Background& Objectives: Although both minimally invasive right anterolateral minithoracotomy and median sternotomy have been used for mitral valve surgery (repair / replacement), the latter approach is considered standard for mitral valve surgery. We hypothesized that mitral valve surgery, if performed through a right anterolateral minithoracotomy, would not be better accepted cosmetically by patients, but also make redo surgery through a median sternotomy easy and trouble free from re-entry bleeding and less postoperative complications with better pulmonary functions and more costeffective. The aim of the study was to evaluate and compare procedure and early postoperative outcome of minimally invasive right anterolateral minithoracotomy in comparison with median sternotomy in mitral valve surgery. Methodology: Thirty patients with mitral valve disease randomized into two equal groups; group “A” underwent mitral valve surgery through a minimally invasive right anterolateral minithoracotomy. Group “B” underwent mitral valve surgery through a median sternotomy. The mean age for group A was 42.73 ± 12.96 with a range from 16-61 years. The mean age for group “B” was 49.8 ± 12.47with a range of 29-65 years. Standard aortic and bicaval cannulation with antegrade blood cardioplegia was adopted in group“B”, while bifemoral (venous, arterial) cannulation with antegrade blood cardioplegia was adopted in group “A”.Results: There was no statistical difference between the two groups preoperatively regarding their age, sex, NYHA class, EF%, LA dimension, spirometric study. There was no operative mortality in both groups but fewer postoperative complications occurred in both groups. Total hospital stay, ICU stay, postoperative bleeding, inotropic requirement, ventilatory support, blood transfusion was less in group “A”, with better cosmetic appearance, more cost effective.Conclusion: Right anterolateral minithoracotomy minimally invasive technique provides excellent exposure of the mitral valve, even with a small atrium and offers a better cosmetic lateral scar which is less prone to keloid formation. In addition, minimally invasive right anterolateral minithoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. It should be used as an initial approach for mitral valve surgery.