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Objective analyse the outcomes and safety of conversion in off-pump coronary artery bypass (OPCAB), and propose prevention strategies for achieving better surgical results.Methods 93 conversion patients from April 2010 to May 2013 were studied.Among them 80 cases were emergent conversion, 13 cases were selective conversion.Data of mechanical ventilation time, ICU and hospital stay, utilization of circulatory assisted device, operative mortality and morbidity rates were reviewed.Results compare to selective conversion group, emergent converted patients have long mechanical ventilation time (35.1±48.5 hrs vs.78.3±89.7 hrs p<0.05), more ICU treatment time (35.5±17.5 hrs vs.78.3±89.7 hrs p<0.05) and hospital stay (16.9±3.9 vs.19±9.6 days p<0.01), increased peri-operative myocardial infarction rates (7.7% vs.38.8%, p<0.05), higher rates of intra aortic balloon counter pulsation (IABP) (15.4% vs.87.5%, p<0.01) and extracorporeal membrane oxygenator (ECMO) supporting (0 vs.26.3%, p<0.05).Operative mortality was significantly higher in emergent conversion group (0 vs.37.5%, p<0.01).Conclusion emergent OPCAB conversion are associated with worse adverse outcomes and higher operative mortalities, a prevention protocol including OPCAB surgeon training, preoperative risk factors evaluation, intraoperative decision making and surgical team cooperation should be emphasized during daily OPCAB practice.