Objective: The aim of the study is to compare the effectiveness of chordal transfer (transposition) and chordal replacement (substitution) using artificial PTFE chordae to treat pure mitral valve insufficiency due to anterior mitral leaflet (AML) prolapse. Patients and Methods: In a prospective, comparative, non-randomized, non- blinded study, 40 patients who were diagnosed of having mitral valve regurgitation due to anterior mitral leaflet prolapse. The patients were divided into two groups well-matched for age, sex and preoperative risk factors. Group A: (20 patients) who underwent mitral valve repair by chordal transfer; and Group B: (20 patients) who underwent mitral valve repair by artificial (PTFE) chordae replacement. Results: Regarding intraoperative comparison, there was no statistically significant differences regarding the total cardiopulmonary bypass time, the aortic cross clamp time, intraoperative inotropics, and other weaning procedures. Neither mortality nor conversion to mitral valve replacement occurred intraoperatively. In both groups, there was a matchable obvious improvement in the patient's symptomatology during postoperative follow-up by clinical examination and echocardiography. Despite no statistical significance between both groups, there was a favorable step-up in the postoperative NYHA's clinical condition. After 2 years of follow up in both groups, there was no recurrence of severe MR, no reoperation, and no mortality. There were no morbidity complications, thromboembolic episodes nor anticoagulant related hemorrhage and there appears to be preserved and improving LV function. Conclusion: Both surgical procedures were performed with no mortality, acceptable low morbidity and reasonable technical ease. We hence considered both techniques to be soundly-safe, easy to perform, under TEE guidance, and are hence reproducible.