Background: Pre-discharge elevated mean mitral gradients (>5mmHg) may occur after repair for degenerative mitral regurgitation. We sought to identify risk factors associated with elevated gradients as well as to evaluate its impact on functional outcomes at 12 months in this sub-analysis of the Canadian Mitral Research Alliance (CAMRA) CardioLink-2 trial.Methods: 104 degenerative mitral regurgitation patients undergoing mitral repair were randomized to either a leaflet resection or preservation strategy.