COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh VermaTotal arterial off-pump coronary revascularization The Holy Grail?Raja, Shahzad G. Author Information Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom Correspondence to Shahzad G. Raja, BSc, MBBS, MRCS, FRCS(C-Th), Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom. Tel: +44 1895826511; fax: +44 1895828992; e-mail: [email protected] Current Opinion in Cardiology: September 2019 - Volume 34 - Issue 5 - p 552-556 doi: 10.1097/HCO.0000000000000645 Buy Metrics Abstract Purpose of review Coronary artery bypass grafting (CABG) remains the standard of care for patients with complex multivessel coronary artery disease. However, conventional CABG utilizing left internal mammary artery and supplemental vein grafts performed on cardiopulmonary bypass is marred by questionable long-term patency of vein grafts and risk of neurological injury. Total arterial off-pump CABG is a strategy associated with avoidance of neurological injury and vein graft failure. The aim of this review is to summarize recent evidence on safety and effectiveness of total arterial off-pump CABG. Recent findings Two key studies have been published recently. One describes a dual inflow technique that achieves anaortic, off-pump complete revascularization using arterial grafts only. The other is single centre study that reports 10-year survival of 89.33%, rate of freedom from repeat revascularization of 91.33% and early stroke rate of 0.9% after total arterial off-pump CABG. Summary Total arterial off-pump CABG with its advantages of improved survival, enhanced freedom from repeat revascularization and low stroke rate can be regarded as the Holy Grail of myocardial revascularization. However, the results of a large, multicenter, prospective trial are required to substantiate this status. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.