ABSTRACT. Mitral regurgitation (MR) is prevalent in the general population. Disease progression, involving potentially irreversible left ventricular dysfunction, implies a poor prognosis for patients who do not receive appropriate treatment. Immediate surgery is indicated in those with severe MR in whom subclinical left ventricular dysfunction is suggested by echocardiographic measurements or the presence of symptoms, however minor. Patients whose symptomatology is unclear should be evaluated by exercise testing. Ischaemic mitral regurgitation is a distinctive valve disease, it is a pathology of the muscle rather than of the valve and the characteristics of the underlying coronary disease are important determinants of clinical presentation and prognosis. Important advances in the understanding of pathophysiology, assessment, and prognosis have occurred in recent years and confirmed that ischaemic mitral regurgitation has many specific features which differentiates it from organic regurgitations. Surgical approaches to correct mitral regurgitation (MR) have evolved over 50 years and form much of the basis for percutaneous approaches to the mitral valve. Surgical mitral repairs have been more durable with the use of annuloplasty, but recurrent regurgitation hardly resulting in reoperation can occur. Less invasive options in treating MR may encourage higher-risk patients to seek anatomic therapy, whether surgical or percutaneous. Rapidly evolving technology will continue to be a dominant driver of surgical approaches to MR, with increasing overlap and interaction with percutaneous approaches. pp. 24–32.

Keywords: regurgitation; outcome; new surgical techniques; mechanism