Heart valve repair and replacement has long been a very mature and even “routine” cardiac surgery, which has been widely carried out nationwide. However, the traditional procedure still has certain shortcomings – the surgical incision is large, the patient loses more blood during the operation, often requiring blood transfusion, and the postoperative recovery time is long …… Although the cardiac surgery department of the Tenth Hospital is a latecomer among the related disciplines in Shanghai’s tertiary hospitals, it has been committed to minimally invasive as the focus of its development since the establishment of the department. The Department of Cardiac Surgery of the Tenth Hospital is a latecomer to the related disciplines in Shanghai’s tertiary hospitals, but since its establishment, it has been committed to minimally invasive as the focus of disciplinary development. After more than two years of construction, a package of technologies, represented by 3D thoracoscopy, 4D esophageal ultrasound monitoring and preoperative autologous blood separation, has been formed to achieve a breakthrough in the field of minimally invasive valve surgery. Traditional heart valve repair and replacement surgery requires a ten-centimeter-long incision in the patient’s thorax, which is highly traumatic, blood loss, and slow recovery can be imagined. To avoid these disadvantages, the cardiac surgery department of the Tenth Hospital now routinely performs the most advanced minimally invasive valve surgeries, such as mitral valvuloplasty and replacement with a small incision in the chest under the breast, and aortic valve replacement with a small incision in the mid-superior or parasternal sternum. In addition, the hospital has taken the lead in introducing 3D thoracoscopic technology, which represents the international frontier, and has completed the first 3D thoracoscopic-assisted mitral valvuloplasty and atrial fibrillation ablation in East China one after another. 3D thoracoscopic heart valve surgery] “Small incision” is only the first step of minimally invasive cardiac surgery, to be truly minimally invasive, more new technologies must be carried out to achieve both internal and external, two-pronged approach. Recently, the Tenth Hospital has introduced the latest international 4D transesophageal ultrasound. This technology is based on 3D ultrasound images with a time dimension. 4D transesophageal ultrasound is like another pair of special “eyes” for heart surgeons, more accurate than conventional esophageal ultrasound. The echocardiogram is performed from the posterior or inferior posterior aspect of the heart by placing the ultrasound probe in the appropriate position in the esophagus. The combination of 4D technology makes the images very fine and realistic, almost identical to the direct view in post-opening surgery, and allows the observation of tissue structures and subtle pathological changes that are difficult to detect with normal ultrasound technology. By applying 4D transesophageal ultrasound technology in cardiac surgery, we can understand in real time whether the disease correction is complete, whether the effect is satisfactory after valvuloplasty, and whether the valve replacement is working normally, so as to achieve more accurate and effective real-time surgical efficacy discrimination. 4D transesophageal ultrasound images] The technique of autologous blood separation is also applied during the surgery. Before surgery, the surgeon will separate part of the patient’s blood into different components such as plasma, red blood cells and platelets, and preserve them according to their respective requirements. After the surgery, the pre-preserved autologous blood components are sequentially transfused back into the patient’s body according to their needs. This meets the patient’s postoperative need for blood products and effectively avoids the possible risks associated with allogeneic blood transfusion, as well as reducing medical expenses and speeding up the patient’s postoperative recovery. Minimally invasive small incision vs. traditional incision】 Since its establishment, the Cardiac Surgery Department of the Tenth Hospital has completed more than 500 cases of cardiac major vascular surgery, with a success rate of more than 98%, which has won the praise of peers and patients alike!