The multicenter prospective cohort study evaluated long-term survival and functional recovery after total arterial coronary revascularization (TAR) in 1,000 patients with multivessel coronary artery disease operated between 2020 and 2025. All participants underwent elective, first-time coronary artery bypass grafting using exclusively arterial conduits under standardized protocols across five tertiary centers. The primary endpoints were overall survival and postoperative functional improvement assessed through left ventricular ejection fraction (LVEF), exercise tolerance, and quality-of-life indices. Over a mean follow-up of 3.1 ± 1.4 years, the projected 5-year survival rate reached 93.2%, with consistent improvements in LVEF and quality-of-life indices. Functional capacity and patient-reported outcomes showed consistent enhancement, and graft patency remained high for all arterial conduits, exceeding 90% at 5 years. Advanced age and baseline LVEF below 45% were independent predictors of mortality on Cox regression analysis. The results confirm that total arterial grafting ensures superior graft durability, sustained myocardial recovery, and better long-term quality of life than conventional mixed or venous grafting. TAR should therefore be considered a prognostically superior and clinically sustainable standard of care in contemporary coronary artery bypass surgery.