Background: Coronary artery bypass graft surgery without cardiopulmonary bypass (CPB) is an alternative technique for myocardial revascularization. Aim: To report the early results and 4 years follow up of the first 220 cases operated with this technique. Patients and Methods: Descriptive study of 220 patients aged 60.6 +/- 8.8 years (171 men) undergoing off-pump coronary surgery between 2004 and 2008. One hundred seventy six (80%) patients had hypertension, 59 (26.8%) had diabetes, 86 (39%) dyslipidemia and 85 (38.6%) were smokers. One hundred forty one patients (64.1%) had stable angina. Fifty four (24.5%) had a recent infarction (< 90 days) and 46 (20.9%) had a previous angioplasty. Ejection fraction was <30% in 9 (4.1%), 30% - 50% in 57 (25.9%) and > 50% in 154 (70%). Additive and logistic EuroSCORE were 3.32 and 3.55% respectively. We studied the complications and mortality at 30 days. Long term follow up (late mortality and major cardiovascular events such as myocardial infarction (MI) stroke and re-intervention were assessed using data of medical records and National Identification Registry Service until June 30, 2011. Results: A total of 481 bypasses were performed (2.27 bypasses/patient). There were 4 (1.8%) conversions and no incomplete revascularization. Post-Operative complications occurred in 42 patients. Eight neurological (five strokes), five renal (two required dialysis), 16 cardiovascular (four myocardial infarctions), 15 surgical and 11 infections. Three patients died (1.36%). After a follow up of 4.26 +/- 1.02 years, overall survival was 92.3%, and survival free of myocardial infarction, stroke or re -intervention was 96.8%, 96.8% and 95.9% respectively. Conclusions: Off-pump coronary surgery in selected patients has immediate and late results comparable to traditional surgery.