Cardiac surgery in patients already implanted with subcutaneous implantable cardioverter defibrillators (S-ICD) represents a challenge. Although a few reports described successful surgical procedures in these patients, a traditional approach with median sternotomy might potentially cause S-ICD malfunctioning. Minimally invasive techniques (e.g. left anterior thoracotomy) should be considered the first choice in order to preserve the integrity of the S-ICD system in suitable patients. Herein, we provide the first report of a patient implanted with S-ICD due to post-ischemic left ventricular dysfunction who underwent successful minimally invasive direct coronary artery bypass (MIDCAB).