**7. Vettath's anastamotic obturator**

In patients with diffusely diseased coronary arteries and in patients with diseased aortas, OPCAB has remained a life saver. We had developed the Vettaths anastomotic obturator (VAO) (Murali.P.Vettath,2003,2004) – which , is is an aortic anastomosis enabling device. This allows the surgeon to avoid the side clamp on the aorta, when a no touch technique is required in cases of diseased aorta. In patients with plaquey aortas, where a saphenous vein top end is to be connected, this could be used to make an anastomosis on a no plaquey zone in the aorta. The technique is to identify a soft spot and make two purse string sutures with 3.0 polypropylene around the intended zone of anastomosis. The purse strings are about a centimeter in diameter. A stab wound is made using a no.11 blade and an aortic punch is used to make a punch hole on the aorta. The VAO is then inserted into the hole and one of the 3.0 purse strings are used to snare the bleeding around the VAO if it persists. The aortic systolic pressure may be maintained at around 100 mm of Hg. The advantage is that this allows the surgeon to perform a hand sewn anastomosis on the vein graft. This is like the devices that are available in the market, like the Heartstring and the Enclose device. This is like an instrument and is made of steel and can be reused and could help in avoiding a stroke in elderly patients. We have performed more than 500 top ends using this device and is a good one to have in the armamentarium of a cardiac surgeon. This is also a good tool to use in redo CABG, when a proximal anastomosis could be made on the hood of the old vein graft.

The VAO is also a useful tool in cases where a combined aortic valve replacement is done with a CABG. Here it is useful when the side clamp needs to be avoided.
