The learning curve in off pump surgery must be followed due to the fact that beating heart coronary surgery is a completely different operation. Beating heart coronary surgery is truly a team approach. Both the surgeon and the anesthesiologist must work in concert to attain a smooth, safe and efficient operation. A sternotomy is performed. All conduits are harvested as for traditional coronary artery bypass grafting (CABG). The pericardium is opened using a "hockey stick" incision. Another incision is made to complete the reflection of the pericardium from the pulmonary artery to the aorta. The heart is then repositioned with the surgeon's hand and exposure device is placed at the apex of the heart. Additional pericardial sutures may place for positioning as needed for exposure to complete the other anastomosis using stabilizers. The left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft is performed first, after the postero-lateral wall or the right side of the heart can be revascularized. After each anastomosis is performed, measurement of the flow through the conduit is recommended. The chest is closed in the standard fashion. Off pump coronary artery grafting has been established as a safe and effective procedure. It involves a totally different mind-set for the surgeon. Indication for off pump coronary surgery depends on the experience and comfort level of the surgeon. Currently, there are a multitude of devices available for both exposure and stabilization to efficiently perform this operation. Therefore, most patients should be considered candidates for off pump coronary revascularization.