Minimally invasive coronary bypass in the UK, by a consultant cardiothoracic surgeon.
A beating-heart LIMA-to-LAD bypass through a 5–8cm cut between the ribs - MIDCAB, robotic TECAB or a hybrid strategy with PCI. The durability of the LIMA graft, without a sternotomy, at UK centres that do this in volume.
Indicative pricing
What MIDCAB, TECAB and hybrid coronary bypass cost privately in the UK.
Indicative ranges across UK high-volume centres.
In short
£22,000–£40,000, ward stay 3–5 days.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| MIDCAB (mini-thoracotomy LIMA–LAD) | £22,000–£40,000 | 2–3 hours | 3–5 day stay |
| TECAB (robotic totally endoscopic CABG) | £35,000–£55,000 | 3–5 hours | 3–5 day stay |
| Hybrid revascularisation (MIDCAB + PCI) | £25,000–£45,000 | Same or staged | 3–6 day stay |
| Conventional sternotomy CABG (comparison) | £20,000–£38,000 | 3–5 hours | 5–7 day stay |
| Coronary CTA + angiogram work-up | £1,200–£3,000 | Half-day | Same week |
| Consultation with cardiothoracic surgeon | £300–£500 | 45 min | Same visit |
Prices vary by centre, by which surgeon does the case, by whether the anaesthetic is standard or complex, and by whether a hybrid PCI stage is included. NHS care is funded via SCTS pathways.
The problem
The right operation, at the right centre, for your anatomy.
MIDCAB, TECAB and hybrid revascularisation are only genuine choices at UK centres that do them in volume - and only for the right coronary anatomy. Elsewhere it defaults to a sternotomy by habit.
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Isolated LAD disease?
MIDCAB is often the honest answer - the LIMA graft has above 95% patency at 10 years, without a sternotomy.
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Multi-vessel disease?
A hybrid MIDCAB plus PCI may avoid the sternotomy - but complex three-vessel disease is still best served by conventional CABG.
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High-risk or redo?
Fragile, obese, respiratory-compromised or a previous sternotomy - a lateral approach can be the safer route in the right hands.
When it helps
When MIDCAB or a hybrid strategy is the right step.
The situations seen most often, the ones better suited to conventional CABG, and the one red flag that means an emergency rather than an appointment.
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Isolated proximal LAD stenosis
A tight lesion in the proximal left anterior descending - particularly a left-main equivalent or a complex lesion unsuitable for PCI.
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Hybrid candidate (LAD + non-LAD disease)
MIDCAB for the LAD plus PCI to circumflex or RCA - the durable LIMA–LAD graft without a full sternotomy.
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Redo cardiac surgery
A previous sternotomy where re-opening the chest carries real risk - a lateral approach avoids the scarred midline.
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Fragile patient physiology
Elderly, obese or respiratory-compromised patients where the morbidity of a full sternotomy and bypass is a genuine concern.
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Off-pump preferred
High-risk patients - heavily calcified aorta, prior stroke, renal impairment - where avoiding cardiopulmonary bypass is the priority.
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Patient preference for smaller incision
For the right anatomy, a 5–8cm submammary scar and faster return to work is a reasonable, informed choice.
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Not for complex multi-vessel disease
Three-vessel or left-main disease needing complete revascularisation is still best served by conventional sternotomy CABG.
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Red flag: acute coronary syndrome
Ongoing chest pain, rising troponin or a STEMI is an emergency - 999 or A&E now, not a private clinic booking.
Procedure options
MIDCAB is one of several honest options.
What each option on the table actually involves - mini-thoracotomy, robotic, hybrid, or a conventional sternotomy - and which fits which anatomy.
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MIDCAB (mini-thoracotomy)
A 5–8cm left submammary incision through the 4th–5th intercostal space, LIMA harvested, beating-heart LIMA-to-LAD anastomosis with a stabiliser. Off-pump. 2–3 hours.
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TECAB (robotic totally endoscopic)
da Vinci robot, three ports, robotic LIMA harvest and anastomosis. Technically demanding - specialist centres only, but comparable outcomes in experienced hands.
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Hybrid revascularisation (HTCR)
MIDCAB LIMA–LAD plus drug-eluting stents to the circumflex or RCA in the same or a staged setting. Increasing UK adoption for multi-vessel disease without a sternotomy.
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Off-pump vs on-pump
MIDCAB is almost always off-pump - avoiding the inflammatory response of cardiopulmonary bypass. TECAB can be either, depending on the centre and case.
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Conventional sternotomy CABG
The gold standard for multi-vessel and left-main disease - a full median sternotomy, multi-vessel bypass, usually on cardiopulmonary bypass. Compared to MIDCAB in the report your surgeon writes.
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Endoscopic LIMA harvest
The internal mammary artery is taken through a small thoracoscopic port rather than open - reducing chest-wall pain and cosmetic footprint.
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Concomitant valve work
MIDCAB does not lend itself to mitral or aortic valve surgery at the same time. If a valve also needs doing, the plan usually shifts to a different approach.
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Consultation only
Safety and recovery
What to expect afterwards - honestly.
MIDCAB is a major cardiac operation - quicker to recover from than a full sternotomy, but the risks of cardiac surgery still apply. The things worth planning are the ITU stay, the rehab timeline, and knowing which symptoms are and are not normal.
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Operative mortality 1–2%
Comparable to conventional sternotomy CABG in appropriately selected patients - for isolated LAD disease at experienced centres.
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LIMA–LAD patency above 95% at 10 years
The durability of the LIMA–LAD graft - the whole reason surgery beats stents for the LAD long-term - is preserved with the minimally invasive approach.
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Conversion to sternotomy in 5–10%
A back-up plan, not a failure. If exposure or the anastomosis is not right, the surgeon will convert to a full sternotomy to keep you safe.
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Atrial fibrillation in 20–30% post-op
Common after any cardiac surgery, usually self-limiting or managed with medication. It does not mean the graft has failed.
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Post-thoracotomy chest-wall pain (10–20%)
Rib-cage discomfort that can linger for weeks or months. Nerve blocks, physiotherapy and simple analgesia are the mainstays.
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Bleeding, pneumothorax, phrenic nerve injury
Less bleeding than a full sternotomy, but the LIMA harvest can cause a small pneumothorax or, rarely, a phrenic nerve palsy affecting the diaphragm.
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MI, stroke, wound infection
The generic serious risks of any coronary revascularisation. Rates are low at experienced centres, and the mini-thoracotomy avoids sternal wound infection specifically.
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Incomplete revascularisation
If your disease is multi-vessel, a MIDCAB alone will not treat the other territories - either a hybrid PCI is planned, or the honest answer is a full sternotomy CABG.
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Red flags after discharge
Fever, spreading redness of the wound, chest pain that returns, heavy bleeding or breathlessness are not normal - call the on-call team or 999 the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whether the approach was MIDCAB, TECAB or hybrid, the note the cardiothoracic surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - ask your care team to explain anything that is unclear.
If anything in the note is unclear, ask the clinician who wrote it or your GP before your review.
- 01 Header
Indication and strategy chosen
Why the operation was done - isolated proximal LAD, hybrid multi-vessel, redo - and which strategy was agreed with you at MDT.
- 02 Technique
Approach, LIMA harvest and anastomosis
Mini-thoracotomy vs robotic, endoscopic vs direct LIMA harvest, on- or off-pump, and how the LIMA-to-LAD anastomosis was constructed.
- 03 Findings
Graft flow, conversion, hybrid plan
Intra-operative graft flow measurements (TTFM), whether conversion to sternotomy was needed, and the timing of any staged PCI in a hybrid plan.
- 04 Impression
Recovery, rehab and long-term follow-up
Read this first: expected recovery, when it is safe to return to driving, work and exercise, cardiac rehab timing, and the antiplatelet and statin plan.
Recognised by major UK insurers
Cover for coronary revascularisation is typically funded when medically indicated, subject to pre-authorisation and centre approval.
Frequently asked
Common questions about MIDCAB, TECAB and hybrid bypass.
Quick answers on candidacy, technique, recovery, risks and cost.
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What is MIDCAB and how is it different from a normal bypass?
MIDCAB (Minimally Invasive Direct Coronary Artery Bypass) is a beating-heart LIMA-to-LAD bypass done through a 5–8cm cut between the ribs on the left side of the chest - no sternotomy, no heart-lung machine. Conventional CABG opens the breastbone and usually uses cardiopulmonary bypass. MIDCAB is only suitable for isolated LAD disease or as part of a hybrid strategy - not for multi-vessel or left-main disease on its own.
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What is TECAB, and is it better than MIDCAB?
TECAB is the totally endoscopic version - three small ports and a da Vinci robot doing the LIMA harvest and the anastomosis. In experienced hands the outcomes are comparable to MIDCAB with an even smaller footprint, but it is technically demanding and only a handful of UK centres do it in volume.
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What is hybrid revascularisation?
A planned combination: MIDCAB LIMA-to-LAD by the surgeon, plus PCI (drug-eluting stents) to the circumflex or right coronary by the interventional cardiologist. You get the long-term durability of the LIMA–LAD graft for the most important vessel, without a full sternotomy for the others. It is increasingly used in the UK for the right multi-vessel patient.
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How much does MIDCAB, TECAB or a hybrid procedure cost privately in the UK?
Roughly £22,000–£40,000 for MIDCAB, £35,000–£55,000 for TECAB, and £25,000–£45,000 for a hybrid MIDCAB plus PCI package. Conventional sternotomy CABG is £20,000–£38,000 by comparison. On the NHS these are SCTS-funded.
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Am I a candidate for MIDCAB rather than a full sternotomy?
MIDCAB is best for isolated proximal LAD disease, hybrid multi-vessel strategies, redo cardiac surgery avoiding re-sternotomy, and fragile patients where the morbidity of a full sternotomy is a real concern. It is not the right operation for three-vessel disease needing complete revascularisation, left-main disease, or complex LAD anatomy that is heavily calcified, small or deep in the muscle.
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How long is the recovery compared to conventional CABG?
Faster across the board: ITU 12–24 hours, ward 3–5 days (vs 5–7 for sternotomy), office work at 4–6 weeks (vs 8–12), driving at 4–6 weeks per DVLA guidance, full recovery 2–3 months. Cardiac rehab starts at 6–8 weeks.
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What are the risks of MIDCAB?
Operative mortality is 1–2%, comparable to sternotomy CABG. Specific risks include bleeding (less than sternotomy), a 5–10% chance of conversion to a full sternotomy for safety, pneumothorax, phrenic nerve injury, post-thoracotomy chest-wall pain in 10–20%, atrial fibrillation in 20–30%, and the generic risks of MI, stroke and wound infection.
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How durable is the LIMA-to-LAD graft?
The LIMA-to-LAD graft has patency above 95% at ten years - that number is why surgery beats stenting for the LAD long-term. MIDCAB and TECAB preserve that durability, they just deliver the same graft through a smaller incision.
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Can MIDCAB be done at the same time as valve surgery?
Generally no. The mini-thoracotomy approach does not give the exposure needed for concomitant aortic or mitral valve surgery. If you need a valve too, the plan usually shifts to a different minimally invasive approach or to a full sternotomy.
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When should I call 999 rather than the clinic?
Ongoing crushing chest pain, breathlessness at rest, collapse, or heavy bleeding from the wound after discharge are all 999 or A&E, not a clinic call. Fever, spreading wound redness or a graft-related concern warrants the on-call cardiothoracic team the same day.
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