Early surgery for mitral regurgitation, before clinical triggers emerge, has best outcomes

Patients with mitral regurgitation face a dilemma of whether to undergo corrective surgery early, when they might have no or few symptoms, or wait until their condition worsens. Current guidelines allow for watchful waiting until certain symptoms appear that would then “trigger” the decision to proceed with surgery. The authors argue that these guidelines are based on relatively weak class C evidence from clinical experience that is now 20 to 30 years old, and surgical methods, including mitral valve repair instead of valve replacement, have now made surgeries safer with good long-term outcomes, especially when performed at high-quality, high-volume centers. The results of a study indicate that delaying surgery until clinical triggers appear leads to increased mortality and congestive heart failure.