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Objective: Valve replacement, either surgical or interventional, is the treatment modality in most cases with aortic valve disease. Alternative surgical incisions are promoted to facilitate postoperative weaning and pain control in cases with comorbidities. Anesthetic techniques are also modified for the same goal and the era of “Fast track” anesthesia is opened recently.

Methods: High thoracic epidural anesthesia through T1-T22 or T2-T3 intervertebral space and upper half mini-sternotomy is our routine approach. Aortic valve replacement was performed under cardiopulmonary bypass (CPB) without general anesthesia in 3 patients. Standard CPB was initiated with central aortic cannulation and two stage single venous cannula. The patients were able to verbally communicate during the operation.

Results: All cases were successfully transferred to the intensive care unit after operation and no complications occurred.

Conclusion: We combine HTEA with minimally invasive aortic valve replacement in selected cases, to perform open heart surgery in awake patients. Perioperative low dose anesthesia and consciousness of the patient are main goals. There is no need for weaning from mechanical ventilation and the patients can be mobilized after hemodynamic stabilization, which leads to shorter ICU and hospital stay.