Minimally invasive direct coronary artery bypass surgery (MIDCAB) is now an accepted technique of myocardial revascularization in selective cases of coronary arterial occlusive disease. A 55-year-old male admitted for frequent anterior chest pain who was heavy alcoholics and smoker. The lesion was nearly total (95%) occlusion of proximal left anterior descending artery. We herein report a case of successful MIDCAB with mini-sternotomy approach to left anterior descending artery in which we used propofol for induction and maintenance, additionally, adenosine and esmolol for ischemia management and providing a slower rate and hence a "quieter" field for the surgeon to work.