The coronary arteries are responsible for supplying the heart with oxygen-rich blood. Pathological and calcified narrowing of the coronary arteries leads to reduced blood flow to the affected heart tissue and, in the worst case, to a heart attack and death of the affected heart muscle. If such a narrowing of the coronary arteries is diagnosed, bypass surgery is necessary. In this procedure, the body's own vessels are harvested and used as bridging graft material to supply the inadequately perfused heart tissue with sufficient blood again.

In minimally invasive bypass surgery, there are two types of procedure that can be performed on the beating heart:

1. Bypass surgery without use of a heart-lung machine is called “off-pump” or “beating heart” bypass surgery (OPCAB). This procedure involves opening the chest (sternotomy).

2. Minimally invasive direct coronary artery bypass surgery (MIDCAB) is an advanced technique for the treatment of coronary heart disease. In this method, surgical access is performed via a four-centimeter-long skin incision on the left side between the ribs at the level of the fourth intercostal space. Endoscopic removal of the body's own vessels is first performed using a 3D camera and special surgical instruments. The narrowed coronary vessels are then bridged by using the removed arteries and/or veins to ensure that the blood supply to the affected heart muscle is fully restored.

Whether OPCAB or MIDCAB surgery is suitable for the patient as a surgical approach depends mainly on the individual clinical condition of the patient and the decision of the cardiac surgeon.

Overall, minimally invasive bypass surgery offers a promising alternative to conventional open heart surgery and has the potential to significantly improve recovery for patients with coronary heart disease.