In small incision cardiac surgery, the aorta, right atrium, right ventricle, upper and lower vena cava and main pulmonary artery are well exposed, and the intracardiac structures are satisfactorily revealed, which can successfully complete the traditional surgery via right atrium, left atrium, atrial septum, right ventricle and aortic approach, and can complete some complex direct cardiac surgery including transvalvular annular patching for radical treatment of tetralogy of Fallot, with complete deformity correction and safe and reliable results. It is suitable for most congenital and acquired heart diseases, such as mitral and tricuspid valvuloplasty or replacement, atrial septal defect repair, ventricular septal defect repair, radical treatment of tetralogy of Fallot, pulmonary valvuloplasty, partial endocardial cushion defect correction, partial pulmonary vein malformation drainage correction, aortic sinus aneurysm correction, ventricular double outlet correction, right coronary artery right ventricular fistula correction, atrial mucus aneurysm removal The following procedures were performed: atrial mucinous aneurysm removal, etc. For intracardiac malformations combined with arteriovenous ductus arteriosus and permanent left superior vena cava, small-incision open-heart surgery may also be used. The pericardium should be carefully suspended to facilitate the exposure of the aorta and pulmonary artery; the ascending aortic wire should be placed accurately and effectively to prevent tissue tearing; the aorta should be pulled toward the foot side for the purpose of exposure and operation; when extracorporeal circulation is established, the aorta should be cannulated first to cope with intraoperative accidents; the vena cava can be cannulated with a right-angle tube according to the situation; the left superior vena cava can be freed from the sleeve when the left superior vena cava is present. When the left superior vena cava is present, the band may be free, intermittently blocked or drained by coronary sinus cannulation; when repairing a sub-stem ventricular septal defect or a trans-pulmonary annular patch to the left pulmonary artery with poor exposure, the heart may be gently rotated to the right and should be carefully sutured to prevent bleeding; intravenous application of scopolamine before opening the circulation may reduce pulmonary complications of right-sided open incision, especially in combined pulmonary hypertension. The right-sided open thoracotomy maintains the integrity and stability of the thorax and does not require wire fixation. However, the right-sided open-chest incision has poor exposure to the left side of the heart, and intraoperative cardiac traction can cause injury; compression and injury to the lung; and greater injury in the event of intraoperative accidents that require extension of the incision. Therefore, a small right-sided open-chest incision requires higher preoperative diagnosis and surgical operation, and its wide application is limited. The right axillary skin incision has better aesthetic results than small incisions in other parts of the chest. However, this incision has a deeper operative field and is relatively difficult to operate intracardiacly (especially in adults), and is most appropriate for children aged 1 to 5 years. The right anterolateral thoracic incision is made through the intercostal approach, which shortens the operation time; the direction of the incision is consistent with the skin relaxation line, which reduces postoperative incisional scar growth. It is suitable for most cardiac surgeries, especially secondary and emergency surgeries. However, the skin incision should be chosen away from the nipple for adolescent girls. The right parietal sternal incision provides better exposure of the heart than the right axillary incision. However, it is more traumatic than other open incisions, with relatively more bleeding and significant postoperative pain. The small lower sternal incision has no direct damage to the lung and pleura, reduces pulmonary complications, and facilitates the recovery of respiratory function; it can be easily enlarged into a conventional incision if an unexpected situation is encountered during surgery; postoperative sternal dehiscence does not occur. However, the incision is not good for revealing the base of the heart and large blood vessels. Therefore, for very complicated cardiac surgery, especially for cases with more operations on the bottom of the heart and large blood vessels, a conventional open chest incision should be used. In conclusion, small thoracic incision surgery can not only safely and effectively correct most cardiac lesions, but also provide less postoperative pain, fewer complications, faster recovery and better aesthetic results, reduce patients’ physical and mental trauma and improve their quality of life. However, it should be clinically selected for application according to specific conditions. For those with unclear diagnosis, especially complex lesions, conventional incision should be used.