Total Arterial Grafting with Bilateral Internal Mammary Artery , a specialised technique where bypass is done using both internal mammary arteries .Most CABG patients require grafting of the three main native coronary arteries; for the last 15 years the “standard” operation has achieved this using a single internal mammary artery (SIMA) and supplemental vein grafts performed with cardiopulmonary bypass. “Numerous surgical groups around the world are reaching the conclusion that complete revascularization with multiple arterial grafts can be reliably achieved without cardiopulmonary bypass and often without aortic manipulation. Whenever feasible, this surgical strategy is most likely to yield excellent short- and long-term results for coronary artery bypass surgery patients.”Using BIMA and total arterial grafting is potentially more time consuming and technically more difficult, but this is surely justified by improved patient outcomes. Over 1000 surgeries successfully done in past 1.5 yrs using the same technique.