Saving space for less invasive direct-vision, mitral valve surgery with altered cannulation protocol.

Saving vital space in less invasive cardiac surgery is of great importance, especially in mitral valve surgery which is sometimes difficult, even with the full sternotomy approach. We present a modification of the venous cannulation protocol we use in less invasive, direct-vision mitral valve surgery through a half-lower partial sternotomy. The superior vena cava is drained with a right jugular vein cannula. For inferior vena cava drainage we use an oval venous cannula which is exteriorized through another small skin incision. These modifications, together with the use of a smaller diameter aortic cannula, provide vital space for surgical maneuvers through a small (810 cm) skin incision.