The aim of the study was to evaluate and compare procedure and early postoperative outcome (3 months postoperatively) of minimally invasiveright anterolateral minithoracotomy versus median sternotomy in mitral valve surgery. Our study was conducted in Armed ForcesHospitals (Maadi Military Hospital, Glaa Military Hospital) during (2013-2014). Itwas a prospective comparative study and after approval of the ethical committeeon the study protocol and procedure. Fifty patients with Rheumatic mitral valve disease were randomized into two equal groups ; group “A” 25 patients underwentmitral valve surgery through a minimally invasive right anterolateralminithoracotomy. Group “B” 25 patients underwent mitral valve surgery through standard median sternotomy. There was no statistical difference between the two groups preoperatively regarding their age, sex, NYHA class, EF%, LA dimension,spirometric study. Total hospital stay, ICU stay, postoperative bleeding, inotropicrequirement, ventilatory support and blood transfusion were less in group “A”with highly significant statistical difference (P-value < 0.01), with better cosmeticappearance and more cost-effectiveness. Minimally invasive right anterolateral minithoracotomy formitral valve surgery was comparable to median sternotomy technique regardingsafety, with fewer complications and postoperative pain, less ICU and hospitalstay, faster postoperative return to work with no movement restriction aftersurgery. It should be used as an initial approach for mitral valve surgery.