Because there is no proven effective medical therapy for mitral regurgitation (MR), mitral valve repair (MVRpr) is the treatment of choice for patients with severe primary nonrheumatic MR. A successfully performed and properly timed MVRpr may lead to a normal lifestyle and life span. The alternative to repair is mitral valve replacement. Although there have been no randomized trials of repair versus replacement, almost all reported series demonstrate superior outcomes with repair, and current guidelines clearly prefer MVRpr over mitral valve replacement for patients with nonrheumatic MR.