To repair or to replace: four decades in the making

The lively debate regarding the surgical treatment options of mitral valve regurgitation continues and remains dynamic. This is likely due to the prevalence of degenerative mitral valve disease, not just in the United States, but all around the world. With the emergence of the concept of the mitral valve “Centers of Excellence” and newer and ever-evolving repair techniques, mitral valve repair has far surpassed replacement in popularity. Because of the observed superiority of mitral valve repair—both anecdotally and by multiple large studies that have recently emerged (1-3)—we are witnessing a paradigm shift in which mitral valve repair is preferred over replacement. This is reflected in the latest guidelines, in which repair is strongly recommended as the preferred surgical intervention for severe degenerative mitral regurgitation by both the American Heart Association/American College of Cardiology and European Society of Cardiology (4,5).