An effective balance is based on many pillars.

their about our recently published study. Annular stabilization is the main concern of cardiac surgeons for long-term durability of transapical neochords implantation (NC) due to our well-established surgical technique. Transcatheter edge-to-edge mitral repair is always done with no annular stabilization but apparently, this is not seen as a major concern among interventional cardiologists who have demonstrated to be perseverant and keep on expanding indications and performing trials (REPAIR MR ClinicalTrials.gov and PRIMARY ClinicalTrials.gov Identifier: As a matter of fact, so far data do not support the lack of mitral annulus stabilization as a potential cause of NC failure. In entire experience with transapical-NC [1], failure has never been related to mitral annular enlargement. Furthermore, it has demonstrated that annular remodelling (reduction of annular di- ameter) occurs in patients undergoing this procedure [2]. Early referral and consequently early treatment of patients with degenerative mitral regurgita- tion (DMR) is likely going to reduce the need for annular stabilization. It is true that conventional surgery for DMR provides optimal results in terms of mortality and complications as well as of freedom from recurrent mitral regurgitation (MR) in centres of excellence that are dedicated and highly commit- ted to this procedure [3] but the real world is a different thing [3, 4]. Our data show no statistical differences between conventional surgery and NC at follow-up in patients with type A anatomy in terms of recurrence of moderate MR (63.9% vs 74.6%), severe MR (79.3% vs 79%)