In a large series from Korea, repair was accomplished in 22% of patients operated on for rheumatic dis- One-third of these patients who underwent repair had significant stenosis or regurgitation at 10 years. Repair of rheumatic mitral valve disease should be limited to patients with less advanced disease in whom a durable repair can be accom- plished or to patients in whom a mechanical pros- thesis cannot be used because of anticoagulation 8. Mitral valve repair is the procedure of choice for isolated severe primary MR limited to less than one-half of the posterior leaflet, and mitral valve replacement is inappropriate unless mitral valve repair has been attempted and was unsuccess- Surgical repair of primary MR has been remarkably successful. Repair of isolated degenerative mitral disease, when leaflet dys- function is sufficiently limited that only annu- loplasty and repair of the posterior leaflet are necessary, has led to outcomes distinctly supe- rior to those with biological or mechanical mitral Repair is associated with an operative mortality rate of <1%, long-term survival rate equivalent to that of age-matched general population, approximately 95% free- dom from reoperation, and >80% freedom from recurrent moderate or severe ( 3) MR at As much as one-half of the posterior leaflet may be excised, plicated, or resuspended. Posterior leaflet repair has become sufficiently standardized in this situation so that repair, rather than mitral valve replacement, is the standard of care. Execution of this procedure with a success rate 95% should be the expectation of every cardiac sur- geon who performs mitral valve procedures. 7.3. Chronic Secondary MR 7.3.1. Stages of Chronic Secondary MR In chronic secondary MR, the mitral valve leaflets and chords usually are normal or minimally thickened. 