**4.3 Considerations in the use of water sac blocking method**

• Since the needle tip of the anastomosis is easy to puncture the water sac, polypropylene suture for the first time in non-full-layer type, and then another

**269**

**Figure 6.**

*Management of Ascending Aorta Calcification in Coronary Artery Bypass Grafting*

polypropylene suture can be performed for full layer suture after knotting to

• The change of arterial pressure should be observed when injecting water into water sacs, and the circulation index should not be affected as much as

*Procedures: (A) cutting off the adventitia; (B) purse string suture; (C) perforation and finger hemostasis; (D) urinary catheter insert and sterile normal saline injection; (E) great saphenous vein anastomosis (non-full* 

ensure the accuracy of the anastomosis.

*layer); (F) balloon suction and removing for secondary anastomosis (full layer).*

*DOI: http://dx.doi.org/10.5772/intechopen.91909*

*Management of Ascending Aorta Calcification in Coronary Artery Bypass Grafting DOI: http://dx.doi.org/10.5772/intechopen.91909*

#### **Figure 6.**

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

"Water sac blocking" refers to the method of proximal anastomosis without using side wall clamp when anastomosing great saphenous vein or radial artery with

• Left internal thoracic artery and great saphenous vein are harvested routinely. In OPCABG, the internal thoracic artery is usually anastomosed to the left anterior descending branch, and the rest are treated by sequential CABG of

• When the saphenous vein is anastomosed with the ascending aorta, the adven-

• After purse string is anastomosed, use a sharp knife to prick a small incision,

• Quickly insert a 12–14F urethra catheter into the aorta, inject 8–10 ml sterile normal saline through the water injection hole, make the water sac inflate, fix the distal end, and make the water sac tightly close to the anastomosis position

• The saphenous vein was anastomosed with ascending aorta by 6–0 polypropylene suture while removing the pre-sutured purse string. The direction of the needle entering the aortic wall was from the internal to the external, without penetrating

• Use a syringe to suck out the normal saline in the water sac, quickly remove the urethra catheter, pull down the great saphenous vein, and tighten the suture

the whole layer of the arterial wall. The total number of needles was 8–10.

• Lastly, another 6–0 polypropylene suture was used to full-layer suture the

• Since the needle tip of the anastomosis is easy to puncture the water sac,

polypropylene suture for the first time in non-full-layer type, and then another

aortic wall along the previous anastomosis position. (**Figure 6**).

**4.3 Considerations in the use of water sac blocking method**

titia of the artery is cut off at the perforating position.

**4.2 Operation process**

ascending aorta (**Figure 5**).

great saphenous vein.

and press to stop bleeding.

for hemostasis.

and knot.

• Use an aortic perforator to make a hole.

The specific processes are as follows:

**268**

**Figure 5.**

*Composition of the water sac device.*

*Procedures: (A) cutting off the adventitia; (B) purse string suture; (C) perforation and finger hemostasis; (D) urinary catheter insert and sterile normal saline injection; (E) great saphenous vein anastomosis (non-full layer); (F) balloon suction and removing for secondary anastomosis (full layer).*

polypropylene suture can be performed for full layer suture after knotting to ensure the accuracy of the anastomosis.

• The change of arterial pressure should be observed when injecting water into water sacs, and the circulation index should not be affected as much as 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.

