Flail-Leaflet MR: If in Doubt, Don't Delay Surgery

Much uncertainty surrounds the optimal timing of surgery in patients with severe mitral regurgitation (MR) without heart failure (HF) symptoms or left ventricular (LV) dysfunction. To offset the lack of randomized trials of surgical versus medical management in these patients, an international consortium of investigators from six tertiary-care centers used the Mitral Regurgitation International Database to evaluate care and outcomes in patients with MR and flail leaflet but with no HF symptoms and LV ejection fractions ≥60%.

Of 1021 consecutive patients enrolled from 1980 to 2004, 575 were initially managed medically, and 446 underwent surgery within 3 months after diagnosis. During these first 3 months, mortality and rate of HF did not diff…