The Prolene is secured to the cut fenestration edge with three interrupted sutures of fine 4-0 Prolene or GoreTex. The atriotomy is closed. Completing the operation With suction being applied both to the aortic root and the left ventricular vent, and while the coronary arteries are being temporarily occluded, the aortic cross-clamp is removed. The superior and inferior caval snares are released. Two pleural tubes and two mediastinal tubes are placed as prolonged pleural effusions not unexpected.
Ventilation is resumed The superior vena cava line is clamped and the cannula removed.
The superior vena cava cannula site is repaired with interrupted 6-0 Prolene if there is any distortion. The left ventricular vent is removed while a Valsalva is being performed. Left and right atrial lines are generally needed. Atrial and ventricular wires are placed. The fenestration snare is brought out underneath the fasciae in the midline.