Cardiac surgeries have become complicated, although the procedures have been sophisticated as well as anesthetic management and postoperative care. Cardiac surgery team's main concerns include how to preserve cardiac function after aortic cross-clamp and chemical cardiac arrest, which cause myocardial edema and reperfusion injury. These days beating-heart surgery for mitral valve diseases is reported. Patients of mitral disease with low cardiac function due to ischemic cardiomyopathy or dilated cardiomyopathy as well as patients of mitral disease with functional coronary bypass graft might be good candidates for beating-heart mitral valve surgery, via either median sternotomy or right thoracotomy approach. Beating-heart surgery with aortic cross-clamp and coronary perfusion and that without aortic cross-clamp are available. Of great importance during beating-heart surgery without aortic crossclamp is to vent the left ventricle enough and maintain aortic root pressure, resulting in constant closure of aortic valve. The equivalent results are reported compared to conventional mitral valve surgery with cardiac arrest, and the beating- heart mitral surgery could be an alternative for patients with low ejection fraction and patients with previous sternotomy.