In off-pump coronary artery bypass grafting (off-pump CABG: OPCAB) procedures involving multiple vessels, the Aorta No-Touch technique is increasingly being adopted to avoid cerebral infarction, while gastro-epiploic artery (GEA)-left anterior descending coronary artery branch (LAD) anastomosis or composite T-grafting is performed to supply blood to multiple coronary arteries through the left internal thoracic artery (LITA) as an inflow conduit. The objective of the present study is to investigate the effectiveness and advisability of grafting in patients who undergo OPCAB involving multiple vessels, including those who undergo standard CABG. CONCLUSIONS 1: Composite T-grafts of the LITA in OPCAB involving multiple vessels can present certain problems with patency, patient survival, and need for subsequent revision procedures. In the event of a graft failure, serious symptoms resembling left main coronary trunk (LMT) may develop. 2: The incidence of cardiac events with GEA-LAD is high, and patency in the distal phase is poor. 3: Ideally, LITA-LAD should be performed alone. 4: Among patients who have been screened before the procedure, satisfactory results are obtained for OPCAB in which the ascending aorta serves as an inflow conduit; this procedure should be considered as a viable option.