Nevertheless, use of limited incisions may increase in the future with the advent of hybrid strategies that use a direct surgical approach (usually for grafting the LAD artery through a small parasternal incision) and percutaneous coronary intervention (PCI) of the other diseased coronary arteries. The benefit of hybrid revascular- ization and hybrid operating rooms, in which PCI and CABG can be accomplished in one procedure, is yet to be deter- mined. In patients with certain comorbid conditions, such as severe aortic calcification, previous chest irradiation, and obesity in combination with severe diabetes mellitus, full median sternotomy may be problematic,136 and hybrid revas- cularization may be preferable. 2.1.6. Anastomotic Techniques At present, most coronary bypass grafts are constructed with hand-sewn suture techniques for the proximal and distal anastomoses, a practice that has resulted in good short- and intermediate-term patency rates. Because surgeons have dif- ferent preferences with regard to the technical aspects of the procedure, a wide variety of suture configurations is used. Sewing of the proximal and distal anastomoses with a continuous polypropylene suture is commonly done, but techniques with interrupted silk sutures have been used, with similar results for graft patency and adverse events. Certain clinical scenarios have precipitated an interest in alternative techniques of constructing coronary bypass anas- tomoses. Some surgeons and patients wish to avoid the potential morbidity and cosmetic results of a median sternot- omy, yet the least invasive incisions usually are too small to allow hand-sewn anastomoses. To solve this problem, coro- nary connector devices have been developed for use with arterial or venous conduits to enable grafting without direct suturing. 