Minimally invasive cardiac surgery mitral valve surgery (MICS MVS) that was pioneered almost three decades ago was proven to be as effective as procedures performed through midline sternotomy, however, with clear advantages in patient recovery following valve surgery. Patient selection is critical to MIMVS. Particularly for less-experienced surgeons starting a MICS MVS program, potential candidates should have uncomplicated mitral pathology, reasonable chest wall anatomy, and few comorbidities. Generally, cannulation for MICS MVS is achieved with femoral arterial and venous cannulation. The two options for myocardial protection are to clamp and arrest the heart and to use a fibrillating heart approach. Minimally invasive mitral valve repair has comparable surgical mortality to standard median sternotomy approaches, but offers reduced pain, bleeding and transfusion, and length of hospital stay with faster surgical recovery.