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 clinical outcome of anterior thoracotomy compared to traditional median sternotomy for mitral valve replacement.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 group I (46.05 ± 4.7 minutes). Total bypass time was higher in group II (86.2 ± 5.7 hours) than group I (75.5 ± 5.1 hours). Also, total operating time was higher in group II (276.2 ± 5.6 minutes) than group I (238.1 ± 5.6 minutes). A significant discrepancy was found between VAS scores in the two groups in the 1st and 2nd day and time to return to normal activity that were higher in group I than group II. Hypertrophic scar was found in 21 patients (28.7%) of group I and 7 patients (9.5%) in group II with 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: 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.