Background: As early as the era of cardiopulmonary bypass, Median Sternotomy was used to execute mitral valve surgeries. Minimally invasive mitral valve surgery (MVS) through right mini-thoracotomy has lately received a great deal of interest. The major aim of this study was to evaluate the clinical outcome of anterior thoracotomy compared to traditional median sternotomy for mitral valve replacement. Patients and Methods: 146 subjects with mitral valve disease (moderate to severe) scheduled to undergo elective mitral valve replacement were separated into two groups: group I through a conventional median sternotomy and group II through anterior thoracotomy. Results: A statistically significant difference was found in cross-clamp time between the two groups. Cross-clamp time was higher in group II (67.2 ± 5.6 minutes) than in group I (46.05 ± 4.7 minutes). Total bypass time was higher in group II (86.2 ± 5.7 hours) than in group I (75.5 ± 5.1 hours). Also, total operating time was higher in group II (276.2 ± 5.6 minutes) than in group I (238.1 ± 5.6 minutes). A significant discrepancy was found between VAS scores in the two groups on the 1st and 2nd day and the time to return to normal activity that was higher in group I than in group II. The hypertrophic scar was found in 21 patients (28.7%) of group I and 7 patients (9.5%) in group II with a statistically significant difference. 24 patients in group I (32.8 percent) and 68 patients in group II (93.1 percent) were happy with the look and aesthetic quality of their scars. Conclusions: Mitral valve replacement through minimally invasive right anterolateral thoracotomy has a longer cross-clamp duration, total bypass time, and total operating time than the standard median sternotomy, but it is a viable option. It results in less bleeding, less discomfort, a shorter hospital and ICU stay, and a quicker recovery.