The management of mitral valve regurgitation (MR) has evolved significantly over the past 2 decades. During that time, there has been a change in the pathology and, consequently, the pathophysiology of patients referred for operative treatment. In current practice in the Western world, consequent to the decline in the frequency of postinflammatory valvopathy, most patients presenting for mitral valve (MV) surgery have degenerative valve disease. Two factors have been influential in broadening the indications for performing MV repair. First, patients are identified earlier and followed more regularly to prevent the deleterious consequences of chronic persistent MR on left ventricular (LV) size and function. Second, the outcome of surgical management has improved, and the long-term durability of primary and reoperative valve repair has been clearly established.
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