**4.8 Graft patency**

Graft patency after OPCAB may be related to the surgeon's skill level. A previous study by Khan showed a decreased 3-months-graft patency rate in the OPCAB group compared to that in the on-pump group (Khan et al., 2004). However, the article was criticized because of the lack of the surgeon's adequate OPCAB experiences, lack of postoperative antiplatelet therapy with clopidogrel, and failure to use a suction device for stabilization of the heart (Dewey et al., 2004). A recent randomized trial by Puskas (Puskas et al., 2009), and the European study (Widimsky et al., 2004) independently confirmed similar 1-year graft patency rate between OPCAB and on-pump CABG.
