Abstract
Arterial cannulation is sometimes more difficult in adult patients due to a highly positioned ascending aorta in the classical Tshaped lower mini-sternotomy approach. Excessive traction of the aorta during the cannulation may cause lacerations which requires alternative cannulation or increase in skin incision and sternotomy. We performed a 8 to 10 cm skin incision between 2 cm below sternal angle and 3 cm above xiphoid. Sternal division was done with an oscillating saw. Two additional sternal divisions were done towards both right 2nd and 4th or 5th intercostal space. The final shape of the sternal division resembled a square bracket. This type of sternal incision provides adequate surgical exposure for performing safe ascending aorta and bicaval cannulation.
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