Background: Postoperative pulmonary complications (PPCs) are not uncommon events that lead to long hospital stay, readmissions into the intensive care unit (ICU), high costs, and death after cardiac surgery. Objective: Our research compares the prevalence of postoperative lung complications between minimally invasive mitral valve surgery (MIVS) and tradiotional full median sternotomy (FS) approach. Methods: 100 patients underwent isolated mitral valve surgery (50 MIVS through thoracotomy and 50 FS) in our institution between January 2020 and January 2022. Propensity score-matching analysis was used to compare outcomes between the groups and to reduce selection bias. Results: The incidence of PPCs was insignificantly less in the MIVS group than in the FS group. The most common PPCs were atelectasis, pleural effusions, and pulmonary infection. Prolonged mechanical ventilation time (> 24 h), length of hospital stay, and ICU phase were significantly less in the MIVS group. Cardiopulmonary bypass (CBP), aortic cross-clamping, and operative times were significantly longer in the MIVS group than in the matched FS group (P < 0.001). Conclusion: MIVS for isolated valve surgery carries low risk of PPCs compared with the full sternotomy approach.