The off-pump technique reduces the complications of coronary artery bypass grafting performed with extracorporeal circulatory assistance. This hypothesis was tested by analyzing the results of 53 patients operated with and 48 without cardiopulmonary bypass by a single surgeon (ARR) from February 2001 to September 2001.The angiograms of all the patients scheduled for isolated coronary artery bypass grafting were carefully analyzed and a plan for revascularization made. After sternotomy and inspection of the vessels, a decision was taken to perform the surgery on- or off-pump. All the demographic, operative and postoperative data were prospectively collected and analyzed statistically. Major end-points, such as mortality, perioperative infarction and organ dysfunction, were not different between the two techniques. The incidence of renal and pulmonary dysfunction was similar. There were no neurological problems in either group. In contrast to many reports. bleeding complications and the use of blood products were the same in both groups (1.6+/-2.3 in the on-pump group and 0.8+/-1.7 in off-pump group: p=0.06). The only important difference between the two groups was the incidence of low cardiac output and use of inotropes, being more common in the on-pump group.Off-pump coronary artery bypass grafting is as safe as that done on-pump. The claims of a lower incidence of organ dysfunction and blood product use in the off-pump group were not substantiated in this study. The incidence of low cardiac output and use of inotropes was significantly lower in the off-pump group.