Abstract
BACKGROUND: Although the field of minimally invasive aortic surgery is steadily progressing across India, the adoption of totally endoscopic techniques remains in its nascent phase, limited to a handful of centres. CASE SUMMARY: We report a 67-year-old male with a familial history of aortic dissection and progressive aneurysmal dilatation of the ascending aorta. Elective totally endoscopic supracoronary ascending aorta replacement was performed via a 3-cm right anterior minithoracotomy with the aid of 3D visualization. Postoperative recovery was uneventful. CONCLUSION: This case demonstrates the safety and feasibility of totally endoscopic ascending aortic replacement in an Indian patient using a contemporary minimally invasive approach. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13019-026-03872-w.