In a randomized trial comparing thoracoscopically-guided minithoracotomy with median sternotomy for mitral valve repair in patients with degenerative mitral regurgitation, minithoracotomy was not found to be superior to sternotomy in terms of recovery of physical function at 12 weeks. Both techniques showed similar high rates of valve repair quality and safety outcomes at 1 year, providing evidence to inform treatment guidelines and shared decision-making.