Figure 56-5 A, Preparation for aortic and bicaval cannulation. Recipient cardiectomy follows initiation of cardiopulmonary bypass. Ao, aorta; IVC, inferior vena cava; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RV, right ventricle; S-A, sinoatrial; SVC, superior vena cava. B, Recipient cardiectomy is complete, with maximum lengths of ascending aorta and main pulmonary artery left. Much of the recipient's atria remain because they have been divided near the atrioventricular groove. Implantation begins with the left atrial anastomosis. C, Right atrial anastomosis. D, Frequently, the pulmonary artery is next to be anastomosed. However, as shown here, the aortic anastomosis may precede anastomosis of the pulmonary artery to shorten the ischemic time of the graft. E, The anastomoses have been completed and the patient has been separated from cardiopulmonary bypass.(From Shumway SJ, Shumway NE: Operative techniques in lung transplants. In Thoracic Transplantation. Oxford, Blackwell Scientific, 1995, pp 164–167.)