Minimally invasive cardiac surgery has captured the interest and attention of cardiac surgeons throughout the world. We reviewed our experience of minimal access cardiac operations performed through a lower median ministernotomy. Between January 1997 and August 2003, 100 congenital, 178 valvular, 168 coronary, 12 aneurysmal, and 2 other operations were performed via a 6 to 9 cm lower ministernotomy in 460 consecutive patients. No special instruments were required. Four patients died, and 2 re-operations were necessary. Complications occurred in 28 patients (6.1%). The mean cardiopulmonary bypass time was 88.50 +/- 65.16 min, crossclamp time was 55.81 +/- 31.89 min, time to extubation was 14.71 +/- 29.33 h, and total chest drainage was 7.28 +/- 5.07 mL.kg(-1). Blood transfusions of 951.42 +/- 642.34 mL were needed in 282 patients. Postoperative hospital stay was 11.6 +/- 6.0 days. Our experience shows that many types of cardiac operations can be performed through a lower ministernotomy. This technique results in less trauma, quick recovery, and reduces the risk of infection and blood loss. It is a safe and easy procedure that can bring about favorable early outcomes in a wide range of cardiac operations.