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1. The heart is accessed through a full midline sternotomy
2. An off-pump coronary artery bypass graft is performed on the left anterior descending artery using a saphenous vein graft and 7-0 prolene continuous suture
3. The aorta is partially clamped with a side clamp and is opened through a longitudinal incision, about 2 cm length
4. A prosthesis is sutured onto the aorta with a continuous 4-0 prolene suture
5. One branch of the prosthesis is passed behind the ascending aorta,