Although clinically effective, conventional mitral valve surgery has recently been scrutinized because of its high-cost nature. Technologic advances have developed a large assortment of endoscopes and related instruments to treat almost any part of the body using this minimally invasive approach. Consumers have realized that the minimally invasive approach has many benefits including less pain, more rapid wound healing, and faster recovery. Successes seen with video-assisted thoracoscopy along with consumer demand have gained the interest of cardiac surgeons. Recently, a port-access approach to mitral valve repair or replacement has been developed. This article describes this innovative surgical approach, discusses indications and contraindications to the surgery, reviews benefits of the surgery, and examines one institution's approach to the care of this patient population.