The techniques developed and popularized by Carpentier are the basis of the conservative approach to mitral valve surgery and are extensively used at our Institution [8][9]. The E-to-E technique has been reserved to less than one third of the global population of patients with severe isolated MR; we selectively applied it when the incompetence was due to unfavorable lesions such as: prolapse of the anterior leaflet; prolapse of the posterior leaflet with calcified posterior annulus; prolapse of both leaflet; prolapse in the commissural area; and regurgitation secondary to restricted leaflet motion or to endocarditic lesions.