Minimally invasive direct coronary artery bypass (MIDCAB) utilizes a small (4–5 cm) left anterior thoracotomy incision for direct visualization of the diseased coronary artery on the anterior wall of the left ventricle without the use of cardiopulmonary bypass (CPB). Since its first description in 1967 by Kolesov, many variations have been described including single left internal mammary artery (LIMA) to left anterior descending (LAD) coronary bypass, multivessel (including complete) revascularization, robotics, and video-based endoscopic techniques for IMA harvest and revascularization. Finally, hybrid approaches for revascularization (ie, surgical bypass of the LAD coronary artery followed by percutaneous coronary intervention (PCI) of non-LAD targets) utilize the same approach for complex patients needing coronary revascularization. In this article, we will describe the basics of the MIDCAB surgery, emphasizing both the left anterior thoracotomy for the harvest of LIMA and direct anastomosis on a beating heart without CPB. This procedure is done on a 72-year-old patient who had significant long LAD stenosis and presented with effort angina. Following a multidisciplinary “heart team” conference, he underwent a successful MIDCAB and was discharged home on postoperative day 4.