الفهرس 
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Abstract
The Society of Thoracic Surgeons National Database defines minimally invasive cardiac surgery as”any procedure that has not been performed with a full sternotomy and cardiopulmonary bypass support”. All other procedures, on or off pump with a small incision or off pump with a full sternotomy are considered minimally invasive. (4, 5)
Aortic valve replacement (AVR) through a full sternotomy (FS) is the conventional approach for the treatment of aortic valve disease. The most common minimally invasive approach is the partial upper Ministernotomy , followed by the right anterior minithoracotomies.
Compared with conventional surgery, MIAVR has been shown to provide faster recovery, shorter hospital stay, improved cosmesis and less wound infection. In addition, MIAVR has shown to improve postoperative respiratory function due to the preservation of sternum, and reduction of postoperative pain, blood loss and blood transfusions related to the reduction of surgical dissection, as well as facilitating reoperation at a later date, as part of pericardium remains closed. (12)
Minimally invasive surgery offers certain advantages in comparison with conventional treatment as follow:
1. Reduction in surgical drainage and therefore in the need for hemoderivatives in the immediate postoperative period.
2. The reduction of pain felt by the patient and the demand for analgesics in the immediate postoperative period assessed according to different subjective scales.
3. The parameters of pulmonary function will be less affected by minimally invasive approaches.
Reduce surgical aggression and thus favour functional recovery with reduction of the average hospital stay both in time spent in intensive care and total time in hospital.
5. Improved cosmetics remains the unquestionable benefit of MIAVR with lower incidence of sternal wound infection.
6. Furthermore, these patients recover faster and can therefore incorporate themselves into working life faster and with fewer rehabilitation requirements.
A number of factors have been highlighted as potential disadvantages of minimally invasive surgery as compared with the conventional approach as:
1. Longer time taken to do the cardiopulmonary by pass , the time required for aortic clamping and finally the overall surgery time, but this is different according many reasons like surgical experience , the time required for hemostasis.
2. De-airing can be slower and more difficult with the resulting risk of gas embolism .
3. The increase in technical complexity which could put the effectiveness of the surgical procedure at risk.
4. Difficult placement of pacemaker.
5. Need for femoral cannulation with limited control in case of hemorrhage.
6. A steep learning curve are some of the reasons that preclude universal adoption of this technique.
7. Minimally invasive surgery requires specialized high-end medical equipment and The equipment used with MIS is more expensive.