Figure 2.

Setup of the port access system. Cardiopulmonary bypass is established by cannulation of the common femoral vessels (both for venous drainage from the inferior vena cava and arterial inflow in the common femoral artery). A second venous drainage cannula is placed in the superior vena cava through the right internal jugular vein. A right minithoracotomy in the inframammary groove is used to lead prosthetic material into the chest. A camera port is used to provide full videoscopic assistance during the procedure, and three additional instrument ports are used. An expandable balloon inserted through the femoral artery is used to clamp the ascending aorta from the inside (aortic endoclamp), and to deliver cardioplegia to protect the myocardium during the arrest period.