Figure 56-6b C, The left hilar anastomosis is nearly complete. A left atrial clamp permits anastomosis of the pulmonary veins with an appropriately sized cuff of the left atrium. D, On completion of the hilar anastomosis, the lung is reperfused and de-airing maneuvers are performed. Ventilation is initiated, and the procedure is repeated contralaterally in the case of bilateral transplants.