According to literature data there is no common approach to method of mitral valve replacement with preservation of subvalvular structures. Results of 175 operations of mitral valve replacement are analyzed. The preservation of fibrous-papillary contact must not be regarded as the goal itself, but it must improve the clinical effect of operation. Further study of left ventricle remodeling at mitral valve disease and repair of physiological function after surgery permits to predict and improve the functional results in early and long-term postoperative period.