Mitral regurgitation (MR) is most often caused by degenerative disease of the leaflets or develops functionally as a consequence of left ventricular disease (see Figure 1). Patients with severe MR have dyspnea on exertion, fatigue, and, when associated with left ventricular dysfunction or pulmonary hypertension, reduced survival. 1 Therefore, surgery to repair or replace the mitral valve is considered to be a class I indication in symptomatic and asymptomatic patients with left ventricular

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... nction. Surgery is also considered reasonable (class IIA) in patients with preserved left ventricular function if the likelihood of a successful repair is high. 2 However, surgery has a number of limitations. Serious complications occur in up to 20% of patients, and may include peri-operative myocardial infarction (MI), stroke, septicemia, renal failure, respiratory failure, re-operation, and death. Up to 20% of older patients may have additional complications after discharge, prompting re-admission within 30 days. 3 Finally, although many surgical series report a high rate of freedom from re-operation after mitral repair, results including overall survival and the rate of recurrent MR are not as good. For instance, in a recent report of 649 consecutive isolated mitral valve repairs for degenerative MR, the