Early MR Repair in Mild Symptoms — EECC MCQ

Correct answer: E — Yes — the 2025 ESC VHD Guidelines recommend surgery (Class I) for severe primary MR with symptoms, even if mild (NYHA II), when repair is feasible at an expert centre with ≥95% repair rate; waiting for severe symptoms or LV dysfunction represents delayed referral with worse post-operative outcomes

The 2025 ESC/EACTS VHD Guidelines for severe primary MR intervention: CLASS I (recommended): (1) symptomatic patients (any NYHA class II-IV) with severe MR; (2) asymptomatic with LVEF ≤60% or LVESD ≥40 mm (or LVESDi ≥22 mm/m² at expert centre). CLASS IIa (should be considered): (1) asymptomatic with new AF; (2) asymptomatic with PASP >50 mmHg; (3) asymptomatic with flail leaflet and EROA ≥40 mm² when repair is highly likely. This patient is symptomatic (NYHA II) with severe MR — this alone meets Class I criteria. The emphasis on repair feasibility (>95% probability at a reference centre) reflects the evidence that: (1) repair has better long-term outcomes than replacement; (2) early repair before irreversible LV remodelling produces optimal results; (3) the traditional 'watchful waiting' approach risks allowing occult LV damage.

Reference: ESC/EACTS (2025): VHD Guidelines