OBJECTIVE: The aim of this study was to evaluate pain and pulmonary function after partial upper versus complete sternotomy for aortic valve surgery. METHODS AND RESULTS: In a prospective study of 31 adult patients, 15 individuals underwent aortic valve replacement via partial upper sternotomy, and 16 patients were operated on by means of a full median sternotomy. Chest pain was assessed at rest, after spirometry and coughing, using the visual analogue scale and a structured questionnaire. Forced expiratory volume at I second and forced vital capacity were measured by a hand-held spirometer. Minimal-access patients had less postoperative pain and improved pulmonary function in comparison with conventional aortic valve replacement. After partial upper sternotomy, the postoperative chest pain was confined to the sternal area, while after standard sternotomy a more generalized chest pain occurred. Differences in pain scores could still be demonstrated one month after discharge. CONCLUSIONS: This study suggests that partial upper sternotomy improves pulmonary function and reduces pain in comparison with standard full sternotomy.