Multiple minimal access techniques have been described for aortic valve replacement (AVR). Although no appropriately designed prospective randomized trial of full median sternotomy vs a minimally invasive approach has been conducted, numerous retrospective cohort studies have shown no mortality or postoperative stroke difference between a full sternotomy and the various minimal access approaches to the aortic valve. In addition, multiple studies suggest blood product usage, ICU length of stay, hospital length of stay are reduced with the minimal access techniques. As minimal access techniques to the aortic valve become more common, cardiothoracic surgeons should be aware of these techniques, their unique challenges and pitfalls, as well as potential advantages and disadvantages of these approaches.
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