[Conventional surgery continues to be the best option for surgical treatment of aortic valve disease. Arguments against].

The median sternotomy is still the gold standard of cardiac surgery approaches. The main disadvantages of this cardiac access are osteomyelitis and mediastinitis which are infrequent but very serious; the aesthetic impact of a large and visible scar from the median lane and lastly respiratory failure consecutive to pain and sternal dehiscence. Other pathways have been developed in trying to reduce these complications and lessen the length of stay, pain and costs. From the many variants described up until now, the "J" ministernotomy seems to be the most accepted of these techniques. Although there are many published series describing these different cardiac approaches, the lack of prospective, randomized studies comparing conventional and minimally invasive surgery precludes the demonstration of the benefits of the new technique. In spite of this, we think the "J" ministernotomy undoubtedly has aesthetic advantages, smaller complications in patients with respiratory failure, easier repair in case of mediastinitis or osteomyelitis and fewer adhesions in surgical redos.