**5. Conclusion**

In conclusion, for high-risk patients, such as those with acute coronary syndrome, cardiogenic shock or with left ventricular dysfunction, the OPBHC seems to be a valid alternative to the off-pump and on-pump CABG techniques, reducing early mortality and decreasing the risk of postoperative complications such as myocardial ischemia or stroke. In particular, the OPBHC could provide an acceptable trade-off in cases of severe complications caused by cardioplegic arrest or manipulation of the heart. Although this technique is still in a rising phase, there are several studies and secondary research supporting its benefits, and we advocate its introduction in future guidelines for revascularization. However, more analyses are needed to develop a common consensus to overcome the blind spots (such as its long-term clinical impacts) that are preventing its adoption as a recognized technique worldwide.
