*5.4.1 Advantages*

*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*

• Use 6–0 polypropylene suture to perform end to side anastomosis in anticlockwise direction before perforating ascending aorta. The direction of the needle entering the aortic wall is from the internal to the external through the whole

• The polypropylene suture is divided into two clusters, and two thick sutures for traction are used to pull it in the opposite direction respectively to fully

• Use a sharp knife to pierce the artery wall in the middle of the anastomotic position, press with fingers for hemostasis, and then use an aortic perforator to

• Remove the traction suture, pull down the great saphenous vein, tighten the

• Finally, another 6–0 polypropylene suture was used to suture the aortic wall

• Before aortic wall suture with polypropylene, ascending aorta palpation should be carried out in order to avoid atherosclerotic plaques and local thickening

• The perforator shall be positioned accurately before drilling to prevent damage

• During drilling, anesthesiologists should reduce blood pressure and slow down

• As the polypropylene suture requires a long distance in the aortic wall, it may be astringent when tightening, and as a result, it should be tightened one by

• The two traction sutures should be pressed as close to the aortic surface as

possible for maximum expose of anastomotic position.

layer of the arterial wall.

perforate (**Figure 7**).

polypropylene suture and knot.

**5.3 Considerations of no clamp technique**

part and prevent plaques detachment.

to the polypropylene suture.

one with a nerve hook.

heart rate to minimize bleeding.

*Puncture the artery wall and press it with fingers to stop bleeding.*

along the previous anastomosis position.

expose the position of the anastomosis.

**272**

**Figure 7.**

