Patient characteristics
Between January 2017 and July 2021, a total of 230 patients (157 males; mean age 53.9 ± 8.8 years) underwent AVR in our department. The underlying pathology leading to the procedure was severe aortic insufficiency due to annulus dilatation/leaflet restriction or severe stenosis due to calcification. All AVRs were completed by the same experienced surgeon, and the access was achieved through one of a thoracoscopic approach, a r upper mini-sternotomy, and conventional median sternotomy. All patients were divided into the total thoracoscopic AVR group (n=18), the upper mini-sternotomy AVR group (n=43), and the conventional AVR group (n=169) according to the surgical access. Ethical approval for this retrospective study was granted by the local ethics committee. Individual patient consent was not required.