Barlow’s disease (BD) has a distinctive macroscopic appearance, which is characterized as an advanced stage of excess myxomatous degenerative leaflets, including bileaflet prolapse, billowing, chordal elongation, and considerable annular dilation with or without calcification. This is in contrast to fibroelastic deficiency, which mainly includes limited prolapsing segments. Therefore, BD requires a more difficult surgical repair strategy, including anterior and posterior leaflet repair, compared with fibroelastic deficiency. The present review evaluates which mitral valve repair for BD has better long-term results. Recent studies have reported that mitral valve repair with resection-and-suture, neo chordal repair (or the loop technique), and the Alfieri stitch provide comparable long-term results. However, a simple repair technique is not favorable. This is because studies that obtained excellent long-term results used combined repair technique sowing to the fact that BD consists of complex lesions. Moreover, redundant leaflets should be removed and elongated chorda should not be used because lesions may develop recurrent regurgitation. In mitral annuloplasty, recent studies have reported that non-use of a ring was a risk factor of recurrent regurgitation in the long term and a small-sized ring was associated with anterior systolic motion. Therefore, a large-sized ring is recommended for preventing systolic anterior motion and recurrent regurgitation. Comprehensive repair procedures that consist of resection of redundant leaflets with neo chordal repair, or the Alfieri stitch with leaflet resection or cleft plasty, and using a large annuloplasty ring for BD, may be ideal. These procedures can obtain robust long-term results similar to repair for fibroelastic deficiency.