To solve this problem, coro- nary connector devices have been developed for use with arterial or venous conduits to enable grafting without direct suturing. In addition, these devices have been used in subjects with diseased ascending aortas, in whom a technique that allows construction of a proximal anastomosis with minimal manipulation of the ascending aorta (typically by eliminating the need for aortic cross-clamping) may result in less embo- lization of debris, thereby reducing the occurrence of adverse neurological outcomes. In this situation, the operation is performed through a median sternotomy, and the proximal anastomoses are created with a connector (or may be hand- sewn with the assistance of a device that provides a bloodless operative field) without partial or complete clamping of the ascending aorta. 2.1.7. Intraoperative TEE: Recommendations Class I 1. Intraoperative TEE should be performed for evalu- ation of acute, persistent, and life-threatening hemo- dynamic disturbances that have not responded to treatment.137,138 (Level of Evidence: B) 2. Intraoperative TEE should be performed in patients undergoing concomitant valvular surgery.137,139 (Level of Evidence: B) Class IIa 1. Intraoperative TEE is reasonable for monitoring of hemodynamic status, ventricular function, regional wall motion, and valvular function in patients un- dergoing CABG.138,140 145 (Level of Evidence: B) The use of intraoperative TEE in patients undergoing cardiac surgery has increased steadily since its introduction in the late 1980s. Although its utility is considered to be highest in patients undergoing valvular and complex open great-vessel/ aortic surgery, it is commonly used in subjects undergoing CABG. 