Background:Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting (CABG).We summarized our experience with total arterial off-pump coronary artery bypass grafting (OPCAB) and assessed the early clinical results,surgical complications,and follow-up.Methods:From January 2007 to May 2017,508 coronary artery disease patients undergoing total arterial OPCAB were enrolled.Clinical features,approaches,outcomes of surgical treatments,and follow-up data of these patients were studied retrospectively.A total of 122 patients underwent single left intal mammary artery (IMA)-left anterior descending artery grafts,whereas the other 386 patients underwent multiple vessel grafts.Results:The average distal anastomosis was 2.34 + 0.97 (range:1-4).All the patients were discharged from hospital except one died.A total of 457 (90.32％) patients were tollowed up.In the 4-,7-,and 10-year follow-up groups,the rate of death from any cause was 1.19％,6.47％,and 10.67％;rate of cardiac death was 0.60％,2.88％,and 3.33％;rate of repeat revascularization was 0.00％,3.60％,and 8.67％;rate ofischemic symptoms was 1.79％,7.91％,and l 1.33％;and incidence of stroke was 2.38％,4.32％,and 6.67％,respectively.Poor medication adherence was observed in 9.38％ of the follow-up population.Conclusions:Total arterial OPCAB with bilateral IMA,radial artery,and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group,without a significant increase in early mortality or morbidity.Moreover,the long-term outcomes are also positive.