Distal coronary anastomoses

The right coronary artery is isolated and an elastic stitch is applied for better exposure. The coronary arteriotomy is made to match the venous diameter, and the anastomosis is performed with a running 7/0 suture with a parachute technique. An oxygen blower is utilized to obtain a bloodless field. When the anastomosis is done, cold cardioplegia is delivered through the graft, to detect also any leak from the suture. Blood is then collected to fill the graft after the cross-clamp removal and exclude any twisting, and the vein is then clamped and prepared for the proximal anastomosis.