Arterial conduits, especially internal thoracic arteries (ITAs), are rarely affected by intimal hyperplasia or atherosclerosis, major contributors to early and late vein graft failure. Improved survival and freedom from reintervention with multi-arterial grafting (MAG) are reported in large observational studies, particularly when more than one anatomically important coronary territory is supplied. Several grafting configurations are possible depending on conduit and target characteristics, with the left ITA to the left anterior descending (LITA-LAD) typically being the cornerstone around which the rest of the conduits are constructed. The right ITA (RITA) or radial artery (RA) is used to bypass the second most important target after the LAD. The fundamentals of MAG depend on thorough preoperative evaluation, meticulous surgical technique and intraoperative flow assessment. Pitfalls to avoid include tension in short conduits or kinks in longer ones, poor ITA inflow, competitive native and graft flow, flow imbalance between segments of a composite graft, and sequentially grafting deep intramyocardial targets. Versatility and flexibility are critical in mitigating difficulties or potential complications in MAG. Refinements in complex bilateral ITA (BITA) and RA grafting require a deliberate iterative process that ideally incorporates dedicated training and mentorship by experienced MAG surgeons. Arterial conduits, especially internal thoracic arteries (ITAs), are rarely affected by intimal hyperplasia or atherosclerosis, major contributors to early and late vein graft failure. Improved survival and freedom from reintervention with multi-arterial grafting (MAG) are reported in large observational studies, particularly when more than one anatomically important coronary territory is supplied. Several grafting configurations are possible depending on conduit and target characteristics, with the left ITA to the left anterior descending (LITA-LAD) typically being the cornerstone around which the rest of the conduits are constructed. The right ITA (RITA) or radial artery (RA) is used to bypass the second most important target after the LAD. The fundamentals of MAG depend on thorough preoperative evaluation, meticulous surgical technique and intraoperative flow assessment. Pitfalls to avoid include tension in short conduits or kinks in longer ones, poor ITA inflow, competitive native and graft flow, flow imbalance between segments of a composite graft, and sequentially grafting deep intramyocardial targets. Versatility and flexibility are critical in mitigating difficulties or potential complications in MAG. Refinements in complex bilateral ITA (BITA) and RA grafting require a deliberate iterative process that ideally incorporates dedicated training and mentorship by experienced MAG surgeons. Corrigendum: Multi-arterial Coronary GraftingOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 4PreviewThe authors regret that in the article “Multi-arterial Coronary Grafting” by Rami Akhrass and Faisal G. Bakaeen in the Summer 2022 issue (27(2):126-146, 2022; https://doi.org/10.1053/j.optechstcvs.2021.09.001 ), (Figures 2 and 10) included an error with the course of the right internal thoracic artery (RITA). The corrected figures are included on the next 2 pages. Figure 2 was used as the cover image for the issue. In both Figures 2 and 10, the RITA should be anterior to the superior vena cava and posterior to the pulmonary artery. Full-Text PDF Commentary: Multiple Arterial Grafting for Coronary Artery Bypass Surgery: Choosing the Right Conduits for The Right Vessels for The Right PatientsOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 2PreviewDespite the known increased patency of arterial versus saphenous vein graft (SVG) conduits for Coronary Artery Bypass Graft (CABG) surgery, a recent Society of Thoracic Surgery (STS) national database study showed that while a single internal thoracic artery (SITA) graft was used in 89.4% of CABG patients, only 10.6% received multiple arterial grafts (MAG) and only 4.9% had bilateral internal thoracic artery grafts (BITA).1 What are the factors that have discouraged surgeons from embracing MAG and BITA grafting? In a 2018 national survey from the United Kingdom, almost one third of surgeons cited the lack of evidence in favor of MAG and BITA as a limiting factor for not adopting these techniques in their practices. Full-Text PDF Commentary: Time to Set New Standards for Coronary Bypass Surgery?Operative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 2PreviewAsk any cardiac surgeon who started their training in 90s, and you'll find that many of them, at some point, must have thought that surgical coronary revascularization was ill-fated. Especially in the mid 2000s, when drug-eluting stents appeared on the market and furtherly improved the outcomes of percutaneous revascularization1... God knew what would come next! History - and clinical trials - proved them wrong: almost 20 years later, coronary artery bypass grafting (CABG) is still the most common procedure in adult cardiac surgery and remains the gold standard for treatment of complex triple vessel disease and left main disease, particularly in younger patients and in case of diabetes or reduced left ventricular function. Full-Text PDF