After exploring several less invasive approaches for cardiac valve surgery, we have concluded that the partial upper sternotomy is the incision of choice for minimally invasive aortic and mitral valve surgery. From March 1997 to January 1999, 827 patients had cardiac valve surgery using this approach; 462 had mitral valve procedures and 365 had aortic valve procedures. Of those having mitral valve surgery, 87% had mitral valve repair. Aortic valve surgery included replacement with stented bioprostheses (38%), allografts (29%), and mechanical prostheses (10%); in addition, 23% had aortic valve repair. Operative mortality was 0.8%. Conversion to full sternotomy was necessary in 2.4%. Blood use was low with 80% of patients receiving no blood transfusions. We conclude that all primary mitral and aortic procedures can be accomplished safely via partial upper sternotomy.