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Minimally invasive techniques are increasingly important in aortic valve surgery. The aim of this publication is to review our experience and recent literature to assess and present the current ‘state-of-the-art’-role of minimally invasive aortic valve operations for high-risk patients.Minimally invasive aortic valve operation for high-risk patients (e.g. patients with left ventricular dysfunction, reoperation, elderly, multimorbid patients, etc.) can be performed with an operative mortality similar to standard sternotomy approach. Less postoperative bleeding, fewer blood transfusions, better cosmesis, lower ICU and in-hospital stays as well as the absence of sternal wound infection are the main advantages of this technique.Minimally invasive aortic valve surgery has evolved into a well tolerated, efficient surgical treatment option in experienced centers, providing greater patient satisfaction and lower complication rates in high-risk patients.