**5. No clamp anastomosis technique**

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

possible. The amount of water injected into the water sac is usually less than 10 ml; otherwise, it may cause bursting or affect the left ventricular blood flow.

• When the distal end of the urethra catheter is fixed after the water injection, the rubber tube should keep a certain tension to make the water sac stay closed

• During the drill, anesthesiologists should control blood pressure and slow

• When inserting the catheter, it is necessary to press the anastomose with the

• During suturing, the position of the urethra catheter should be adjusted and the same tension should be maintained to ensure that the suturing field is exposed. Avoid the bleeding caused by the needle penetrating the water sac or

• Surgeons should be properly trained before using water sac blocking method.

help of fingers and inject water quickly to avoid excessive bleeding.

**4.4 Advantages and limitations of urethra catheter-water sac technology**

• As an innovative suture method, "water sac blocking" method has the advantages of both OPCABG and proximal anastomosis device. It requires no additional medical costs, and the operation process is simple, effective and accurate. It can minimize the incidence of stroke or embolism caused by the detachment of atherosclerotic plaque via clamping or intubating on

• This method is very safe. Due to the softness of the water sac, it is rare that the

• For patients who fail to use Heartstring and Enclose, the water sac method

• During the first suture, it is possible that the urethra catheter could not be pulled out when the needle caught the outer membrane of the water sac. In this case, it may be necessary to cut the suture and pull out the urethra catheter,

• It is relatively time-consuming due to the requirement for secondary suture. Moreover, the operation around the aortic incision is more frequent, which

For patients with severe aortic atherosclerosis, avoiding the use of side wall clamp is one of the important methods to reduce postoperative neurological complications [27]. The water sac blocking method is simple, effective, accurate and

**4.5 Clinical significance of urethra catheter-water sac technology**

aortic wall will be damaged, even when the water sac is broken.

to the inner wall of the aorta.

*4.4.1 Advantages*

the aorta.

*4.4.2 Limitations*

could be the remedy.

and then repeat the operation.

increases the risk of bleeding.

down heart rate to minimize bleeding.

pulling out the urethra catheter-water sac.

**270**

When using great saphenous vein to anastomose with ascending aorta during OPCABG, it is necessary to clamp part of ascending aorta wall and may cause ascending aorta atherosclerotic plaques to fall off, leading to cerebral embolism. Meanwhile, it may also induce great saphenous vein graft obstruction and influence its patency rate. We applied "no clamp" suture method in OPCABG for patients with severe aortic calcification and achieved satisfying results.
