The vast majority of mitral valve replacement procedures require open-heart surgery. With an open chest, the heart is cut open under direct visualization and the mitral valve is replaced. There are a few patients who can be treated by other minimally invasive methods, such as thoracoscopic surgery, where only a few holes are made in the chest cavity and special lumpectomy instruments are used to replace the mitral valve, and in a very few cases, the mitral valve can be replaced by intervention. This procedure is still relatively new in China, and only a few large cardiac centers in China are able to perform it. The procedure is more difficult and requires a higher level of expertise. Therefore, mitral valve replacement surgery requires open-heart treatment for the majority of cases. Open-heart surgery for mitral valve replacement is very traumatic, so the patient’s subjective feelings after surgery are not good, such as pain, large wounds, and aesthetic impact, which may be factors that affect the patient’s postoperative feelings. Minimally invasive surgeries, such as transthoracoscopic or interventional mitral valve replacement, are characterized by low trauma and can be performed without extracorporeal circulation. The patient is less traumatized after the procedure and recovers quickly with less pain, which are all advantages. However, not all valve replacement procedures can be performed by interventional or thoracoscopic methods. For most valve replacement procedures, especially for patients with severe valve calcification, combined left atrial thrombosis, combined atrial fibrillation, and combined aortic valve lesions that require simultaneous surgery, the traditional surgical approach of open-heart surgery should be chosen.