after within these general limitations and guidelines the invention can be varied and adapted as desired and necessary to provide suitable surgical instruments without departing from the invention the overall appearance and some limited functional information can be determined from fig1 and 2 to which reference is now made the aortic punch 10 shown in fig1 and 2 comprises a main sleeve 20 to which an end cap 60 is attached at the distal end thereof and punch die 70 is attached at the proximal end a punch 80 is slidably received in the die 70 and connected to be moved by the operating bar 36 which extends through an external slidable sleeve 100 the specific structure and function of the die and punch are the focus of the present invention and are described more fully below in connection with fig3 through 7 briefly however punch tip 80 is inserted through an incision in the aorta and the operating bar 36 retracts the punch into the die to punch a hole through the aorta of a precise dimension referring now to fig3 which is a cross sectional view taken along line 3 u2014 3 of fig2 the main cylinder 20 will be seen to be an elongate cylindrical tube constructed to define internal threaded receiving structures 22 at the distal end and 24 at the proximal end having a pair of opposed slots 26 and 28 formed through the cylinder walls intermediate the ends an elongate actuator slide 30 is slidably received in the main cylinder 20 the actuator slide 30 may except as specified hereinafter with respect to the proximal.