Is early surgery recommended for mitral regurgitation? Primum Non Nocere The Case for Watchful Waiting in Asymptomatic "Severe" Degenerative Mitral Regurgitation

Despite current enthusiasm for prophylactic surgery in patients with asymptomatic severe degenerative mitral regurgitation, existing data suggest that watchful waiting is the preferred strategy. In revisiting the words of Hippocrates, there are no convincing data that prophylactic surgery can be construed as "doing good" because excellent outcomes have been shown with a watchful waiting strategy. In addition, the short-and long-term risks of mitral surgery, coupled with the risk that mild to moderate regurgitation may be inappropriately labeled as severe, translate to a very real possibility of doing harm. Only randomized prospective trials will resolve this intense debate. However, for now, "primum non nocere" is best translated as "watchfully wait and operate only when conventional triggers are met." Copyright © 2010 American Heart Association. All rights reserved.