The introduction of the E-to-E technique safely allowed the expansion of the indication for mitral valve repair at our Institution, including patients with more complex lesions. Since 1991, over 95% of the patients with MR underwent reconstructive surgery compared with less than 80% before that date at our institution. The E-to-E repair is applicable to lesions of any etiology and it is effective not only when MR is due to leaflet prolapse, but also with other types of valve dysfunction. Due to its intrinsic simplicity, the E-to-E repair could be the technique of choice when exposure is difficult or when the repair is carried out through a port access. Eventually, the concept introduced by this type of repair can open the perspective of percutaneous correction of MR. Longer follow-up period is needed to confirm long term expectations with this promising alternative technique of valve repair.