This is the “cardiac” pledget. This can be used for repairing an aortic tear. How to do it? It seems a bit complicated but it is not. Just follow the steps as described below.
Use a 4/0 Prolene stitch, double needled. Pass both needles from the stitch from the same side to the other. Then use each of the needles to suture the bleeding point on figure-of-eight concept. Then, pass each needle from the pledget the other way to the first passage. The final condition will be one pledget coming down over the tear as seen in the picture.