Demal TJ, Fehr S, Mariscalco G, et al. - Whether there may occur impaired early outcome following on-pump vs off-pump coronary artery bypass grafting (CABG) in patients with a preoperatively estimated high risk of severe perioperative bleeding, was investigated in this study utilizing data from consecutive patients who had isolated CABG from January 2015 to May 2017. This analysis involved 3,548 patients with an elevated risk of severe perioperative bleeding (defined as a WILL-BLEED score ≥4). A total of 721 patients (20.3%) had off-pump surgery. Receipts of more packed red blood cell units, a longer stay in the intensive care unit, and a higher rate of postoperative atrial fibrillation, were found in on-pump patients. A trend towards a higher rate of postoperative stroke was also demonstrated by on-pump patients. Overall, higher morbidity was evident in relation to the use of cardiopulmonary bypass in patients with an elevated risk of bleeding. Off-pump surgery may be beneficial in these patients if complete revascularisation can be ensured.