Aim To probe into clinical application value of off-pump coronary artery bypass grafting（OPCABG） in elderly patients with coronary heart disease. Methods Selected from January 2010 to December 2012, 308 elderly patients with coronary heart disease were treated with coronary artery bypass grafting （CABG） in our department. According to the surgical approach, the patients were divided into on-pump CABG group （32 cases） and off-pump CABG group （276 cases）. The therapeutic effects of the patients with CABG in two groups were compared and analysed. Results Compared with on-pump CABG group, the mortality in 30 days, number of bypass vessels, rate of reoperation, incidence of acute renal failure, respiratory failure and new onset atrial fibrillation, blood transfusion, incidence of cerebral infarction and pulmonary infection were significantly reduced in off-pump CABG group, and ventilator time, intubation time and stayying-inhospital time were significantly shorter, which were statistically significant （P<0.05）. Conclusions Off-pump CABG could improve the effect effectively， reduce the mortality and the incidence of complications for the elderly patients with coronary heart disease. It could be used as the preferred method of surgical treatment for elderly patients with coronary heart disease and promote the further application.