Mitral valve repair remains an underutilized technique for patients with degenerative mitral valve disease. A clear understanding of pathological anatomy and dysfunction helps the referring cardiologist and surgeon define the likelihood of repair for a given patient with mitral valve disease. With currently available surgical techniques, the majority of degenerative mitral valve patients should enjoy the benefits of a valve repair if referred appropriately. Patients referred in a timely fashion that receive a mitral valve repair can expect to enjoy a normal survival in line with the general population.