BACKGROUND: We present a case of redo aortic valve replacement in a patient with thrombocytopenia. The initial operation was performed through limited access transverse sternotomy. This is the first report of this kind in the literature. CASE PRESENTATION: A 62 year old Caucasian male farmer with thrombocytopenia had uneventful redo aortic valve replacement when the first xenograft failed after 9 years, the transverse upper hemisternotomy in the first operation appearing to facilitate the redo complete sternotomy. CONCLUSION: With this only case of redo aortic valve replacement in our practice of 90 hemisternotomies over 10 years we present for consideration the use of a tissue valve in a complex relatively young patient.