[Stepwise technique of the proximal anastomosis with the new proximal anastomotic system for the prevention of kinking of the graft].

In using the proximal anastomotic system, the anastomotic site should be carefully selected to prevent the kinking of the graft, because the angle of the graft and the aortic wall is perpendicular. There recommended anastomotic sites are the left lateral aortic wall adjacent to the pulmonary artery for the left coronary system grafting and the lower aortic wall adjacent to the right atrium for the right coronary system grafting respectively. When the selection of these sites are difficult because of the atherosclerotic lesion of the aorta, the short vein graft (2-3 cm) was first anastomosed with PAS-Port device to the site free from atherosclerosis. Then, the long vein graft was anastomosed to the short graft with monofilament suture under end-to-side fashion. The angle of the anastomosis was decided according to the relationship of the aorta and the target coronary artery to establish a smooth graft line. By this stepwise technique, the optimal graft design could be obtained without a risk of the kinking of the graft.