The results of our analyses suggest that the postrepair gradient is partially associated with patient characteristics (both patient age and body surface area likely reflect the relation of these parameters to systemic metabolic needs and hereto related cardiac output). Moreover, our results demonstrate that the choice of annuloplasty device used might affect postrepair gradients. This is likely correspondent to the differences in the ratio between the anterior-posterior diameter (reflecting anterior MV leaflet surface area to which the ring is sized) and the length of the ‘posterior perimeter’ of the annuloplasty ring between different annuloplasty devices. We are unaware of any studies demonstrating that the increased saddle shape of the Physio II ring is related to improved diastolic MV opening properties when compared to annuloplasty devices with less pronounced saddle-shape. Because of the lack of studies, we cannot exclude the possibility that the Physio II ring results in superior diastolic opening properties of the anterior leaflet that might explain our observation. For the time being, this should, however, be seen as a theory and properly designed studies will need to be conducted in the future.