In patients with degenerative mitral valve disease, the very low operative mortality (less than 0.5%) and excellent long-term results of mitral valve reconstruction have considerably modified the indications of surgery during the last decade. Several factors such as clinical symptoms, atrial fibrillation, severity of mitral regurgitation, left ventricular ejection fraction, left ventricular end-systolic diameter, pulmonary hypertension, and the overall surgical risk profile (age, co-morbid factors) should be taken into consideration for the decision-making with regard to the indication of surgery.
All symptomatic patients with moderate or severe mitral regurgitation should be referred for surgical intervention. It is preferable to operate on patients early in their symptomatic course, as long-term survival following mitral valve reconstruction is less favorable in patients with New York Heart Association Class III or IV symptoms or left ventricular ejection fraction <60%. It is important to stress that in patients with degenerative mitral valve disease with New York Heart Association Class I or II and ejection fraction >60%, the life-expectancy following mitral valve reconstruction is similar to that of an age and gender matched general population. As Carpentier stated “following valvular reconstruction most patients with degenerative valve disease are cured for the rest of their lives”.