Backaround: Surgical myocardial revascularization in certain subset of patients carries significantly higher morbidity and mortality. Off pump myocardial revascularization versus revascularization using cardiopulmonary bypass and cardioplegic arrest in these patients remains a matter of debate. We evaluated our results of off pump myocardial revascularization in these palients by comparing them with similar group of patients who underwent off pump myocardial revascularization at another prime institute of the country, Methods: From October 2004 to September 2005, 181 patients were operated for off pump CABG at our institute. Out of these, data for 132 patients having one or more adverse prognostic factors were retrospectively entered into a database. These factors included: • Unstable angina. • Recent acute myocardial infarction. • Severe left ventricular dysfunction • Critical left main coronary artery stenosis. • Diffusely diseased or small or intramyocardial target arteries, • Patients' operated as emergency. Results: Hospital mortality was nil. Mean duration of mechanical ventilatory support was 10.75 hours (Standard deviation of 5.76 hours) Mean duration of ICU stay was 4.22 days. (Standard deviation of 0.89 days) Mean duration of postoperative hospital stay was 8.06 days (Standard deviation 1.18 days) Complications: • Post operative atrial fibrillation in 8 patients (6.06%) • Ventricular tachycardia in 1 patient (0.76%) • Respiratory insufficiency requiring ventilatory support in 2 patients (1.52%) • Pulmonary oedema in 1 patient (0.76%) • Pre-renal azotemia in 1 patient (0.76%) • Myoclonic seizures in 1 patient (0.76%) • Chest wound infection in 1 patient (0.76%) • Leg wound infection in 3 patients (2.27%) • Urinary tract infection in 1 patient (0.76%) Conclusions: Our experience of off pump CABG in high risk patients compares well with published results of contemporary cardiac surgery. in India.Background: Patients above the age of 65 comprise a significant proportion of those being referred for CABG. Total arterial revascularization is often not considered an option owing to their age. We have followed the principle of using only arterial conduits in all patients -whatever the age or gender. Our aim is to study the feasibility and the effects of such a policy.