We have demonstrated that it is possible to repair practically all prolapsing degenerative mitral valves, with a low surgical risk and absence of residual significant mitral regurgitation in a high-volume reference center. Our study is unique because we have not selected patients and have applied mitral valve repair to all comers regardless of complexity of valve disease, patient age or comorbidity, and perceived surgical risk. Most large series of contemporary mitral valve surgery for degenerative disease in reference centers have reported a valve replacement rate of up to 5% to 10%, with preferential use of valve replacement in higher-risk groups, such as elderly patients, or for more complex valve pathology, including bileaflet prolapse. Although other series have also shown repair rates nearing 100%, those series have been limited to a selected group with posterior leaflet prolapse. Although the superiority of repair relative to replacement remains controversial for certain high-risk subsets, we have shown that with a systematic approach it is possible to repair all degenerative valves with low operative risk and good immediate result.