OBJECTIVE: The aim of the study was to evaluate the technical feasibility and the postoperative course of aortic valve replacement through a ministernotomy. SETTING: The Montreal Heart Institute and the Hopital Lariboisiere, Paris, France. DESIGN: A case series from 2 institutions. PATIENTS: Fifty-one patients who underwent aortic valve replacement through a ministernotomy. The sternal incision was started at the level of the sternal notch extending down to the third or fourth intercostal space with a transverse section of the sternum at this level on both sides or limited to the right side (inverted T or L incision). Thirty-nine patients had aortic stenoses, 6 patients were operated for aortic insufficiency and 6 had mixed disease. The mean (and standard deviation) preoperative left ventricular ejection fraction was 0.56 (0.17). MAIN OUTCOME MEASURES: Cardiac bypass time, complications and outcome. RESULTS: The patients received Carbomedics and St. Jude mechanical valves, Hancock and Carpentier-Edwards bioprostheses. Thirty-eight patients were administered antegrade and retrograde cardioplegia, 10 patients antegrade and 3 retrograde blood cardioplegia only. The mean (and standard error) cardiopulmonary bypass time and aortic cross- clamp time were 104 (38) minutes and 72 (16) minutes respectively. Two patients (4%) died and 2 patients (4%) showed evidence of a stroke after the procedure. Hospital stay averaged 8 (5) days. CONCLUSION: We conclude that aortic valve replacement can be done through a ministernotomy approach with perioperative results similar to those obtained through a conventional sternotomy.