Introduction: Excessive manipulation of the aorta in conventional on-pump coronary artery bypass (ONCAB) is associated with postoperative neurological complications. We assessed the results of a protocol of 'minimal-aortic manipulation' in off-pump-CABG (OPCAB) using Guidant Heartstring aortic-seal with selective epiaortic scanning. Materials and Methods: A protocol of 'minimal-aortic manipulation OPCAB' using Heartstring aortic-seals was introduced in patients undergoing OPCAB from January 2005. Data were prospectively collected for one year. Intra-operative epiaortic scanning was selectively used. Mean graft flow and pulsatility index (PI) were routinely measured. Results: Sixty-nine Heartstring aortic-seals were used in 31 patients (23 Male; 8 Female). Mean age and left ventricular ejection fraction (LVEF) were 62.5 ± 10.8 years and 57.8 ± 14.2% respectively. Five patients had intra-operative epiaortic scanning performed. Left internal thoracic artery (LITA) to left anterior descending (LAD) artery was achieved in 100% with mean LITA graft flow and PI of 32.09 ± 19.48 ml/min and 3.26 ± 1.74 respectively. Mean flow and PI in radial artery graft (RAG) and saphenous venous graft (SVG) were 20.47 ± 5.37 ml/min; 1.97 ± 0.31 and 22.84 ± 16.88 ml/min; 3.93 ± 2.83 respectively. There were no postoperative neurological complications or death. Conclusions: Routine use of Heartstring aortic-seals with selective epiaortic scanning in a protocol driven 'minimal-aortic manipulation OPCAB' is safe. The avoidance of partial aorta cross-clamping may translate to a reduction in post-operative neurological complications.