Subannular repair for secondary mitral regurgitation: a step towards peaceful conversations

The initial results in 94 patients seem very promising, with a 1.1% in-hospital mortality and a 4.2% rate of recurrent ≥MR at 1 year. Guideline-directed medical therapy may reduce MR to less than moderate in 38%–42% of patients, while 16%–18% patients with heart failure without regurgitation develop significant MR despite maximal medical therapy2 3; the extent, intensity and duration of medical therapy prior to surgical intervention are not reported in the current study. Furthermore, in the current study significant MR was considered to be present at an effective regurgitant orifice ≥0.2 cm2 and a regurgitant volume of ≥30 mL, levels that are no longer endorsed as severe MR by the European Society of Cardiology and American Heart Association/American College of Cardiology. Oversimplification through classification Current European Society of Cardiology and American Heart Association/American College of Cardiology guidelines on valvular heart disease emphasise the difference between primary and secondary MR; this concept has long been accepted given the substantial evidence of different pathophysiology, approach to therapy and long-term outcomes.