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Indications

Relative risks

1. Scar
2. Bleeding
3. Infection
4. Death (by logistic Euroscore)
5. Renal failure
6. Stroke: CHADS2
7. Arrythmias

Other procedure

1. Pacemaker insertion
2. Intercostal drain
3. Intra-aortic balloon pump 

Procedure

1. Using a single stay suture, tag onto the posterior edge of the pericardium and lift out of the thoracic cavity
2. Identify the target vessels
3. Insert a silastic stay through the fat / epicardium?; using clips place onto the ends and gently lift up to control blood flow
4. Using 11 blade; make a longitudinal arteriorotomy (use sucker-blower to clear the operative field: blow to conter the direction of blood flow)
5. Insert a shunt (on the end of a string) to occlude the blood flow
6. Use a bulldog clip to occlude flow
7. Using a mosquito clip; clip the fascia surrounding the conduit onto the edge of the operative field
8. Parachute the end to side anastomosis; assistant to follow through out
9. Do back end; switch needle to do front end
10. Cut ends; wet hands and suture; tie off and cut with ~5mm 
11. Test with spy cam

Using the blower-sucker

• Utilises carbon-dioxide with saline to achieve a jet
• Blow to maintain a clear field of view
• Blow open the artery
• Do not blow when the surgeon is not operating (can damage tissues)