The choice of incision for cardiac surgery has undergone some changes, and nowadays, median opening has become the routine choice for cardiac surgery. Except for a few procedures such as arterial catheter ligation and simple aortic narrowing, where the left side incision is chosen (because the descending aorta and the arterial catheter are located on the left side, the left side incision is chosen to facilitate exposure and operation), the choice of a median incision for other cardiac procedures is not only powerful for the exposure of the operative field, but also convenient for operation and best for handling in case of accidents, which is consistent with the anatomical location and structural characteristics of the heart. From a purely medical point of view, the median incision is certainly the best choice. However, from the patient’s standpoint, from the psychological and social needs, the median incision has many shortcomings, especially for some simple congenital heart disease patients, who are basically a normal person after surgery, and since they are normal people, they will have higher requirements, and a large scar on the chest becomes a “heart disease” for many patients and parents after surgery. Disadvantages of the median incision: 1. The incision is located in front of the chest, which affects the aesthetics, dressing and social activities. 2. For children, most of them have different degrees of corpus cavernosum after surgery and need to wear a corpus cavernosum control device for correction, and serious cases need surgery for correction. 3.The sternum is fixed with steel wire after splitting, and a metal foreign body is left in the body, and MRI cannot be performed. 4.It is not conducive to the protection of patient privacy. The small axillary incision on the right side just avoids the above disadvantages. Why the right side instead of the left side: Although the heart is generally located on the left side, cardiac surgery requires extracorporeal circulation and cannulation through the aorta and the upper and lower vena cava, which are located on the right side, so the right side is chosen. Factors to be considered when choosing a small right axillary incision: 1. From a purely medical point of view, choosing a right-sided incision is the surgeon’s way of “asking for trouble”, but it can bring the patient a more “perfect” result, which is a reflection of the humanization of modern medicine. 2, choose the right side of the incision can not be at the expense of the safety of surgery and treatment results. The use of a small right axillary incision has a deep field and a small field of view, which requires a high level of skill for the surgeon and more experience and skill to handle unexpected situations. 3, for those heart disease suitable for the right side of the incision, there is still more controversy, this and the surgeon’s education and training experience, experience in medicine, academic views are related. My personal opinion is: simple congenital heart disease, such as atrial and ventricular septal defects (including sub-stem type), partial pulmonary venous malformation drainage, partial endocardial cushion defect, etc. with clear diagnosis, combined with left superior vena cava is not a contraindication. The small right axillary incision is not suitable for tetralogy of Fallot and other complex malformations and valvular diseases, which are complicated and risky, and face many problems after surgery. 4, the right axillary straight incision or oblique incision I personally think there is no substantial difference, after all, all have to go through the intercostal into the chest, muscle damage is similar, the incision is located in the axilla, straight or oblique in the aesthetic effect is not much difference. My personal experience is that the incision can be made smaller and straighter for atrial septal defect or small perimembranous septal defect, and the incision can be extended anteriorly for inferior ventricular septal defect and combined left superior vena cava, after all, safety is the most important. In principle, for female patients, the incision should not exceed the level of the anterior axillary line, so as not to affect the growth and development of the breast.