Introduction
Minimally invasive cardiac surgery has become a new trend in modern medicine because of its reduced trauma, less bleeding and shorter post-operative recovery time, and there has been a significant increase in the number of studies related to minimally invasive valve surgery[1]. With the promotion of minimally invasive concepts and advances in total thoracoscopic valve surgery, total thoracoscopic valve surgery is not limited to the mitral valve procedure anymore, and total thoracoscopic aortic valve surgery has become a new option for patients with aortic valve lesions. However, due to its anatomical characteristics, poor surgical field exposure and limited operating space, total thoracoscopic aortic valve surgery has not become a routine choice of minimally invasive aortic valve surgery just like total thoracoscopic mitral valve surgery. Total thoracoscopic aortic valve replacement (AVR) was first proposed in 2014 by Vola et al[2], and a single-arm study that included 14 patients who underwent total thoracoscopic AVR in 2016 confirmed the safety and reliability of this procedure[3].
In this study, patients hospitalized for aortic valve lesions who underwent AVR were divided into three groups and underwent conventional AVR, upper mini-sternotomy AVR and total thoracoscopic AVR respectively. Baseline data, perioperative data, and early outcomes were used for observation and comparison to assess the safety and reliability of total thoracoscopic AVR.