Minimally invasive techniques are an important milestone in the history of surgical development. With the popularization of minimally invasive concept, the invention and improvement of new surgical equipment and minimally invasive instruments, and the maturation of surgical techniques, minimally invasive cardiac surgery, especially minimally invasive valve surgery, has developed rapidly in recent years. Zhongshan Hospital of Fudan University has completed more than 1000 minimally invasive cardiac surgeries so far, including more than 800 minimally invasive valve surgeries, which is the leading position in China. A perfect minimally invasive incision can reduce the damage to the sternum and chest wall, the disturbance to the body, and the psychological impact on the patient without sacrificing good field exposure, reducing the quality of intracardiac operations, or increasing the risk of surgery. A variety of minimally invasive surgical approaches have been used for mitral valve surgery, among which the right anterolateral thoracic incision (4-6 cm) is the most widely used because it completely preserves the integrity of the sternum, exposes the valve and subvalvular structures satisfactorily with thoracoscopic or robotic assistance, and provides a more concealed incision with good cosmetic results. The most widely used minimally invasive aortic valve surgery is the upper sternal incision (7-8 cm) and the transverse third intercostal incision (4-5 cm) via the right parasternal sternum. The indications for minimally invasive heart valve surgery are not yet standardized and depend on the surgical experience of the minimally invasive surgical team including cardiac surgeons, anesthesiologists, and extracorporeal circulators and the degree of mastery and recognition of minimally invasive cardiac surgery, which is most suitable for patients with cosmetic requirements and can also benefit patients with osteoporosis and severe diabetes mellitus. Patients with simple mitral or aortic valve lesions currently seen at our institution may be considered for minimally invasive surgery for reasons other than the following: 1. patients with a history of right thoracic surgery or infection; 2. patients in whom TEE cannot be placed; 3. patients with severe pulmonary hypertension; 4. patients with severe peripheral atherosclerosis or arteriovenous malformations; 5. patients with combined untreated severe coronary artery disease; 6. preoperative cardiac ultrasound findings of severe calcification of the mitral annulus or patients with severe calcification of the mitral annulus or aortic annulus; 7, patients with severe calcification of the ascending aorta detected by preoperative chest CT; 8, patients with severe obesity, etc. Patients undergoing minimally invasive valve surgery have a better postoperative recovery than those undergoing conventional surgery. Our findings suggest that the postoperative ICU time, postoperative hospital stay, and mean recovery time after minimally invasive mitral valve surgery are shorter than those of median sternotomy surgery. We believe this is related to the fact that minimally invasive valve surgery causes less damage to the heart such as distraction incision, less impact on the patient’s respiratory function, less bleeding, and better preservation of sternal integrity and chest wall stability. In our experience, minimally invasive approaches can be used to perform most single-valve procedures with thoracoscopic assistance or direct vision, to perform a variety of complex mitral valvuloplasty techniques, to perform simultaneous atrial fibrillation ablation procedures, and to perform double-valve or Wheat procedures in selected patients, mainly for patients with cosmetic requirements, patients with high-risk factors for poor sternal healing, and some patients with a history of prior cardiac surgery. Minimally invasive valve surgery is safe and effective, does not increase operative mortality or complication rates compared with traditional surgery, and is worthy of selective clinical application because it shortens ICU time and postoperative hospital stay, reduces the use of blood products, and accelerates postoperative psychological and physical recovery of patients.