Methods of minimally invasive total arterial CABG through a 2-in left minithoracotomy incision with the BITAs harvested under direct vision total arterial revascularization of the myocardium was done using the LITA-RITA Y composite conduit and surgical and postoperative techniques are also included. Surface marking of the RITA and the LITA were done using avascular Doppler and skin-marking pencil. The LITA was anastomosed to the LAD, and the RITA Y was used for sequential grafting of the circumflex and inferior wall vessels. Minimally invasive total arterial CABG, the operation was completed without conversion in 408 patients and mean number of grafts was 3.1. The approach for minimal access coronary bypass surgery has been an anterior approach for grafting of the left anterior descending artery with a pedicled ITA conduit.