Median sternotomy incision is the usual incision used for aortic valve replacement although it has manyadvantages but also has many disadvantages we use right anterolateral thoracotomy incision for the sameoperation, aiming to overcome some disadvantages of median sternotomy incision as sternal woundcomplication as infection and dehiscence hoping to decrease patient morbidity, enhancing postoperativerecovery, reducing surgical trauma and length of stay. We also hypothesized that patients which do rightanterolateral thoracotomy will have a second good chance for another redo-cardiac injury. The aim of thework is to compare and evaluate the operative and postoperative results of the two incisions. 60 patients with isolated aortic valve lesion were divided into two equal groups. 30 patients in group (A)underwent right anterolateral thoracotomy incision for isolated aortic valve replacement and the other 30patients in group (B) underwent median sternotomy incision for isolated aortic valve replacement.The mean age were 18:38Y (mean 25.73 ± 5.95) with group (A) and 17:37 Y. (mean 22.38 ± 4.57) with group (B).Standard anesthetic technique, surgical instrument, and surgical technique were the same for both groups. Length of skin incision/cm (8.22±0.78 vs. 22.40 ± 1.54 P = < 0.005) perfusion time/min ( 88.80 ±9.93 vs. 92.70 ± 12.95P = 0.196) cross clamp time/min (68.50 ± 10.05 vs. 68.53 ± 10.81 P = 0.990) total operative time/min (174.10 ±13.58 vs. 202.87 ± 17.78 P = <0.005) No conversion to median sternotomy with group (A). IV. Narcotic (pithidin)dose/mg (180.50 ± 83.43 vs. 117.67 ± 85.41 P= 0.006) NSAI. Drug /day (5.47 ± 1.87 vs. 7.23 ± 2.11 P= 0.001)ventilation time/ h (8.77 ± 1.76 vs. 11.10 ± 3.89 P= 0.005) Number of chest tube (1 ± 0.0 vs. 2.20 ± 0.48 P= <0.005)post operative discharge/ml (99.93 ± 13.21 vs. 465.53 ± 327.84 P= <0.005) post operative blood transfusion/u(1.83 ± 0.70 vs. 3.07 ± 1.01 P= <0.005) ICU stays/d (2.40 ± 0.50 vs. 3.50 ± 1.22 P= <0.005) post operative pain in 1stday (6.97 ± 1.29 vs. 5.22 ± 1.41) 2ed day (4.78 ± 1.19 vs. 4.11 ± 1.12) 3ed day (3.4 ± 1.59 vs. 3.1 ± 1.75) and 6th day(2.66 ± 1.69 vs. 1.97 ± 0.79) post operative re-exploration (0 vs. 10% p = 0.237) post operative pulmonarycomplication (6.66% vs. 9.99%) post operative pericardial collection (9.99% vs. 3.33%) Brachial plexus injury (0 vs.3.33%) superficial wound infection (13.3% vs. 23.3%) deep wound infection (0 vs. 3.33%) total hospital stay/day(7.11 ± 0.88 vs. 11.67 ± 3.65 P= <0.005) Back to work and normal life activity (20:30 day vs. 60: 90day). Right anterolateral thoracotomy incision provides excellent exposure for aortic valve, safe, quick, superiorcosmetic appearance and good cost beneficial effect and can be used as an initial approach for aortic valvereplacement and preserve the median sternotomy incision for any open-heart surgery which may be neededlater in life.