Direct aortic cannulation is preferable to avoid the potential for wound complications related to femoral cannulation. In addition, inserting the cannula through the superior vena cava can avoid a wide opening in the sternum, allowing a J-shaped sternotomy with a right incision between the third and fourth rib. Furthermore, the cannula can lay vertical close to the patient’s shoulder during the procedure without interfering with the operative field, providing a clear field of view and making valve implantation easier.
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