From 1987 to 1991, 48 patients received a right internal thoracic artery (RITA) to the left anterior descending artery (LAD). No operative death occurred, but two patients (4.2%) died during hospitalization due to graft versus host disease, and congestive heart failure. Graft patency of the RITA was 100%. After a 17.2 month mean follow-up, the 4 year actuarial survival rate (including all causes of death) was 85.3%, and the 4 year cumulative cardiac event free rate (including all cardiac deaths, myocardial infarction, reoperation, and PTCA) was 87.6%. The length of the RITA graft to the LAD, 15.6 +/- 1.1 cm, was significantly longer than that of the left internal thoracic artery (LITA) to the LAD, 12.9 +/- 1.1 cm. However, the flow of the RITA-LAD graft, 42.3 +/- 21.1 ml/min, was same as the flow of the LITA to the LAD, 42.1 +/- 19.6 ml/min. These findings justify wider use of the RITA to the LAD as a second arterial graft.