Objective: Minimal invasive cardiac surgical techniques recently have been applied in the management of various cardiac lesions. The aim of the study was to evaluate right anterolateral minithoracotomy as an alternative procedure with a better cosmetic and clinical outcomes. Methods: Fifteen male and 64 female patients underwent open heart surgery during cardiopulmonary bypass through a right anterolateral minithoracotomy at the fourth intercostal space. The average age was 41±6 years. Fifty-two (65.8%) patients underwent mitral valve replacement, 5 (6.3%) patients underwent mitral valve replacement + tricuspid annuloplasty, 5 (6.3%) patients underwent tricuspid valve replacement, 7 (8.9%) patients underwent closure of the atrial septal defect (ASD), 3 (3.8%) patients underwent closure of the ventricular septal defect (VSD), 1 (1.2%) patient underwent closure of the ASD+VSD and 5(6.3%) patients underwent mitral re-replacement. Results: The postoperative average ventilation time was 6±2 h in 38 (48.1%) patients and 11±3 h in 41 (51.9%) patients. The postoperative average mediastinal drainage was 350±110 ml during first 24 hours, and postoperatif stay in intensive care was 1.8±0.8 days. Conclusion: As a result, the right anterolateral minithoracotomy incision is a safe and effective alternative to the median sternotomy for open heart surgical procedures. Most of minimal surgical accesses can be achieved with better cosmetic results and faster recovery.