【Abstract】 Objective To study the effects of coronary artery bypass grafting (CABG) with different operative patterns on thrombomodulin (TM) and myocardial mechanical properties (MMP) in elderly patients with coronary heart disease (CHD). Methods 128 elderly CHD patients admitted to our hospital from July 2015 to June 2018 were selected. According to the method of random number table, the above 128 elderly CHD patients were divided into OPCABG group (n = 64) and CABG group (n = 64). OPCABG group was treated with off-pump coronary artery bypass grafting (OPCABG), and CCABG group was treated with off-pump coronary artery bypass grafting (CCABG). The perioperative indexes of the two groups were observed, such as the operation time, the volume of blood products, the time of admission to ICU, the time of hospitalization and so on. Left ventricular end diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were measured before and 6 months after operation. Before and 7 days after operation, the level of serum TM, global area strain (gas), radial strain (GRS), circumferential strain (GCS), global long axis strain (GLS) and other MMP indexes, and postoperative complications. Results The time of operation, the volume of flow, the time of ventilator assistance, the amount of blood products, the time of admission to ICU and the time of hospitalization in OPCABG group were less than those in CCABG group (P＜0.05). There was no significant difference in the number of bridging vessels between the two groups (P＞0.05). On the 7th day after operation, GAS, GRS and GLS in OPCABG group were higher than those in CCABG group, and TM was lower than those in CCABG group (P＜0.05). There was no significant difference in GCS between the two groups (P＞0.05). The incidence of perioperative complications in OPCABG group was lower than that in CCABG group (P＜0.05). There was no significant difference in LVEDd and LVEF between the two groups (P＞0.05). Conclusion OPCABG can reduce the injury of vascular endothelial and cardiac function, reduce the generation of TM, and help the patients recover after operation, and has a good long-term effect.