In this single-center retrospective PSM analysis, women and men had similar early clinical outcomes after MIMVS, including 30-day all-cause mortality. However, women had a higher prevalence of calcified mitral valves due to rheumatic disease and MAC, potentially increasing procedural complexity. Women also showed increased perioperative resource utilization and longer stays than men. In the degenerative cohort, repair success rates were similar between groups. In conclusion, our findings suggest that MIMVS may help mitigate sex-based differences in surgical strategy and early outcomes after valve surgery, but we emphasize the importance of early diagnosis and optimized perioperative strategies targeting the female population.