The term minimally invasive mitral valve surgery has been reported (MIMVS) by American Heart Association and referred to a collection of new techniques. All of these new techniques aiming to reduce surgical trauma by minimizing surgical incision, modified perfusion methods and use of new instruments . The right anterior mini-thoracotomy is the most common approach, next to it the lower mini-sternotomy approach, then the parasternal incision or the left posterior thoracotomy approach .

Technically MIMVS is more complex, requires a special learning curve and associated with higher Incidence of neurological events, aortic dissection, groin complications and infection despite all these benefits . MIVS also has controversies among cardiac surgeons, because it makes the exposure worse and requires a more complex surgery, which may lead to a less satisfying effect

Inclusion Criteria:

• Patients with isolated rheumatic mitral valve disease in need for mitral valve replacement.

Exclusion Criteria:

• Redo mitral valve replacement.
• Emergency mitral valve replacement (non-rheumatic cases).
• Patients who have combined other valve diseases e.g. (severe Aortic Regurgitation).
• Patients need Tricuspid valve repair or replacement.
• Severely calcified mitral valve disease (mitral annular calcification).