In 1962, Thomas Kuhne coined the term ¿paradigm shift¿ while arguing that human knowledge advances by quantum leaps with interspersed smaller steps. Preparation for the major advance is generally not a concerted effort by thought leaders. Rather, a few (or one) visionaries gain insights into a process and are able to definitely demonstrate the accuracy of their worldview. Often, the epiphany does not occur during the intellectual lifetime of the discoverers. Medicine has had numerous such ¿paradigm shifts¿ including the compelling reworking of Galen¿s concepts of the body. Of note, the scientific world of the time explained the new views by arguing that the human body must have changed between the time of ancient Greece and modern Europe. The inauguration of cardiac surgery itself required profound shifts in medicine¿s view of physiology. Yet, over the ensuing 40 years, the field was fine tuned so we could provide greater than 95% success rates in elective surgery with low cost and short h- pital stays. In some parts of the world, the procedures were viewed as commodities and prices dropped as providers were unable to differentiate the quality of their work. As patients and their physicians became more demanding, the desire to make the procedures ¿minimally invasive¿ grew. In effect, what we were really searching for was a life saving procedure that also preserved quality of life. In short, ¿minimally invasive¿ has really been a code phrase for procedures that disrupt our quality of life the least.

I Physiology of Coronary Bypass Grafting With and Without Cardiopulmonary Bypass.- 1 Pathophysiology of Cardiopulmonary Bypass.- 2 Endothelial Injury During Minimally Invasive Bypass Grafting.- II Minimally Invasive Coronary Bypass Grafting.- 3 Minimally Invasive Bypass Grafting: A Historical Perspective.- 4 Tailoring Minimal Invasive Coronary Bypass to the Patient.- 5 OPCAB: A Primer on Technique.- 6 Mechanical Stabilization: The Medtronic Octopus System.- 7 Mechanical Stabilization Systems: The Genzyme-OPCAB Elite System.- 8 Mechanical Stabilization Systems: The Guidant OPCAB System.- 9 The MIDCAB Operation.- 10 Minimally Invasive Coronary Artery Bypass Grafting on the Beating Heart: The European Experience.- 11 Minimally Invasive Coronary Artery Bypass Grafting: The South American Experience.- 12 Reoperative Off-Pump CABG.- 13 Perioperative Evaluation of Graft Patency in OPCAB.- 14 Minimally Invasive Conduit Harvesting.- 15 Hybrid Revascularization.- 16 Neurocognitive Issues in Off-Pump CABG.- 17 Multivessel Off-Pump Revascularization in High-Risk Patients: Severe Left Ventricular Dysfunction.- 18 Multivessel Off-Pump Revascularization in High-Risk Populations: Octogenarians.- III Minimally Invasive Valvular Surgery.- 19 Minimally Invasive Mitral Valve Surgery.- 20 Port-Access Mitral Valve Surgery.- 21 Minimally Invasive Aortic Valve Surgery.- IV Minimally Invasive Congenital, Pericardial, and Arrhythmia Surgery.- 22 Strategies for Reducing Trauma in Congenital Heart Surgery.- 23 Thoracoscopic Pericardial Surgery.- 24 Less Invasive Surgical Treatment of Atrial Fibrillation.- V Miscellaneous Aspects of Minimally Invasive Cardiac Surgery.- 25 The Economic Impact of Minimally Invasive Cardiac Surgery.- 26 Minimally Invasive Cardiac Surgery: Quality-of-Life Issues.- 27 Experimental Percutaneous Mitral Valve Repair.- 28 Alternative Anastomotic Techniques.- 29 Making Cardiopulmonary Bypass Less Invasive.- VI Robotic Surgery.- 30 Robotics and Telemanipulation: The ZeusTM System.- 31 Robotics and Telemanipulation: The da VinciTM System.- 32 Totally Endoscopic Atrial Septal Defect Repair with Robotic Assistance.