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.

Part I. Physiology of Coronary Bypass Grafting With and Without Cardiopulmonary Bypass

Pathophysiology of Cardiopulmonary Bypass
Ron G. H. Speekenbrink, Wim van Oeveren, Charles R. H. Wildevuur, and León Eijsman

Endothelial Injury During Minimally Invasive Bypass Grafting
Robert J. Dabal, Craig R. Hampton, and Edward D. Verrier

Part II. Minimally Invasive Coronary Bypass Grafting

Minimally Invasive Bypass Grafting: A Historical Perspective
Enio Buffolo and Luís Roberto Gerola

Tailoring Minimal Invasive Coronary Bypass to the Patient
Michael A. Borger and M. Anno Diegeler

OPCAB: A Primer on Technique
John D. Puskas

Mechanical Stabilization: The Medtronic Octopus System
Michael Gibson, Robert B. Beauford, and Daniel J. Goldstein

Mechanical Stabilization Systems: The Genzyme-OPCAB Elite System
William E. Cohn and Marc Ruel

Mechanical Stabilization Systems: The Guidant OPCAB System
Marc W. Connolly and Valavanur A. Subramanian

The MIDCAB Operation
Mercedes K. C. Dullum and Albert J. Pfister

Minimally Invasive Coronary Artery Bypass Grafting on the Beating Heart: The European Experience
Antonio M. Calafiore, Michele Di Mauro, Alessandro Pardini, Antonio Bivona, and Stefano D'Alessandro

Minimally Invasive Coronary Artery Bypass Grafting: The South American Experience
Federico J. Benetti and Maximo Guida

Reoperative Off-Pump CABG
Valavanur A. Subramanian, James D. Fonger, and Nilesh U. Patel

Perioperative Evaluation of Graft Patency in OPCAB
Vinod H. Thourani and John D. Puskas

Minimally Invasive Conduit Harvesting
Kevin D. Accola, Mike Butkus, and Brenda Dickey

Hybrid Revascularization
Uwe Klima and Axel Haverich

Neurocognitive Issues in Off-Pump CABG
Ronald M. Lazar and Daniel F.Heitjan

Multivessel Off-Pump Revascularization in High-Risk Patients: Severe Left Ventricular Dysfunction
Daniel J. Goldstein, Robert B. Beauford, Patricia Garland, and Craig R. Saunders

Multivessel Off-Pump Revascularization in High-Risk Populations: Octogenarians
Frederic Sardari, Robert B. Beauford, and Daniel J. Goldstein

Part III. Minimally Invasive Valvular Surgery

Minimally Invasive Mitral Valve Surgery
Victor F. Chu, L. Wiley Nifong, and W. Randolph Chitwood, Jr.

Port-Access Mitral Valve Surgery
Ashish S. Shah and Donald D. Glower

Minimally Invasive Aortic Valve Surgery
Jerome Sepic and Lawrence H. Cohn

Part IV. Minimally Invasive Congenital, Pericardial, and Arrhythmia Surgery

Strategies for Reducing Trauma in Congenital Heart Surgery
Redmond P. Burke and Robert L. Hannan

Thoracoscopic Pericardial Surgery
P. Michael McFadden

Less Invasive Surgical Treatment of Atrial Fibrillation
Mathew R. Williams and Michael Argenziano

Part V. Miscellaneous Aspects of Minimally Invasive Cardiac Surgery

The Economic Impact of Minimally Invasive Cardiac Surgery
Aftab R. Kherani, Elizabeth H. Burton, and Mehmet C. Oz

Minimally Invasive Cardiac Surgery: Quality-of-Life Issues
Giulio Pompilio, Francesco Alamanni, and Paolo Biglioli

Experimental Percutaneous Mitral Valve Repair
Juan P. Umaña and Peter Fitzgerald

Alternative Anastomotic Techniques
David A. D'Alessandro and Mehmet C. Oz

Making Cardiopulmonary Bypass Less Invasive
James R. Beck, Linda B. Mongero, and A. Kenneth Litzie

Part VI. Robotic Surgery

Robotics and Telemanipulation: The Zeus¿ System
Hersh S. Maniar, Sunil M. Prasad, and Ralph J. Damiano, Jr.

Robotics and Telemanipulation: The da Vinci¿ System
Volkmar Falk, Thomas Walther,