Abstract Background: Most cardiac surgeons prefer to preserve only the posterior leaflet of Mitral Valve During Mitral Valve Replacement because preserving both leaves prolong surgery, necessitates a smaller prosthetic valve, and increases the risk of both the prosthetic valve contacting subvalvular structures and obstructing the left ventricular outflow tract (LVOT). Aim of Study: To Compare the short-term outcomes of preservation of both leaflets versus preservation of the posterior leaflet alone in mitral valve replacement surgery. Patients and Methods: 24 adult patients undergoing or had mitral valve replacement during this study period and Patients were divided into two groups Group A 12 Patients undergoing or had MVR with preservation of both leaflets, Group B 12 Pa-tients undergoing or had MVR with preservation of Posterior leaflet only as a Control. Results: In our study the analysis revealed a statistically significant difference in LVEF between the two groups, The study findings indicate that preservation of both leaflets during mitral valve replacement (MVR-P) may result in a compara-tively higher LVEF at the postoperative stage compared to pres-ervation of the posterior leaflet only (MVR-NP). Conclusion: Preservation of both leaflets during mitral valve replacement results in significantly higher left ventricular ejection fraction (LVEF) and better left ventricular end-systolic diameter (LVEDD) and left ventricular end-diastolic diameter (LVEDD) compared to preserving the posterior leaflet only.