Left-sided grafts – held by assistant at superior aspect of sternotomy with ring-tip forceps held in the right hand. Aim for the heel at 1 ‘o clock on the aorta. Start backhand out-side in on the vein graft at its 3’o clock position.

Right-sided grafts – held by assistant at inferior aspect of sternotomy with ring-tip forceps held in the left hand. Aim for the heel at 5 ‘o clock on the aorta. Start backhand out-side in on the vein graft at its 9’o clock position.

Grab needle with forceps and keep back hand stroke. Backhand inside out 5 ‘o clock on aorta. Grab the needle with the needle-holder backhand. Use forceps to hold vein at 9’o clock position to open the vein out, assistant retracts 3’o clock vein with suture.

Keep needle 90-120 deg. Do not hook into the vein as this can catch back wall.

Two diameters for vein – a) outer edge diameter that will cinch the vein down with the suture, b) inner diameter that is effective lumen of the graft. Larger bites on the aorta increases a) and decreases b), and flattens the graft.

Pull on both ends before tying. Cut the end of the needle on the shod to keep the knot on the aorta side when tying.