Asymptomatic chronic severe organic mitral regurgitation: contemporary management strategies

Abstract: Chronic organic mitral regurgitation resulting from mitral valve prolapse is increasing in prevalence due to aging of the population. Although "watchful waiting" has been the conventional standard for many years in patients with minimal or no symptoms and chronic severe organic mitral regurgitation, several factors including changing etiology, better understanding of the natural history, improved diagnosis and advances in surgical techniques are now paving the way for earlier mitral valve surgery. The ability to successfully repair the myxomatous mitral valve with low operative risk (< 1%) and advances in imaging in the recent years have led to a major change in the treatment paradigm for organic mitral regurgitation. It is clear from the preponderance of evidence that mitral valve repair in asymptomatic patients with preserved ejection fraction and severe organic mitral regurgitation leads to "cure" or "suppression" of the disease, underscoring the need for early surgery. Whether further advances in imaging, robotic surgery, and percutaneous mitral valve repair lead to even better outcomes remains to be seen.