- Plan the position of the proximals - On the right, take into consideration the planned lie of the graft to avoid the right atrial appendage on the caudal side, and the pericardial reflection overlying the SVC on the cranial side. These can perturb to the graft - On the left, take into account proximity to the root vent and the cross-clamp, and the intended lie of the graft relative to the PA, taking into account the distended PA. - While the aorta is distended with antegrade cardioplegia, grasp the adventitia overlying the areas of the intended proximals with a regular DeBakey forceps, and use electrocautery to remove a circle of adventitia large enough for the proximal. This will also cauterize adventitial vessels. - Mistrust the aorta whose adventitia does not have a little freedom of motion relative to the deeper layers. It may be thicker than usual.