Benetti and Buffolo repopularized off pump surgery (OPCAB), developing the technique and using it in all arteries of the heart with veins and arteries in the different clinical situations inclusive in patients with acute myocardial infarction. Despite my personal experience with more than 2500 cases of off pump conducted in my country and different places of the world during the teaching and education process. In 1997, we started a new approach (xiphoid) to perform the ambulatory off pump surgery (ie, discharging the patient after 24 hours of the operation). Between October 1997 and December 2001, 78 patients were operated on through the xiphoid (lower sternotomy approach). The mean age of the patients was 64.2 years (range 45-78), there were 70% males, and all were class 3-4 according to the Canadian Association. The mortality of the 78 patients was 1% (1 patient), conversion to complete sternotomy was 1% (1 patient), and perioperative infarction was 1% (1 patient). From the 16 patients restudied immediately the patency rate was 100% G A anastomosis. Six patients from this group were discharged during the next 24 hours after the operation. The mortality was 0% and perioperative infarction 0%. With the xiphoid (lower sternotomy approach) we had good initial experience in discharging the patients during the first day. Using the technology that already exists, it is possible to perform multiple arterial grafts with this approach and in the future expand the concept of ambulatory coronary surgery in multiple vessels.