Objective To compare perioperative outcomes of minimally invasive aortic valve surgery by a right anterior minithoracotomy (RAMT) and conventional sternotomy. Methods A retrospective analysis of patients who underwent isolated aortic valve surgeries in our hospital between May 2021 and August 2023 with a minimal incision via the right anterior minithoracotomy approach (a RAMT group) or conventional incision via the full sternotomy approach (a conventional group). A propensity score-matching analysis was performed to balance preoperative data and compare perioperative data of the two groups. ResultsThere were 58 patients in the RAMT group, including 46 males and 12 females with an average age of 52.0±14.1 years; 128 patients were enrolled in the conventional group, including 87 males and 41 females with an average age of 60.0±12.4 years. After propensity-score matching, there were 51 patients in each group. The RAMT patients had a longer mean operation time, cross-clamping time and cardiopulmonary bypass time compared to the conventional group (all P<0.05). However, ICU length of stay, ventilator-assisted time and postoperative hospital stay were significantly shorter in the RAMT group (all P<0.05). Patients in the RAMT group had lower 24 hour chest drain output (P<0.05). RAMT was associated with a trend towards a lower blood transfusion rate in comparison to the sternotomy group, although this was not statistically significant (P>0.05). The occurrence of all-cause death, stroke and perioperative complications was also similar in both groups (P>0.05). Conclusion Right anterior mini-thoracotomy is associated with less trauma, faster recovery, less postoperative drainage, and shorter hospital stay than conventional approach. Right anterior mini-thoracotomy in patients undergoing isolated aortic valve surgery is a safe approach and can be performed by a wide range of surgeons.