached via a right or left anterior mini-thoracotomy through which an internal mammary artery is harvested and anastomosed to the targeted coronary artery under direct vision without the use of cardiopulmonary bypass.2 ,3 Even though the MIDCAB procedure has been used for complex cases, the most common clinical use of MIDCAB has been for single vessel disease, predominantly involving the left anterior descending coronary artery. Indeed, several recent reports have claimed that the clinical outcome of patients managed with this approach is favourable.2-4

Not surprisingly, there are calls for randomised controlled trials of MIDCAB against …