An 86-year-old male underwent minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass, for severe triple-vessel coronary disease. Left descending coronary artery was anastomosed with the in situ left internal thoracic artery through a limited anterior thoracotomy, and right coronary artery was anastomosed with the in situ right gastroepiploic artery through a small upper laparotomy. The postoperative angiography showed patent grafts, and the patient has been doing well without any complications. MIDCAB is a useful technique even for multivessel coronary diseases in selected cases.

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