Table 1.

Advantages and disadvantages of aortic valve surgery approaches.

	Full Sternotomy	Hemi-Sternotomy	Right Anterior Minithoracotomy
Access	Unfettered view of whole mediastinum and whole heart	Good access to aortic root, limited to whole heart	Most challenging view
Sternal disruption	Whole sternum	To 2nd–4th intercostal spaces unilaterally or bilaterally	None, although costal cartilages are sometimes divided (may include right mammary artery ligation)
Cannulation	Full central	Variable—from full central to aortic arterial only	Typically requires peripheral cannulation
Instruments	Standard cardiac	Variable—can be standard or long-handled	Typically requires long-handled
Technical difficulty	Baseline	Learning curve easily traversed, including for trainee surgeons	Accepted to be technically challenging
Adjuncts Required	None	Variable—possible with standard equipment. Facilitated by rapid deployment valves, suture placement devices, and knot-tying devices	Facilitated by rapid deployment valves, suture placement devices, and knot-tying devices; Light source advantageous; Single lung ventilation.
Benefits (from most recent meta-analyses) *		Reduced intensive care and hospital length of stay; Reduced ventilation time	Reduced hospital length of stay; Reduced ventilation time; Lower stroke rate; Lower pacemaker rate
Risks *		Increased operative time; Increased costs	Increased operative time; Increased costs (including vs. ministernotomy); Lung herniation

* compared to median sternotomy unless stated otherwise.