Minimally invasive cardiac surgery defined.

There is no operation as complex, yet as fundamentally unchanged over time, as conventional coronary artery bypass grafting (CABG). This remarkable achievement is attributed to the operation's adaptability to a wide variety of clinical settings; its reproducibility, although performed by surgeons all across the world; and its proved track record for safety and effectiveness. A monumental effort, however, is currently under way to redefine CABG. This paradigm shift has received a groundswell of support as advances in minimally invasive surgery in other areas, such as arthroscopy, laparoscopic cholecystectomy, and thoracoscopy, combined with an increasing focus on cost containment, have forever changed the milieu of the cardiac surgeon. This review examines the clinical and research issues surrounding minimally invasive CABG from the vantage point of a surgeon-scientist working in the field.