Introduction

Access to the thoracic cavity for the purpose of cardiac surgical procedures can be obtained through a variety of incisions depending on the type of procedure being performed, urgency of the operation, history of previous surgery, patient comorbidities, and patient preference. Traditionally, median sternotomy has been the most commonly used incision to access the heart and major vasculature given its excellent exposure of all cardiac chambers and great vessels; however, within the past 2 decades many procedures have undergone refinement such that they can be performed through smaller, less invasive incisions. As the choice of incision determines operative exposure and visualization, the right choice for each patient and procedure is imperative. Through careful planning and patient selection, each patient may be matched with an appropriate procedure and approach in order to maximize the potential benefit while minimizing risk. This chapter will outline several commonly performed incisions and approaches in cardiac surgery, including operative technique, common pitfalls, and possible complications.