Summary of LIMA-LAD anastomosis steps: 1. 1st needle backhand 7-0 prolene (the other needle is placed on the abdominal wall, without clamping the rubber vinculum) from the left side of the LAD heel (1 o’clock) inside in and out, out of the needle, backhand from the outside of the LIMA heel (6 o’clock) inside out, out of the needle, and change to a positive hand holding the needle; 2nd needle positive hand from the inside of the LAD heel (12 o’clock) outside in and out, and a positive (or backhand) from the right side of the LIMA heel (7 o’clock) inside out. LIMA heel right side (7 o’clock) in and out; 3rd stitch in hand from LAD heel right side (11 o’clock) in and out, change to the other needle and in hand from LIMA heel left side (5 o’clock) in and out. Three stitches in total. Remember: the first stitch is worked backhand from the left side of the LAD heel (1 o’clock) and from the LIMA heel (6 o’clock), the needle is held in the forehand after the stitch is worked out, and then it is worked forehand. —Assistant right hand CO2 mist flushing system flushing 2, close the thread, under the bridge blood vessels, do not change the needle. —-Assistant rubber text clamp LAD heel right side (11 o’clock) out of the needle suture put in the fish-shaped propped open the right upper end 3, first sewing anastomosis on the opposite side of the mouth, the positive hand clockwise suture in order from the LAD 2 o’clock, 3 o’clock, 4 o’clock, 5 o’clock, 6 o’clock into the needle LIMA out of the needle, to the tip of the LAD (6 o’clock) change backhand suture. ) change to a backhand stitch. For a total of five stitches, change to the other end of the needle. — Assistant left hand holding the line, the right hand CO2 mist flushing system flushing, over the toe suture rubber text clamped on the patient’s abdominal wall 4, sewing anastomosis on their own side, positive hand counterclockwise suture from the LIMA into the needle in turn LAD 10 o’clock, 9 o’clock, 8 o’clock, 7 o’clock out of the needle. A total of four stitches. — The assistant left hand holding forceps LIMA end next to the right side of the fascial tissue, so that it turned to the left side of the anastomosis, the right hand CO2 mist flushing system flushing 5, take out the shunt, open the blood flow exhaustion, tighten the suture, clipping the needle, water on the hand, knot. —-Assistant lifts up the clamped suture rubber wench with the left hand, cuts the suture 6.Remove the pug, check the anastomosis for bleeding. —-Assistant strikes water 7, No. 11 sharp knife picks the fixed piece of suture, removes the fixator. Draw out the rubber band. — The assistant loosens the fixator with the right hand in a counter-rotating motion and the base of the fixator with the left hand. 8. 5-0 prolene fixation of the internal mammary artery tip to decompensate. —-Assistant’s left hand pumps water to check for bleeding Summary of AO-SVG anastomosis steps: (Recommended classic 10 or 11 stitches) 1, backhand 5-0 prolene (the other head of the needle is left short, and the rubber band clamp is placed on the abdominal wall) in the SVG at 3 o’clock outside in and outside out, and AO at 2 o’clock backhand inside out. Outside SVG clockwise AO counterclockwise until from AO 8 o’clock forehand inside out, a total of five stitches. Remember: the first three stitches are backhand up from both SVG and AO. The fourth stitch is worked backhand from SVG at 7:30, and then becomes a forehand stitch from AO after the stitch is worked out. The fifth stitch is the same as the fourth stitch or both on the front hand. —-Assistants hold Debakey tweezers in the left and right hands and gently tweeze SVG at 3 o’clock and 9 o’clock. 2. Close the thread, lower the bridging vessel, and seat the bridging vessel without changing the needle. 3, positive hand counterclockwise suture anastomosis on the upper side (the patient’s head side), respectively, from the SVG into the needle AO 7 o’clock, 6 o’clock, 5 o’clock out of the needle (pay attention to the change of counter-needle maneuver), a total of three stitches. If in the AO 8 o’clock counterclockwise to the 5 o’clock area encrypted a needle, a total of four stitches, sewing needle to take into account the last backhand two stitches. That is, under the bridge after the forehand four stitches, backhand two stitches, pay attention to these six stitches should be evenly spaced. —- The assistant left hand to forceps traction SVG anastomosis to the far 3cm, the right hand to pull the suture 4, backhand counterclockwise suture anastomosis on the lower side (the patient’s foot side), respectively, from the SVG into the needle AO 4 o’clock, 3 o’clock out of the needle, a total of two stitches. — The assistant right hand loosen the suture line, without holding the line, the left hand forceps also do not need to hold the forceps SVG 5, tighten the suture line, cut the needle (clip the rubber wen pliers on one end of the suture line of the needle), rinse, tie the knot. —Assistant cut the thread 6, left hand loose sidewall clamp, right hand holding the end of SVG open blood flow after exhaustion, clip hobbies. 7, Check the anastomosis for bleeding. —-Assistant watering Summary of SVG-DIA anastomosis steps: 1, backhand 7-0 prolene (the other end of the needle and thread to stay long, clip rubber texture clamp placed on the abdominal wall) SVG toe (3 o’clock) into the needle, out of the needle after the backhand DIA opposite side of the midpoint (3 o’clock) into the needle, SVG clockwise DIA counterclockwise to DIA self-side center point (9 o’clock) out of the needle, a total of seven stitches. Remember: the first three stitches are on the backhand from either SVG or DIA. The fourth stitch is worked backhand from the center of the opposite side of the SVG, and then changed to forehand from the heel of the DIA (12 o’clock). The fifth, sixth and seventh stitches are the same as the fourth stitch or are worked forehand. (See handwritten notes brown book P165) —- The assistant’s left hand forceps pinches the midpoint of the own side of the SVG anastomosis, and the right hand CO2 mist flushing system flushes. 2. Close the thread, and go down to the bridge blood vessel, without changing needles. —The assistant’s left hand tweezers pinch the SVG under the bridge, loose – tight – loose 3, positive hand sewing anastomosis on their side, counterclockwise from the SVG into the needle in order to DIA 8 o’clock, 7 o’clock out of the needle (but not the tip of the foot), counting the two stitches, the video here encrypted a needle, so for three stitches, change the needle. —- The assistant left hand does not need to hold the line, the right hand CO2 mist flushing system flushing, rubber text clip DIA 7 o’clock out of the needle suture placed on the patient’s right abdominal wall 4, positive hand sewing anastomosis on the opposite side of the clockwise from the DIA 4 o’clock, 5 o’clock, 6 o’clock in order to enter the needle from the SVG out of the needle, a total of three stitches. — The assistant holds the thread with the left hand, and flushes the water with the CO2 mist flushing system with the right hand. 5. Remove the shunt, open the blood flow for exhaustion, tighten the suture, cut the needle, and tie the knot with water on the hand. —-Assistant lifts up the clamped suture rubber wench with the left hand, and cuts the suture. 6. Remove the pug, and check the anastomosis for bleeding. —-Assistant playing water Summary of SVG-OM anastomosis steps: 1, backhand 7-0 prolene (the other end of the needle and thread to stay long, clip the rubber wen pliers placed on the abdominal wall) SVG toe (3 o’clock) into the needle, out of the needle after the backhand OM on the side of the midpoint (3 o’clock) into the needle, SVG clockwise OM OM counterclockwise to the OM side of the center point (9 o’clock) out of the needle, a total of seven stitches. Remember: the first four stitches are backhand on the line from both SVG and OM. The fifth stitch is worked backhand from SVG at 7 o’clock, and then changed to forehand from the right side of the OM heel (11 o’clock). The sixth and seventh stitches are the same as the fifth stitch or are worked overhand. (See Handwritten Notes Brown Book P165.) —- The assistant’s left forceps pinches the midpoint of the hexagonal side of the SVG anastomosis, and the right hand CO2 mist flushing system flushes. 2. Close the threads, and lower the bridging vessels without changing the needle. —The assistant’s left hand forceps pinch the SVG under the bridge, loose – tight – loose 3, positive hand sewing anastomosis on its own side, from the SVG into the needle in turn OM 8 points, 7 points, 6 o’clock out of the needle (over the toe), in order to avoid the knot at the toe, toe encryption of a needle, a total of four needles, change the needle. — assistant left hand without holding the line, right hand CO2 mist flushing system flushing, over the OM toe out of the needle suture clamp rubber wen pliers placed on the abdominal wall or fish shaped prop openers right lower 4, positive hand sewing anastomosis on the opposite side of the mouth, clockwise from OM 4 o’clock, 5 o’clock into the needle SVG out of the needle, counting the two needles, the boss! The surgical video here encrypts one stitch, so it is three stitches. — The assistant’s left hand can be used without holding the thread, and the right hand CO2 mist flushing system flushing 5. Remove the shunt, open the blood flow and exhaust, tighten the suture, cut the needle, water on the hand, and tie the knot. —-Assistant’s left hand lifts up the clamped suture rubber wen pliers, cut the thread 6, take out the pug, check the anastomosis for bleeding. —-Assistant’s left hand hit the water Summary SVG-PDA/RPL (heel to heel) anastomosis steps: 1, the first needle backhand 7-0 prolene (the other head of the needle clamp rubber texture pliers placed on the abdominal wall) from the left side of the SVG heel (5 o’clock) outside the inside out, out of the needle backhand from the PDA/RPL heel right side (5 o’clock), backhand from the PDA/RPL heel right side (PDA/RPL heel right side), cut the line. / RPL heel right (7 o’clock) inside out; 2nd needle backhand from SVG heel (6 o’clock) outside in inside out, out of the needle backhand from the PDA / RPL heel (6 o’clock) inside out; 3rd needle backhand from SVG heel right (7 o’clock) outside in inside out, out of the needle backhand from the left side of the PDA / RPL heel (5 o’clock) out of the needle, SVG clockwise PDA / RPL counterclockwise, a total of SVG clockwise PDA/RPL counterclockwise, totaling three stitches. Remember: For these three stitches, whether the needle comes in from SVG or from PDA/RPL, backhand on the line. —Assistant left hand tweezers pinch the apex of the SVG break end opening (at the toe), right hand CO2 mist flushing system flushing 2, close the thread, under the bridge blood vessels, without changing the needle. —-Assistant’s left hand tweezers pinch the SVG lower bridge, loose-tighten-loose 3, positive hand sewing anastomosis on the opposite side of the mouth, counterclockwise in order from the SVG into the needle PDA/RPL 4 points, 3 points, 2 points, 1 point, 12 points, 11 o’clock out of the needle (over the tip of the foot), counting six stitches, change the needle. — Assistant left hand holding the line, right hand CO2 mist flushing system flushing, over the toe suture rubber text clamped put in placed on the side of the patient’s head 4, positive hand sewing anastomosis on the side of their own, clockwise in order from the PDA/RPL 8 o’clock, 9 o’clock, 10 o’clock into the needle SVG out of the needle, counting three stitches. — The assistant’s left hand can hold the line, or change the forceps to hold the SVG anastomosis proximal 2cm assistant’s right hand CO2 mist flushing system flushing 5, remove the pug open blood flow exhaust, tighten the suture, cut the needle, water on the hand, tie the knot. —- The assistant left hand lifted the clamped suture rubber wen pliers, cut the line 6, check the anastomosis with or without bleeding. —-Assistant left hand hit water