Minimal-access "J" or "j" sternotomy for valvular, aortic, and coronary operations or reoperations.

For more complex aorta, valvular, and coronary operations or reoperations where the new minimal-access operations are difficult to apply, a "J" or "j" sternal incision from the first interspace or sternal notch into the right fourth intercostal space is a useful alternative. The approach has been used for aortic and mitral valve procedures, coronary artery bypass with or without cardiopulmonary bypass, aortic root rupture, atrial septal defect repair, hemiarch repair, maze procedure, and composite valve grafts, including reoperations and transannular mitral valve replacements in 30 patients without complication related to it.