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In this discussion we review a six-year study of over 53,000 patients that reveals the extraordinary safety and durability of mitral valve repairs among patients with primary mitral regurgitation. We explore: ● Morbidity/mortality outcomes at 30 days for mitral valve repair versus mitral valve replacement ● The impact of higher volumes of mitral surgeries on lowering mortality and morbidity ● Key quality metrics, including procedural success at 30 days and one year, and durability at five years ● The four cornerstones of an excellent mitral valve repair: Minimize any recurrent mitral regurgitation Minimize the development of atrial fibrillation Minimize the risk of stroke by reducing the risk of blood clots or thromboembolic events from the left atrium. Minimize the development of late tricuspid regurgitation Ani Anyanwu, MD Professor and Vice Chair, Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai Randolph P. Martin, MD Clinical Professor, Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai