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Technical improvements in coronary revascularization over the past decade have led to a revival of interest in off-pump coronary artery bypass surgery. Cost containment in coronary artery bypass surgery is becoming increasingly important in modern hospital management. Therefore, further savings could be obtained by using a surgical technique able to decrease the fixed direct cost while maintaining clinical quality of care. Economic considerations are an extremely important issue in evaluating the role of off-pump coronary artery bypass grafting in the future of cardiac surgery, as off-pump coronary artery bypass grafting is expected to lower costs by reducing perioperative morbidity and recovery time. However, the acceptance of this procedure as a routine alternative for the treatment of coronary artery disease will depend on both long-term graft patency rates as well as a competitive market cost. This review examines these effects., Introduction Kolessov (1) reported the first experience with coronary artery surgery on the beating heart in 1967, but the technique was soon abandoned with the advent of cardiopulmonary bypass (CPB). [...]