The observation that the risk of reintervention might be related to postrepair MV gradient has not previously been reported. The incidence of reoperation for MV stenosis after previous repair is known to be low [13, 23], but reflects only the patients most affected by this condition. Other studies have additionally shown that high postrepair gradients will result in decreased exercise tolerance and quality of life [3, 5]. We followed the established concepts of valve repair for degenerative disease that include annular remodelling and stabilization. As fixation of the maximal posterior perimeter length and hereto related maximal MV area are likely inevitable with any type of annuloplasty device used, elevated postrepair gradients might not be avoidable in all patients. Omitting annuloplasty device implantation is controversial, as this is known to result in a higher risk of recurrent MR [24]. Possibly, new annuloplasty device design and identification of patients in whom annular characteristics are sufficiently preserved to support valve sufficiency in the long term even without annular stabilization would help reduce the burden of this problem.