This study evaluated the outcomes of mitral valve re-repair vs replacement after failed primary mitral regurgitation repair. The Society of Thoracic Surgeons (STS) database was queried, and 1,749 reoperations after failed mitral repair for degenerative regurgitation were identified: 410 re-repairs (23.4 percent) and 1,339 replacements (76.6 percent). Re-repair demonstrated superior intermediate-term survival compared to replacement (adjusted HR 1.96, p=0.022), with lower postoperative morbidity (6.8 percent vs 11 percent, p=0.042). Factors favoring re-repair included younger age, fewer comorbidities, reintervention within two years, and posterior leaflet pathology. The authors concluded that mitral re-repair offers significant survival advantages over replacement in appropriately selected patients, suggesting it should be preferentially pursued at expert centers when anatomically feasible for recurrent degenerative mitral regurgitation.