Since its development in the late nineties a minimal invasive approach via right lateral thoracotomy has been increasingly used as the standard technique for mitral valve surgery.In our center currently all procedures are performed using the direct transthoracic clamp method, blood cardioplegia, CO2-flooding and continues venting of the aortic root.In our recent series between February 2009 and May 2010 more than 229 minimal invasive isolated mitral valve procedures were performed.The 30 day mortality was 2.1% and the stroke rate was 0.8%.No aortic dissections were observed.Reconstruction rate was 95% in patients with prolaps using the Goretex loop technique.Minimal invasive mitral valve surgery can be offered with excellent results and safety profile and should be the standard approach for mitral valve surgery.