Anastomotic connectors may enable more routine applica- tion of totally endoscopic anastomoses in subjects undergoing minimally invasive CABG. Because hand-sewn anastomoses are technically challenging when performed endoscopically, consideration has been given to the concept of anatomic connectors to facilitate more reproducible and less technically demanding procedures and ultimately to allow widespread use. Both proximal and distal connectors may be used. Several options are being developed, some only available outside the United States, and the evidence base supporting their use is evolving.1254 The PAS-Port proximal device has been associated with acceptable outcomes. In two prospective studies, its angiographic graft patency 9 months after CABG was similar to that of hand-sewn anastomoses.1255,1256 With this device, the proximal anastomoses must be constructed Hillis et al 2011 ACCF/AHA CABG Guideline e699 before the distal ones. At present, only 1 distal device, the Cardica C-Port, has been approved for use in the United States. The prospective studies1257,1258 demonstrated a 6-month overall patency of 96% in 102 subjects. These devices increase the cost of the operation. Over the past 20 years, the patency rate of all graft types has improved gradually, so that the present failure rate of LIMA grafts at 1 year is about 8% and of SVGs roughly 20%.1259 Many patients being referred for CABG nowadays have far advanced CAD, which is often diffuse and exhibits poor vessel runoff. Technical issues at the time of surgery may influence graft patency, and intraoperative imaging may help to delineate technical from nontechnical issues. Because coronary angiography is rarely available intraoperatively, other techniques have been developed to assess graft integrity at this time, most often the transit-time flow and intraopera- tive fluorescence imaging. 