They can be done either with the clamp still on or after removing the aortic clamp and isolating a small segment of the aorta by placing a partial clamp (but atheromatic aortas might be damaged by overhandling them; atheromatic derbis might get detached and cause embolization in end organs)
Weaning from cardiopulmonary bypass and closureAfter the proximal anastomoses are done, the clamp is removed, aorta and conduits deaired, pacing wires might be placed if indicated and if the heart and other systems are functioning well CBP is discontinued,  cannulas removed and protamine is administered to reverse the effect of heparin . After possible bleeding sites are checked, chest tubes are placed and sternum is closed. Off-pump (OPCABG)
Off-pump coronary artery bypass graft (OPCABG) surgery avoids using CPB machine by stabilizing small segments of the heart. It takes great care and coordination among the surgical team and anesthesiologists to not manipulate the heart too much so hemodynamic stability will not be compromised; however, if it is compromised, it should be detected immediately and appropriate action should be taken. To keep heart beating effectively, some maneuvers can take place like placing atrial wires to protect from bradycardia, placing stitches or incisions to pericardium to help exposure. Snares and tapes are used to facilitate exposure. the aim is to avoid distal ischemia by occluding the vessel supplying distal portions of the left ventricle, so usually LIMA to LAD is the first to be anastomosed and others follow.
Distal myopathy  is a group of rare genetic disorders that cause muscle damage and weakness, predominantly in the hands and/or feet. Mutation of many different genes can be causative. Many types involve dysferlin. Signs and symptoms
All of the different types affect different regions of the extremities and can show up as early as 5 years of age to as late as 50 years old. Distal myopathy has slow progress therefore the patient may not know that they have it until they are in their late 40s or 50s.Miyoshi myopathy affects the posterior muscles of the lower leg, more so than the anterior muscles of the lower leg. Cause
The cause of this myopathy is very hard to determine because it can be a mutation in any of at least eight genes and not all are known yet. These mutations can be inherited from one parent, autosomal dominant, or from both parents, autosomal recessive. There are eight known types of distal myopathy. Types
Diagnosis
In terms of diagnosis, Vocal cord and pharyngeal distal myopathy should be assessed via serum CK levels, as well as muscle biopsy of the individual suspected of being afflicted with this condition

Management
As of 2011, no disease modifying treatments are known. Foot drop can be managed with ankle-foot orthoses or surgical tendon transfer, in which the tibialis posterior muscle is repurposed to function as a tibialis anterior muscle. In select types of distal myopathy, evaluation of the heart may be indicated. Scoliosis and contractures can be surgically managed. References
Further reading
Udd, Bjarne (February 2007).