Minimally invasive surgical techniques have proliferated at a staggering rate in the last decade. Cardiac surgery has been a late entrant in this process but is currently experiencing a surge of interest in and techniques for minimally invasive approaches. Cardiac valve surgery has seen a rapid and ongoing evolution of minimally invasive approaches that, it is hoped, will decrease patient discomfort, operative morbidity, length of hospitalization, and cost, improve cosmetic healing, and facilitate return to normal function while not compromising short- or long-term outcomes of the surgical procedure. This article examines the evolution of recent experience with minimally invasive valve surgery and emphasizes the surgical considerations surrounding 1) the choice of incision, 2) access techniques for cardiopulmonary bypass (CPB), 3) methods of myocardial protection, 4) techniques for aortic occlusion, and 5) atrial incisions for exposure of the mitral valve. The results of early and currently available series are also reviewed.