Despite circumspect reticence, significant advances were made and various institutions have published favorable results as single-center observational and comparative studies. Most surgeons who performed MIMVS in this era selected either a variation of a sternal incision or a minithoracotomy, and used direct vision with longer instruments. Simultaneous advances in cardiopulmonary perfusion, intracardiac visualization, instrumentation, and robotic telemanipulation hastened a technologic shift, with more surgeons adopting minimally invasive valve surgery in their practice. Less surgical trauma, blood loss, transfusions, and pain, translating into shorter hospital stays, faster return to normal activities, less use of rehabilitation resources, and overall healthcare savings, has driven further development in this field. Today, replacing and repairing cardiac valves through small incisions have become standard practices for many surgeons as patients become more aware of its increasing availability. Changes in surgical indications, largely because of a better understanding of the natural history of organic mitral regurgitation and improved repair techniques, have increased the number of less symptomatic patients with degenerative disease being referred for an elective repair.7,8 For MIMVS to become widely accepted, equivalent, if not better, short- and long-term outcomes have to be demonstrated compared with sternotomy operations.