Valve repair provides superior results in patients with mitral valve prolapse. However, repair with leaflet resection & reconstruction (LRR) can be difficult in complex pathologies, and 5-10% fail rate. This video illustrates artificial chordal replacement (ACR) with precise length adjustment. 43 ACR patients with median 4-yr follow-up had a 7% late moderate recurrence and no failures; LRR (n=23) recurrence was 25% with 8.7% reoperation for falure. ACR produces excellent outcomes and should be used routinely for prolapse.