Off-pump coronary artery bypass is a safe and effective method of coronary revascularization that avoids the use of cardiopulmonary bypass. Randomized trials, typically enrolling low-risk patients, have shown comparable mortality and reduced morbidity between off-pump and on-pump coronary artery bypass. Larger retrospective analyses suggest improved mortality and a lower incidence of adverse events in patients undergoing off-pump coronary artery bypass. This article reviews the available literature comparing outcomes of patients undergoing on- and off-pump coronary artery bypass surgery.