In patients undergoing CABG surgery, the addition of mitral valve repair for moderate ischaemic mitral regurgitation does not lead to significant differences in left ventricular remodelling at 2 years. Investigators in the Cardiothoracic Surgical Trials Network randomly assigned 301 patients to undergo CABG surgery with or without mitral valve repair. After 2 years, the mean left ventricular end-systolic volume index was not significantly different between the two groups. Mortality was also similar. Combined surgery was associated with improvement in the rate of moderate or severe residual mitral regurgitation, but also a higher rate of neurological events and supraventricular arrhythmias. “Individual treatment decisions,” conclude the investigators, “require balancing the risks of these adverse perioperative events against the uncertain benefits of a lower incidence of postoperative ... mitral regurgitation.”