This study compares long-term outcomes between mini-sternotomy and full sternotomy approaches for valve-sparing aortic root reimplantation. The mini-sternotomy group had longer surgical times but similar in-hospital outcomes and shorter hospital stays compared to the full sternotomy group. Over a median follow-up of 5.5 years, survival rates were comparable, with no need for repeat interventions on the aortic valve. The mini-sternotomy approach shows promise for its potential advantages, including cosmetic outcomes.