In a recent attempt to resolve a 4-decade debate over the benefits of off-pump versus on-pump coronary artery bypass surgery (CABG), 12 surgeons including 10 predominantly off-pump surgeons conducted a systematic literature review following American College of Cardiology and American Heart Association standards for the development of clinical guidelines (1). Based on their analysis of 102 randomized trials, they concluded that off-pump surgery may improve short-term outcomes such as renal failure and stroke, but “off-pump may be associated with reduced graft patency, and increased risk of cardiac reintervention and death.” The paucity of long-term data contributed to uncertainty over whether late outcomes differed significantly after on-pump versus off-pump surgery. That remaining question is addressed in a meta-analysis published in this issue of the Journal, which analyzed 6 randomized trials including 3 large multicenter studies and 8,145 participants, reporting a small but persistent survival benefit with on-pump CABG surgery compared with off-pump CABG surgery at 5 years (2).