Objectives: Although the superiority of mitral valve repair (MVr) over replacement (MVR) is well-established in degenerative mitral valve (MV) disease, its role remains controversial in rheumatic heart disease (RHD). Nonetheless, many surgeons agree valve reconstruction should be the preferred primary correction as it boasts copious advantages over MVR. The aim of the review is to investigate current MVr techniques in RHD that address previous concerns of reproducibility, reliability, and longterm durability. Methods: A comprehensive literature search was conducted on PubMed, Cochrane Library, Scopus and Medline using the keywords “mitral valve repair”, “valve repair techniques”, and “rheumatic heart disease”. Thirteen observational studies between 1970 and 2020 were reviewed; analysis was emphasized on surgical techniques employed. Results: Several studies observed a relationship between the degree of diseased tissue and durability of repaired rheumatic lesions. The current trend of MVr techniques emphasize resection of fibrotic rheumatic tissue plaguing valves, including leaflet peeling and shaving, yielding excellent clinical outcomes in studies employing this ‘aggressive’ approach. Of note, two studies found the usage of leaflet-related techniques to be a significant risk factor for valve failure, but mention reserving such methods for severe RHD. Other valuable techniques for successful contemporary RHD MVr include commissurotomy, chordal resection, chordal fenestration, and annuloplasty. Conclusions: Durability of MVr is likely compromised not simply due to high technical demand, but a surgeon’s reluctance; a common notion is that advanced rheumatic lesions are better treated by MVR instead of applying several MVr techniques. Thus, the current ‘aggressive’ MVr trend will both directly address the underlying rheumatic aetiology, and according to several authors, lower a surgeon’s reluctance to repair, thereby enhancing durability.
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