Mitral valve repair: we must do a better job.

Mitral valve repair is the only heart valve operation with the potential to restore a patient to expected survival. A mandate currently exists for early surgical repair of mitral regurgitation before the onset of symptoms and significant left ventricular dysfunction. It is based upon a better understanding of the natural history of mitral regurgitation, the poor results with medical therapy, and the negative impact of abnormal left ventricular size and function, and symptoms of long-term survival. It is also based on better operative mortality, quality of life, and longevity with repair compared with replacement. Despite the existence of this mandate, overall mitral valve repair rates remain generally low in the United States. The biggest impact on mitral repair rates is likely to come from cardiologists, who would embrace the mandate and insist on mitral valve repair and refer their patients to surgeons who consistently and successfully repair mitral valves.