From 1982 to March 1991, 68 patients underwent coronary artery bypass grafting (CABG) using bilateral internal thoracic arteries (ITA). There were 62 males (91.2%) and 6 females (8.8%) ranging from 33 to 74 years old (mean 58.5 +/- 9.2). Thirty four patients had old myocardial infarction (OMI) and left main trunk disease was seen in 8.5% of the patients. The number of grafts was 2 to 6 per patient with an average of 3.2 +/- 1.0. In bilateral ITA grafting the combinations of RITA to LAD and LITA to LCX were most frequently used. There were no operative deaths except for one death which occurred while at the hospital. The patency rates for the RITA and LITA were 98.3% and 96.7%, respectively. Postoperative complications included reexploration for bleeding and heart tamponade in 9 patients, and low output syndrome in 7 patients. The frequency of blood transfusion decreased with the use of cell saver. Routine bilateral ITA grafting for multiple CABG is considered safe, with the early patency being relatively better than with saphenous vein grafting.