Mitral regurgitation (MR) is the second most frequent valvular disease following aortic stenosis. Patients with severe MR who are managed conservatively sustain an excess mortality and morbidity. It leads gradually to the impairment of the left ventricular function which may be hidden behind preserved good ejection fraction of the left ventricle. Nowadays the majority of patients can undergo mitral valve repair. According to the newest guidelines of ACC/AHA/ESC on the management of valvular heart disease the surgical treatment is indicated in early state after the onset of symptoms and even in asymptomatic patients provided that the MR is severe, the valve is suitable for the repair, the surgeon is experienced in valve reconstruction and there is an availability of intraoperative transesophageal echocardiography. Mitral valve repair is an independent predictor of a better outcome after surgery for mitral regurgitation, with lower operative mortality and a better long term survival as compared to valve replacement.