Background: Potential long-term gain in health-related quality of life (HRQoL) using off-pump coronary revascularization in elderly patients >70 years has not yet been fully elucidated. Aim: We compared HRQoL in elderly moderate- to high-risk patients 3 months, 12 months, and 8 years after randomization to either off-pump or on-pump coronary artery bypass grafting (CABG). Methods: After randomization and before heart surgery, 120 consecutive patients were asked to fill in the Medical Outcome Study Short Form 36 (SF-36) and Major Depression Inventory diagnostic scale for self-report of HRQoL. Postoperatively, the same questionnaires were mailed to the patients. Results: No significant difference was found in the change of SF-36 scores between the groups except in the social functioning subscale, where the 8-year score was significantly higher for the on-pump group than the off-pump group (p=0.038). In the on-pump group, all scores improved from baseline to 8 years, with the highest improvement in most of the domains after 8 years. In the off-pump group, there was an improvement in four of the eight domains from baseline to 8 years, with the highest improvement in most of the domains after 12 months. By contrast, there was a noticeable decrease in bodily pain, social functioning, and mental health at 8 years after off-pump operation. No patients showed signs of depression after 8 years. Conclusion: HRQoL SF-36 scores seemed to improve more in patients undergoing on-pump CABG compared with patients undergoing off-pump surgery, although no long-term clinically relevant difference between the groups could be demonstrated.