Background: Coronary artery bypass grafting (CABG) without cardiopulmonary bypass is one of the alternative with an intention to avoid all the complications related to extracorporeal circulation. Off pump CABG (OPCABG) is associated with various hemodynamic alterations and its management is really challenging.

Methodology: The objective of our case series is to study the hemodynamic changes during each artery grafting, its complications and its management. In this study we have studied 27 patients who underwent OPCABG. Heartrate, blood pressure and cardiac output were measured during each grafting and analyzed. The major complications that occurred and its management are discussed.

Result: The heartrate and blood pressure significantly decreased during LAD, OM and RCA grafting compared to the baseline. The cardiac output decreased significantly during OM and RCA grafting. One patient had intra-operative myocardial ischemia. One patient had cardiac arrest in the ICU followed by LAD and LCX graft revision. Two patients had increased post-op bleeding and taken for re-exploration.

Conclusion: Hemodynamic management of OPCABG is always challenging but feasible to manage. All the patients tolerated the hemodynamic changes well and had a good post-operative outcome.