1) Mitral valve repair has advantages over replacement such as lower mortality, better left ventricular function, and lower risks of complications. 2) While most degenerative mitral valves can be repaired, only 75% of rheumatic valves are suitable for repair due to the aggressive nature of rheumatic disease. 3) For rheumatic mitral disease, repair has better long-term outcomes than replacement in reducing mortality and reoperation risks, but repair durability is limited by the progressive nature of rheumatic pathology.