Mitral regurgitation (MR) presents a significant clinical challenge, affecting a considerable segment of the population, particularly with advancing age. It is stratified into primary and secondary forms, each with distinct pathogenic mechanisms necessitating tailored surgical or transcatheter repair strategies. Mitral valve (MV) surgery, encompassing repair or replacement, remains a cornerstone in managing some severe MR cases. An essential component of MV surgery is annuloplasty, aimed at restoring the native architecture of the mitral annulus to mitigate regurgitation and enhance overall cardiac function. However, the selection of annuloplasty rings, characterized by diverse designs and material compositions, significantly impacts surgical outcomes. While repair is generally preferred over replacement, its feasibility depends on a cautious preoperative assessment, including factors such as Carpentier classification and disease etiology. Despite advancements in surgical management, a notable treatment gap persists, with only a fraction of eligible patients undergoing surgical intervention. In response, transcatheter interventions have emerged as a promising alternative. Annuloplasty devices work by leveraging innovative techniques to address MR by targeted reduction of annular dimensions and concurrent improvement in left ventricular performance. These advancements in devices and techniques will change the landscape of MR management and will offer hope to a growing number of previously neglected patients, highlighting the importance of tailoring therapies based on patient characteristics.