Recommendation of Early Surgery in Primary Mitral Regurgitation: Pros and Cons

DOI: 10.5935/abc.20160107 Primary mitral valve regurgitation is the most frequent valvular pathology, affecting approximately 1.7% of the population, with prolapsed mitral as the highlighted etiology.1 In developing countries, such as Brazil, rheumatic fever is still widely prevalent (18.6/1000), and affects about 15.6 million people worldwide.2,3 Currently, the recommendation of mitral surgery for asymptomatic patients is very controversial, since the indication of valvular intervention for symptoms, left ventricular disfunction and dilatation, recent onset atrial fibrillation or pulmonary arterial hypertension is well consolidated in literature (Table 1).4-6 One strand defends the concept of “watchful waiting”, highlighting operative risks and morbi-mortality in early implantation of a bioprosthesis, as well as the benign history of asymptomatic mitral regurgitation. On the other hand, a second group advocates for the indication of early surgery, showing, through literature, that mitral valve repair, in these conditions, reduces surgical mortality and increases survival for these patients.7-11