Abstract: Objective To assess the safety and efficiency of off-pump double grafting in treatment of diffuse anterior coronary descending artery lesion. Methods Of the 36 patients with diffuse anterior coronary descending artery lesion(26 males and 10 females) aged 46-78(63.8±7.3) years who underwent off-pump double grafting in our hospital from October 2008 to December 2012,3 were diagnosed with 2 coronary lesions and 33 were diagnosed with 3 coronary lesions including 8 with main left coronary lesion.Their EuroSCORE score was 5.2±1.4(2-7) and their left ventricular ejection fraction was 32.8%-65.0%(49.4% ±12.2%). Results The operation was successful in all patients without death.Of the 36 patients,26 underwent left mammary internal artery and anterior coronary descending artery bypass,3 underwent radial artery and great sapphenous vein bypass,and 7 underwent anterior coronary descending artery bypass,20 underwent great sapphenous vein and anterior coronary descending artery bypass,16 underwent radial artery and anterior coronary descending artery bypass.The mean number of grafts was 3-5(3.2±0.6).The respiratorassisted ventilation time,ICU stay time,hospital stay time and follow-up time of the patients were 6-16(11.3 ±2.9) h,9-22(16.5± 4.2) h,5-9(6.9±1.4) days and 0.5-4.8(2.8±1.4) years,respectively.All the patients were survived with no angina pectoris occurred. Conclusion Off-pump double grafting is a safe and effective procedure for diffuse anterior coronary descending artery lesion.