INTRODUCTION
Coronary bypass surgery without cutting sternal bone sound like description of a cardiac surgery of future but at Ahmedabad this ground breaking advances in surgical treatment of heart disease
is now reality. Fracture created on the sternum hurts patient and worries them the most most of the patient can be discharged from the hospital within 48 to 72 hrs, and return to full activity within a week or two.

Recommendations for Keyhole(MIDCAB) bypass
surgery should be perform if any of the below
criteria are met.

· Patient with very old age particularly female because of
osteoporotic bone.
Patient who is engaged in manual labors.
· Patient with failed angioplasty with CTO lesions.
· Patient with double vessel disease.
· Patient with triple vessel disease.
· Patient with LMCA with triple vessel disease.
· Patient with compromise LV with triple vessel disease.
· Patient with very bad LV function with Tripple vessel disease in
whom CABG+stem cell therapy is indicated.
· Patient with very bad LV function with triple vessel disease in
whomCABG+TMR is indicated.
· Patients with CABG+AVR.
· Patient with CABG+MVR.
· Following are NOT contraindication to Keyhole surgery.
· Very obese patient.
· Very old patient.
SYNONYMS:
Keyhole surgery, Minimally invasive cardiac surgery, sternal sparing
heart surgery, Video assisted cardiac surgery, port access heart
surgery.