Davierwala PM, Verevkin A, Bergien L, et al. - This study was performed with the aim to assess and analyze the early and long-term outcomes of a large cohort of patients undergoing minimally invasive direct coronary artery bypass (MIDCAB) procedures for isolated complex left anterior descending coronary artery (LAD) disease. In addition, researchers investigated the effects of changing trends in patient characteristics on early mortality. They identified a total of 2,667 patients, who underwent MIDCAB procedures, and divided them into 3 groups based on the year of surgery: Group A- 1996-2003 (n = 1,333); Group B- 2004-2010 (n = 627) and Group C- 2011-2018 (n = 707). Overall patients were older with more cardiac risk factors and comorbidities in Group C relative to those in groups A and B. Findings suggest that it is safe to perform MIDCAB with very good early and long-term outcomes. Over the 22-year period of the study, despite worsening demographic profile of patients, in-hospital mortality remained constant.