**6. Conclusions**

When OPCABG is performed in patients with severe ascending aortic calcification, the above methods of proximal anastomosis are of practical and dissemination value. Based on decades of clinical experience, when encountering atherosclerotic plaque of ascending aorta, proximal anastomosis devices can be used to anastomose proximal aorta as priority, in order to maximally avoid the detachment of aortic atherosclerotic plaque or the damage of aortic dissection. When the proximal

anastomosis device or the suture fails, the water sac or no clamp method could also be applied for remedy. For well-trained surgeons, they will be able to use water sac or no clamp method for proximal anastomosis directly, saving huge costs while achieving the same outcomes. The two original techniques are of great significance for patients in developing countries and remote areas. All these surgical applications aim to avoid complications of nervous system and embolism caused by plaque detachment due to partial blocking of ascending aorta with side wall clamp for proximal anastomosis.
