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Objectives: The aim of our study was to evaluate early outcomes and mid-term survival in patients undergoing minimally invasive aortic valve replacement (MIAVR) with the Perceval S sutureless valve for severe aortic stenosis. Methods: From March 2010 to March 2013, 281 high-risk patients underwent MIAVR with the Perceval S sutureless valve through either right anterior minithoracotomy (RT group, n= 164) or upper ministernotomy (MS group, n= 117) at two cardiac centres. Results: Overall in-hospital mortality was 0.7%(two patients). Mean cross-clamp and cardiopulmonary bypass times were 59±20 min in the RT group and 40±14 min in the MS group. Postoperative stroke occurred in five patients (1.8%). The incidence of paravalvular leak > 1+ and AV block requiring pacemaker implantation was 1.8%(five patients) and 4.2%(12 patients) respectively. No migration occurred and mean postoperative gradient …