CLEARLY REMEMBERED INSIGHTS 1, in most cases: sewing the anastomosis on the opposite side, the assistant holding the thread; sewing the self-side of the assistant does not need to hold the thread. 2. Before the bridge vessel is seated, the length of the suture line is designed: after the bridge is placed, the end of the suture line that is being held stays long. 3, before the bridge blood vessel is seated, stitch placement: 5 stitches under the bridge on the AO-SVG end side, 3 stitches under the bridge on the remaining end side and parallel side, and 7 stitches under the bridge on the criss-cross side. 4. When the bridging vessel is seated: one needle must be threaded from the coronary artery and the other needle from the bridging vessel. After the bridge vessel is seated: if the needle is fed from the coronary artery, the needle will not come out, and the bridge vessel will be set and sewn. 6. For end-to-side anastomosis, LIMA-LAD/DIA/Ramus, SVG-OM/PDA/RPL: after the bridge vessel is seated, first sew the opposite side of the anastomosis and pass the toe; then change the needle and sew the own side of the anastomosis. 7. In the case of cross-lateral anastomosis, SVG-LAD/DIA/OM: after the bridging vessel is seated, the side of the anastomosis is sewn first, but not over the tip of the foot; then the opposite side of the anastomosis is sewn with a different needle and over the tip of the foot. 8, over the toe concept: the purpose is not to let the knot in the toe, to prevent blood leakage. Two methods: one sewing needle from the coronary artery tip into the needle bridge blood vessels out of the needle, that is, over the tip of the foot; another if the sewing needle from the bridge blood vessels into the needle coronary artery tip out of the needle, you must then sew through a needle for the over the tip of the foot, or else the knot will be playing in the tip of the foot. 9, five into the needle skills, four variations of needle techniques: five into the needle skills: 1, AO-SVG near section anastomosis 5 needle on the line, the third needle backhand from the lower corner of the SVG rhombus into the inside out —- backhand to the front of the AO 11 o’clock into the outside. 2, 4th stitch backhand from SVG 7 1/2 o’clock outside in inside out —- forehand forward AO 9 1/2 o’clock out. 3, SVG-LAD/Dia/OM cross, the first needle backhand from SVG 3 o’clock into the needle after the needle tip bent downward, easy to get out of the needle. 4 .AO-SVG anastomosis bridge is seated, the 4th needle positive hand backward from SVG into the needle AO 5 o’clock out of the needle. 5, the boss said the heel and toe into the needle to be flat. That is, when entering the needle, the plane of the curved needle and the plane of the coronary incision should be as parallel as possible to prevent sewing to the opposite side. Four variations of needle techniques: 1, AO-SVG anastomosis bridge seated, the fourth needle positive hand backward from the SVG into the needle AO 5 o’clock out of the needle, the left hand holding forceps – the palm is facing the patient’s right side, clamping the needle that is changed into a reverse needle. 2 .LIMA-LAD/Dia end lateral anastomosis bridge seated, the first sewing anastomosis on the opposite side of the mouth, four needles in the right hand and then backhand a needle over the toe, of which the fourth needle from the LAD/Dia 5 o’clock into the needle LIMA out of the needle, the left thumb middle finger holding forceps, tweezers handle clamped in the tiger’s mouth – index finger over the tweezers pressed to the right foot, so that they are fixed in the index finger between the middle finger – clamping the needle after the external rotation of 180 ° that is, the needle into the reverse. This maneuver is very practical and is promoted to apply to all forehand to backhand and backhand to forehand. For example, in the case of AO-SVG proximal anastomosis, the fourth needle is held in the backhand from the SVG 7.5 o’clock, and the needle is held in the forehand after the needle is discharged, so this technique can be used. This technique is especially convenient for cross anastomosis, which requires the needle to be inserted into the coronary artery with the forehand and the bridge vessel with the backhand, alternating between the forehand and backhand. There are also cold irrigation mattress purse-string suture, drainage tube fixed line mattress suture, as well as the closure of the aortic incision when the continuous horizontal mattress suture, can be used to change the needle technique. 3, forceps clip needle, through the tail line of the drag change positive and negative hand, and then clamped in the needle holder, according to the drag of the different techniques can be divided into long drag and short drag. Long dragging: the left hand tweezers to assist out of the needle after clamping the needle, the left hand overhanging a longer distance dragging the tail line, changing the direction of the needle, this method is relatively simple. Short dragging: the left wrist is fixed at the original pivot point, the left hand forceps vertical needle clamping direction, assisted in the process of the needle (the needle is still in the tissue has not yet been out of the needle), through the rotation of the forearm and wrist joints, the sewing needle drag force, dragging the distance is very short, the general out of the needle can be changed to change the direction of the sewing needle, the method is relatively difficult to be practiced diligently. At present, only the boss can be used freely, and out of the needle change very quickly. 4, the needle holder clip, by turning the needle on the surgical towel, change the positive and negative hand. The above are the surgical techniques used by the boss in bypass surgery. In actual operation, it should be applied flexibly according to the actual situation. There are too many surgical techniques of the boss, due to the short time of following the boss and my clumsiness, I do not have much experience at present, and my understanding and explanation of his methods may not be accurate enough, so I hope that the teachers in the department will keep on adding to it.