To assess the efficacy of arterial revascularization 368 patients were studied who underwent myocardial revascularization with two or more arterial conduits (group M) and compared with 2092 patients in whom a single internal mammary artery±veins (group S), and to a third group in which only saphenous vein conduits (group V, n=602) were used. Group M patients were younger (aged 54.0(9.5) years; 4.1% aged >70 years) than either group V (67.6(8.9) years, 40.7% >70 years, P70 years, PP=0.0001), preoperative intra-aortic balloon pump assist (6.11, P=0.0001), diabetes (1.97, P=0.03), urgent surgery (1.80, P=0.05), and advanced age (2.14, P=0.01) were all predictors of operative mortality. In contrast, while choice of conduit appeared to influence outcome by univariate analysis (4.2% mortality in group V, P<0.001), it was not found to be a predictor of either mortality or morbidity by regression analysis. The present results indicate that, in carefully selected patients, despite increased technical demands with longer periods of aortic occlusion and longer pump times, multi-arterial grafting (compared with conventional revascularization) is a safe and efficacious procedure. Whether or not this approach to revascularization will increase long-term survival and freedom from reoperation will require further study.