Background: New minimally invasive approaches for cardiac surgical procedures are constantly being developed in the hope of decreasing patient morbidity, enhancing the postoperative recovery, reducing surgical trauma and length of stay. This report evaluate the advantages of minimally invasive incisions compared to standard approaches.Methods:60 patients operated upon in Kasr El-Aini Hospital and Zagazig University Hospital with isolated mitral or aortic valve lesion, the patients were divided into two equal groups. 30 patients in group A underwent standard median sternotomy for isolated valve replacement. In group B 30 patients underwent upper ministernotomy for isolated aortic or mitral valve replacement. The anesthetic and surgical protocol was identical for both groups. Pulmonary function tests were performed preoperatively and before hospital discharge in all patients. Calculation of skin to skin time, time of bypass and aortic cross clamp time were done for all patients. Postoperative evaluation for the following data was done. Ventilation time, recovery and extubation, blood loss, postoperative pain, I.C.U stay, hospital stay, wound infection and wound stability, wound cosmoses and pulmonary function tests. Results: Total time of operation was longer in group B 4+0.8 hours versus 3.7+0.6 hours in group A (P=0.03). There were statistical significant differences in bypass time and cross clamp time in both groups, bypass time 76.2 + 13.5, 102 + 14.2 minute in groups A and B respectively, cross clamp time 58.4 + 12.8, 88.5 + 14.8 minutes in groups A and B, respectively. Extubation time was less in group B (3.4 + 1.4) hours than group A (5.8+2.6) hours. Main blood loss was 321+15 ml in group A and 159+51 ml in group B, pain evaluation at discharge was (2.1+0.74) in group A , (1.87+0.68) in group B, I.C.U stay (3 + 0.9 days) in group A, (1.5 + 0.5 days) in group B, hospital stay (9.4+1.7) days in group A, (4.5 + 1.0) days in group B. FVC reduced postoperatively by 27.6% in group A, 23.5% in group B and FEV1 reduced by 33.6% in group A and 24.1% in group B, wound infection was 13.3% in group A and 3.3% in group B. Postoperative cosmetic scale in group A was 2.1 + 1.5 and in group B was 3.6 + 0.9 was significance value, no bleeding and blood transfusion occur in 13.3% in group A and 6.7% in group B, no reoperation for bleeding in both group, no conversion to median sternotomy in group B, and no malfunction valve or mortality in both group Conclusions: The advantages of minimally invasive incision includes less postoperative ventilation and extubation less blood loss, less analgesic dose, less I.C.U and hospital stay, less affection of pulmonary function tests, less wound infection, less cost and more cosmetic. Disadvantages include long total time of operation, cross clamp time and bypass time.