Minimally invasive approach has become key in cardiac surgery over the last decade and nowadays involves all areas of expertise, as it was initially developed for mitral valve surgery and has quickly expanded also to surgery for the treatment of aortic valve disease and to myocardial revascularization. Compared to standard sternotomy, the most evident difference is minimalization of surgical incision, which reduces chest trauma with several benefits for patients. Minimally invasive cardiac surgery requires dedicated instrumentation/devices as well as an additive learning curve. Different perfusion strategies and aortic clamping techniques are available that facilitate this approach, although their well known advantages are also accompanied by several disadvantages, including an increased rate of stroke or vascular complications, that can be minimized in high-volume centers and by adopting a tailored approach based on the patient's features.