| Summary: | Background: Minimally invasive direct coronary artery bypass (MIDCAB) surgery offers advantages over off-pump coronary artery bypass (OPCAB), including reduced trauma and faster recovery. However, differences in perioperative cardiac rehabilitation (CR) outcomes between MIDCAB and OPCAB remain unclear. This study compared perioperative clinical characteristics, surgical features, and CR outcomes in patients undergoing MIDCAB versus OPCAB. Methods: This retrospective cohort analysis included 304 patients (31.2% MIDCAB, 68.8% OPCAB) who participated in a CR program, including the 6-min walk test (6MWT), from November 2023 to December 2024. Results: MIDCAB patients had shorter surgery times, fewer grafted vessels, shorter ventilator-assisted time, less total intraoperative fluid, less bleeding, and shorter postoperative hospital stays (all <i>p</i> < 0.05). After cardiac rehabilitation, MIDCAB patients showed shorter time to 6MWT, longer six-minute walk distance (6MWD) (200 ± 125 vs. 178 ± 125 m), higher 6MWD relative to predicted values, and greater metabolic equivalents (all <i>p</i> < 0.05). The median LVEF of MIDCAB patients was the same as that of OPCAB patients (<i>p</i> < 0.05). Conclusions: Our study demonstrates that MIDCAB patients exhibit superior exercise capacity following cardiac rehabilitation.
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