Researchers evaluated long-term outcomes after on-pump (ONCAB) and off-pump (OPCAB) coronary artery bypass grafting in 2,935 patients treated between 1999 and 2016. After propensity score matching, 402 OPCAB patients were compared with 804 ONCAB patients over follow-up extending nearly 24 years. Survival and cardiovascular mortality were similar between groups, suggesting that when performed by experienced surgeons and appropriately selected patients, both techniques provide comparable long-term outcomes.