Total Arterial CABG on a Beating heart without aortic manipulations should be the gold standard operation for Coronary Artery Disease that requires surgical intervention. This involves the use of multiple arterial grafts (Internal Mammary artery, radial artery) used in various configurations to re-create normal anatomical and functional coronary blood flow. Handling of the ascending aorta is a leading cause of stroke and neurologic complications during conventional bypass surgery . Total arterial CABG using composite arterial grafts avoids all aortic manipulations and thereby prevents these complications. This technique requires special expertise and is only performed by highly skilled and experienced surgeons.

Complete arterial no-touch coronary artery bypass graft configuration. Cx indicates circumflex; LAD, left anterior descending; LITA, left internal thoracic artery; PDA, posterior descending artery; RA, radial artery; and RITA, right internal thoracic artery.