The other suture end is then run up the opposite side to the arteriotomy midpoint (Figure 21). The toe of the graft is sutured down to the tip of the arteriotomy with a horizontal mattress suture (Figure 22). The anastomosis is completed by carefully running one suture all the way around to meet the other end at its midpoint position (Figures 23 and 24).
The anastomosis is completed on the near side. Immediately prior to completion, a coronary dilator of suitable size may be passed downward through the anastomosis to confirm patency. When the anastomosis is completed, the graft is flushed with cold autologous blood to confirm patency and to identify any suture line leaks, which can be repaired at this time (Figure 25).