This cohort study analyzed 316 patients who underwent minimally invasive mitral valve surgery to identify risk factors for higher postoperative myocardial injury, as indicated by elevated levels of high-sensitivity cardiac troponin I (hs-cTnI). It found that prolonged aortic cross-clamp time and a higher preoperative New York Heart Association (NYHA) class were associated with an increased risk, while robotic-assisted surgery appeared to lower the risk. Patients with higher myocardial injury also had worse postoperative outcomes, including higher lactate levels, increased incidence of acute kidney injury, longer mechanical ventilation, and extended hospital stays, although mortality was not affected.