There are three Surgical Techniques for aortic valve replacement: Conventional sternotomy and valve replacement, Minimally Invasive Surgical Aortic Valve Replacement and Right Anterior Mini Thoracotomy. Median sternotomy was introduced by Milton in 1897 and has since become the standard incision in cardiac surgery allowing for access to the mediastinum and pleural cavities. Physicians remain reluctant to recommend AVR for elderly patients more than 80 years of age or those considered very high risk. Instead, many patients are continued on medical management or undergo a balloon aortic valvuloplasty. Unfortunately, these conservative therapies provide minimal or short-lasting symptomatic relief to the patient, eventually leading to restenosis of the aortic valve or sudden death. RAT avoids sternotomy and is associated with a limited skin incision. However, the operative field is smaller and the aortic valve sits deeper within the wound. Exposure is enhanced by minimizing cannula traffic within the incision via peripheral access, coupled with strategic placement of pericardial sutures. This approach is typically performed with a 4–6 cm incision through the second or third intercostal space