Off-pump versus on-pump coronary artery bypass surgery: it still remains a matter of debate which method results in a lower incidence of perioperative morbidity and mortality. This case-matched study evaluates the outcome of elderly patients in both groups.All patients aged 75 and older, who underwent CABG from 1998 to 2002, were examined retrospectively. They were matched according to Euroscore and the number of diseased vessels. The Student's t-test and chi-square test were used where appropriate.270 CABG patients were considered: 135 off-pump and 135 on-pump patients. Mean age was 78.4 +/- 3.1 versus 77.5 +/- 2.9 years, respectively. EuroSCORE was 7.11 +/- 2.3 in both groups; number of distal anastomoses per patient 1.7 +/- 0.74 versus 2.6 +/- 0.63 (p < 0.001), operation time 138 versus 177 minutes (p < 0.001). There were no significant differences in postoperative complications including hospital mortality 3.0 versus 3.7%, renal failure 8.9 versus 12.1% (new onset), acute myocardial infarction 1.5 versus 4.4% and cerebral events 0 versus 1.5%, respectively. The number of transfused packed cells was 2.6 +/- 2.8 versus 4.6 +/- 5.3 (p < 0.001). Intubation time and ICU stay were similar in both groups.OPCAB is not associated with a reduction of perioperative mortality and morbidity in patients aged 75 and older.