Minimally invasive cardiac surgery (MICS) represents a significant advancement in cardiac procedures, emerging prominently since the late twentieth century and gaining traction around 2018–2019. MICS, including techniques like minithoracotomy, offers improved postoperative outcomes compared to traditional sternotomy, with reduced pain, fewer wound complications, better respiratory function, and decreased need for blood transfusions. Patient selection is critical, involving comprehensive preoperative assessments such as chest X-rays, echocardiograms, and vascular Doppler ultrasounds to exclude conditions like thoracic pathology or severe obesity that may complicate surgery. The position of the ascending aorta relative to the sternum is evaluated to determine surgical access, with classifications aiding in risk assessment. Peripheral cannulation, primarily via the right femoral artery and vein, has facilitated MICS, supported by advanced imaging like computed tomography angiography. Innovations in venous cannulation, such as double-stage cannulas, have streamlined procedures, enabling interventions for both left and right heart pathologies, including mitral and aortic valve surgeries, atrial septal defect repairs, and myxoma excisions. Surgical approaches, including trans-axillary methods, allow for tailored interventions, with endoscopic further minimizing trauma. MICS is effective for complex multivalvular surgeries, heart tumors, myocardial revascularization, and pediatric congenital defects, offering faster recovery and improved outcomes, as evidenced by various studies.