Asymptomatic Mitral Regurgitation: When Is Surgery Indicated?

Patients with regurgitant orifices ≥40 mm² should be considered for prompt surgery.

Asymptomatic mitral regurgitation (MR) presents a dilemma: We'd like to avoid surgery in asymptomatic patients, but outcomes might be worse if we wait for heart failure to occur. This prospective observational study from Mayo Clinic provides some guidance.

Researchers followed 456 patients (mean age, 63) with initially asymptomatic primary MR due to diseased valve leaflets (as opposed to MR secondary to dilated cardiomyopathy or ischemia); 80% had mitral valve prolapse. Effective regurgitant orifice (determined by echocardiography) was the best predictor of adverse outcomes. Even with medical management, patients with orifices of ≥40 mm² and those with orifices of 20 mm² to 39 mm² had significantly reduced 5-year survival compared with expec…

Reviewing Author

Allan S. Brett, MD