The road to better outcomes: keyhole heart surgery

Written by: Mr Inderpaul Birdi
Edited by: Cal Murphy

Coronary bypass surgery has traditionally been a major procedure that involves breaking the breastbone to open the chest and reach the heart. However, modern surgery can employ minimally invasive approaches that can lower the risks and reduce the recovery time of these operations. Mr Inderpaul Birdi is here to explain the minimally invasive direct coronary artery bypass (MIDCAB).

Model of a heart

What is a minimally invasive direct coronary artery bypass?

Minimally invasive direct coronary artery bypass (MIDCAB), also called minimally invasive direct coronary artery revascularisation, is a procedure that combines beating heart surgery and keyhole surgery. As such, it requires a skilled surgeon well-versed in both techniques. It involves making a small incision on the chest, through which the surgeon can operate on the heart.

MIDCAB is most commonly used to treat isolated disease of the left anterior descending artery (LAD), which is a major branch of the left coronary artery.


What is the difference between traditional and minimally invasive procedures?

The differences are as follows:

Open heart surgery

Open surgery:

  • It is necessary to break the breast bone.
  • 3-month recovery
  • Unable to do heavy lifting for 12 weeks
  • Mild to moderate pain
  • Small risk of bone infection
  • May leave a significant scar



  • No broken boneKeyhole heart surgery
  • Recovery takes around a week.
  • You can resume activity within days.
  • No bone infection risk
  • Minimal pain
  • Minimal scarring


Hybrid keyhole coronary artery surgery

The benefits of keyhole revascularisation can be further exploited in a therapy called hybrid coronary artery bypass grafting. This involves a second procedure to treat any remaining narrowed arteries using stents inserted via the MIDCAB opening. It can be performed immediately after the MIDCAB procedure or at a later time.

According to a recent article published in The Journal of the American College of Surgeons, hybrid coronary revascularisation is associated with:

  • Reduced rates of in-hospital major morbidity
  • Less blood loss/chest tube drainage
  • Reduced need for blood transfusions
  • Shorter post-operative stay

Hybrid therapies using keyhole techniques like this can be useful in treating coronary disease and valve disease.


Visit Mr Birdi’s Top Doctors profile to book an appointment.

By Mr Inderpaul Birdi
Cardiothoracic surgery

Mr Inderpaul Birdi is an experienced traditional and keyhole (minimally invasive) heart surgeon. He works privately at The Keyhole Heart Clinic where he carries out keyhole mitral, aortic and tricuspid valve surgery, coronary bypass surgery, TAVI, atrial fibrillation ablation and general cardiac surgery. He is also one of only a handful of surgeons in the world who can perform keyhole coronary bypass surgery, and keyhole aortic valve repair. He founded The Keyhole Heart Clinic to provide patients with information and clinical access to specialised minimally invasive cardiac therapies within the most prestigious hospitals in the UK. 

Mr Birdi trained in medicine in the UK and trained in cardiothoracic surgery at the world acclaimed Royal Papworth Hospital. He undertook research at The Bristol Heart Institute and contributed numerous publications to leading international journals. 

Alongside his private practice, the lead consultant for minimally invasive cardiac surgery at The Essex Cardiothoracic Centre which provides both NHS and private facilities and delivers one of the largest keyhole valve programs in the UK. He also works at The Harley Street Clinic and The Wellington Hospital, London.

Mr Birdi is now leading a team to develop a world-class robotic cardiac surgery program in the UK. He is involved in several multi-centre randomised trials as a primary investigator and involved with many world-class clinicians in a wide array of clinical specialities, tasked to develop international VIP clinical services in the United Kingdom. He is a member of the International Society of Minimally Invasive Cardiac Surgery and the Royal Society of Medicine.

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