Background and aim: Aim of the study is evaluate the clinical outcome,in a single center experience,of endo-aortic or transthoracic clamp strategy,in minimally invasive video-assisted mitral valve surgery (MIMVS). Materials and methods: We retrospectively analyzed 55 patients underwent to MIMVS between 2014 and 2018. We used in 33 patients endo-aortic balloon occlusion technique(EAC) with Intraclude© and in 22 transthoracic clamp technique(TTC) with Cygnet©. Results: Surgical operations were in 23 patients mitral repair and in 32 mitral replacement.There were no differences between groups for CPB-time(137 ± 37 EAC vs 141 ± 39 TTC, p-value = 0,866) and clamping-time(87 ± 31 vs 90 ± 21,p-value = 0,329);incidence of peri-operative acute myocardial infarction was null,even if the post-operative CPK-MB are out of normal range.The 24h-blood loss was higher in EAC-group(817 ± 506 vs 550 ± 214,p-value = 0,001),but at the beginning of experience.Postoperative complication included 1stroke in EAC-group and 1TIA in TTC-group(p-value = 0,769);we didn’t assess differences the INVOS values during surgery in those patients.Overall operative mortality was 1,8%(0 in EAC and 1 in TTC),due to not cardiac cause.The post-operative Echo showed mitral regurgitation, classified as 1+ or less, in 6 patients(5 in EAC vs 1 in TTC).One patient underwent to reoperation due to mitral repair failure.Peripheral vascular complication or aortic dissection were not observed in this series.No differences were found between both groups in rate of blood transfusions,atrial fibrillation,AKI,PNX,in-hospital stay,ICU-stay. Conclusion: MIMVS with endo-aortic balloon and trans-thoracic clamp technique are safe and effective.We did not observe an increased risk of stroke or vascular complication in endo-balloon group; our goal is use MIMVS as standard of care in all mitral valve surgery.