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"Transverse incision was made in the antecubital fossa overlying a new area of the arterial end of the graft. The graft dissected and skeletonized. A separate incision made in the deltopectoral region just distal to where the HeRO graft connected to the outflow component. Both of these areas of the graft were resected and skeletonized. Kelly Wick Tunnel used to make a 7 mm tunnel between these two areas. A 6 mm Acuseal graft was brought to the field. It was pulled through these two incisions. The arterial end of graft was clamped and the other end ligated with a hemostat. Graft was then divided. An end-to-end anastomosis was done between the arterial end of graft using one 5-0 C1 suture under loupe magnification. Attention turned to the venous anastomosis. Again graft clamped just distal to the outflow component; graft was transected. Another end-to-end anastomosis was done between Acuseal graft and the old HeRO graft... with a 5-0 C1 suture under loupe magnification. Post anastomosis, clamps were released. There was excellent flow into graft with immediate thrill."