This is a single-centre retrospective study with study limitations inherent to the study design. The results are applicable to the type of MV repair techniques described only and further studies are needed to evaluate the effect or other repair techniques (e.g. edge-to-edge repair) and annuloplasty devises on the occurrence of elevated postrepair gradients. During the study period, the MV repair techniques have evolved with, in particular, annular plication being performed less frequently. As the type of leaflet repair did not affect the sizing of the annuloplasty device implanted, no relevant effect on the results presented is to be expected. Moreover, the number of reinterventions was low and prevented us from exploring the risk factors for MV reintervention specified to the indication for reintervention (i.p. recurrent MR versus elevated MV gradient). While we failed to identify a relation between postrepair MV gradient and survival or atrial fibrillation, we cannot exclude the possibility that a correlation does exist, but we were unable to detect it due to an insufficient number of patients and events. Our results should thus be seen as hypothesis-generating and will need to be confirmed by future studies. We have performed cubic spline analyses, but failed to identify a cut-off value that would ease the identification of patient a risk for complications related to elevated postrepair MV gradient in the clinical setting. Identification of a cut-off value should be pursued in future studies. Nevertheless, in line with previous studies, our results do support the efforts aimed at securing the lowest possible postrepair MV gradient.