ObjectiveTo evaluate the safety of a less traumatic surgical approach in minimally invasive direct coronary artery bypass (MIDCAB). MethodsWe retrospectively analyzed the clinical data of 70 patients underwent MIDCAB via left anterior small thoracotomy between May 2012 and August 2013. There were 60 male and 10 female patients with a mean age of 56.8±9.2 years (ranged 44-76 years), with single vessel disease (left anterior descending artery) in 42 patients,and double or three vessels disease in 28 patients (include left main vessel disease). ResultsThe procedure were successfully completed in all 70 patients. No operation-related death or complication occurred. The extubation time was 4-16 (9.7±5.2) hours. The ICU time was 10-24(20.8±10.8)hours. They were followed up for 1-14 months. No deaths or angina or myocardial infarction occurred. Postoperative coronary angiography in 17 patients found no restenosis. ConclusionMIDCAB via left anterior small thoracotomy can be performed safely by using the new left internal mammary artery (LIMA) harvesting system.