To avoid the inflammatory syndrome generated by cardiopulmonary bypass, a new surgical technique, minimal invasive direct coronary artery bypass (MIDCAB), has been developed. An anastomosis is performed between the left internal mammary artery (LIMA) and the left anterior descending artery (LAD) on a beating heart, through a limited anterior thoracotomy. We describe our experience with this technique. Ten consecutive patients underwent a MIDCAB procedure. (9 males, age 65.9 +/- 9 years). There were 8 bypasses of the LIMA on the LAD, one bilateral mammary bypass on the LAD and the right coronary artery, and one conversion to a standard sternotomy with CPB for a saphenous vein bypass on the LAD because of injury to the LIMA (2nd case). There was one redo for haemostasis of the mammary artery bed (3rd case). The first 3 patients required postoperative blood transfusion. From the 4th operation onwards, with the introduction of new instrumentation which was better adapted to the narrowness of the surgical field, there were no further surgical complications. During the follow-up (mean 5 months; range 2-9), no patient suffered anginal recurrence. With the improvement of instrumentation, the MIDCAB technique offers satisfactory short- and mid-term results, while avoiding CPB with its adverse effects. Lastly, the cosmetic result is far better than with the conventional procedure.