Minimally invasive coronary artery bypass grafting (MICS-CABG) has matured into a dependable alternative to median sternotomy, combining durable revascularization with less surgical trauma and faster recovery. We share a decade of experience with over 1,000 surgeries at a high-volume center in Kerala, India, focusing on practical, reproducible strategies that improve safety and outcome. The primary objective is to share innovative techniques, technical pearls, and critical lessons learned in patient selection, operative planning and intraoperative decision-making. Patient-related considerations such as body habitus, coronary anatomy, comorbidities, and gender-specific factors will be discussed, along with a structured approach to evaluating candidates for MICS-CABG. Particular attention will be given to managing a severely diseased or calcified aorta, optimizing exposure through limited thoracotomy, and performing precise proximal and distal anastomoses in a restricted operative field. Detailed tips and tricks for left internal mammary artery harvesting through small incisions, graft handling and configuration will be discussed, including when and how to employ off-pump techniques versus cardiopulmonary bypass. Real-world data from 1,000 cases over 10 years will be highlighted with focused analysis of the most recent 5-year cohort, during which the mean number of grafts per patient was 2.5 ± 0.7 and the average length of hospital stay was 4.8 ± 1.6 days. Conversion to sternotomy and cardiopulmonary bypass utilization rates will be reported and interpreted in the context of contemporary MICS-CABG outcome literature. By integrating technical nuance with longitudinal institutional results, this presentation aims to provide a practical roadmap for surgeons seeking to initiate, refine or expand a MICS-CABG program, ultimately enhancing procedural efficiency and patient recovery while preserving completeness of revascularization.

Jecco Ani Babu completed his MBBS, MRCS (Edinburgh), MNAMS, DrNB (Cardiovascular and Thoracic Surgery) and received advanced cardiothoracic training at Apollo Hospitals, Chennai, India. He is currently working as a Consultant Cardiovascular Surgeon at Caritas Heart Institute, Kerala, India and is pursuing an IACTS fellowship in minimal access cardiac surgery. His clinical interests include minimally access cardiac surgery and advanced coronary revascularization techniques. He regularly publishes articles in national and international peer reviewed journals and is a frequent invited speaker at various cardiac surgery conferences, contributing to the evolving evidence base in cardiac surgical practice.