A 68-year-old diabetic male patient was urgently admitted to our hospital due to progressive changes in consciousness, ten years after having had OPCAB surgery (LIMA-LAD Bypass) via full sternotomy. The cranio-CT revealed a hemorrhagic metastasis-suspicious mass (8 × 15 × 12 mm) in the right superior temporal gyrus on the posterior wall of the Sylvian fissure. Neurosurgery was performed by microsurgical technique. On the 10th postoperative day, the patient developed sepsis with cardiopulmonary decompensation and cardiorenal syndrome requiring dialysis. The transesophageal echocardiography revealed high-degree mitral valve regurgitation with an eccentric jet flow, a 10 × 12 × 12 mm vegetation adherent to the P2 and P3 posterior leaflet segments, and tricuspid valve regurgitation grade II with systolic reflux in the pulmonary veins. The coronary angiography revealed a patent LIMA-LAD Bypass, normal RCX and a relevant newly developed 70% stenosis of the RCA in segment 2. After signed consent was obtained, the patient was transferred to the cardiothoracic surgery department and underwent complex minimally invasive cardiac repair on the 14th postoperative day after neurosurgery. Standard general anesthesia was applied. A saphenous vein segment was endoscopically harvested from the left thigh. CPB was initiated after cut-down cannulation of the right femoral artery and vein. The heart was approached via a 6 cm skin incision over the fifth right intercostal space from the anterior to medial axillary line. The pericardium was longitudinally incised 3 cm above the phrenic nerve. A needle vent was placed in the ascending aorta. The camera optics for video-assisted surgery and the Chitwood clamp were prepared through separate stab incisions. Aortic cross-clamping and cardioplegic arrest were instituted. The LIMA-LAD Bypass was not visualized and remained opened during the entire procedure. Hyperkalemic cardiac arrest was induced with cold crystalloid cardioplegic solution and was maintained without difficulties during the procedure performed under mild hypothermia (32 °C). The mitral valve was exposed and inspected through a left atrial incision. The vegetation was removed. An annulus dilatation, endocarditic destruction and flail of the P3 segment were assessed and treated by quadrangular P2-P3 resection, sliding plasty and ring-annuloplasty (Carpentier Edwards Physio Ring 30 mm, Fig. a). The left atrium was closed after the successful water test of the valve function. The RCA was exposed and incised on the crux. The aorto-coronary bypass was implanted during cardiac arrest. Aortic declamping followed and reperfusion was initiated after 185 min of cardiac arrest. Epicardial temporary pacemaker stimulation was applied. Vena cava inferior and superior were clamped and total bypass instituted. The right atriotomy was made on the beating heart on CPB during rewarming in the mid right atrium. A 30 mm Cosgrove-Edwards Band was implanted after accurate sizing. The atriotomy was closed in two layers and total bypass resumed after 32 min. Transition from mechanical pump-assisted circulation to spontaneous heart activity was easily achieved with sufficient blood flow to maintain systemic circulation, under minimal catecholamine support. The transit time flow measurement of the RCA venous bypass revealed 37 ml/min. Transesophageal echocardiography showed normal systolic heart function and atrioventricular valve function without wall motion disturbances. Heparin was antagonized. Central aortic venting and CPB cannulas were removed from the groin. The pericardium was closed, and two chest drainage tubes positioned in the right pleura. The thoracotomy and groin incisions were closed in layers. The total operation time was 331 min. Weaning was instituted and rush spontaneous breathing (CPAP ventilation) could be initiated in the early postoperative phase. After the operation, the patient came in contact with a later COVID-19-positive tested ICU nurse and a routine thoracic RTG examination on the 2nd postoperative day (POD) raised the suspicion of Covid-19 infection. A thoracic CT-scan was performed, and the patient was isolated. Routine testing was performed during the next 7 days. Fungal pneumonia was diagnosed, and a tracheotomy performed on the 9th POD, mobilization and feeding were initiated on the 16th POD after cardiac surgery. The patient was transferred to the rehabilitation center on the 27th POD breathing spontaneously without ventilator support. Full neurologic recovery was achieved on the 29th POD.