Median sternotomy has been well established as the standard approach for mitral valve surgery. The rapid development of techniques over the past decade had led to the realization that the minimally invasive approach enables complex mitral valve surgery to be performed with good results. Patients and Methods: 44 patients with mitral valve disease were included in a prospective comparative study. The patients were allocated randomly into : group (A) had mitral valve replacement through the minmally invasive right anterolateral minithoracotomy approach; and group (B) had mitral valve replacement through conventional median sternotomy approach. All patients were followed up for the assessment of the postoperative outcome. Results: The final analysis included 22 patients in each group. A statistically significant difference was detected in skin incision length (9.77 ± 1.38 cm in group A and 16.32 ± 1.25 in group B), Intra-operative blood loss (168.64 ± 67.42 ml in group A and 286.36 ± 49.62 ml in group B) and total operation time (169.71 ± 69.94 in group A and 226.8 ± 79.6 in group B). There was a statistically significant difference regarding postoperative blood loss (256.82 ± 78.0 ml in group A and 470.91 ± 231.56 ml in group B). Group A showed significantly (P < 0.0001) less need for ICU stay duration (2.5 ± 0.74 days) and shorter hospital stay duration (7.73 ± 2.27 days). Additionally, patients in group A experienced lower pain score (9.18 ± 3.71). Conclusion: Mitral valve surgery through minimally invasive anterolateral thoracotomy approach offers better outcomes over the conventional median sterontomy approach in aspects of intra-operative time and blood loss, skin incision length, postoperative blood loss, ICU and hospital stay duration, and pain score.