<div>Author name: Actis Dato Guglielmo M., MD, Actis Dato Giulia, MD</div><div>Affiliation: Cardiac Surgery, Mauriziano Hospital Umberto I, Turin,
Italy</div><div>Short Title: Mitral valve rapair in elderly</div><div>Corresponding author details: Cardiochirurgia, Ospedale Mauriziano,
largo Turati, 10125 Torino, Italia</div><div>Mitral valve surgery immediately after treatment of congenital diseases
represents the symbol of the birth of Cardiac Surgery more than 70 years
ago (1). Over the last few years cardiac diseases, from an
epidemiological point of view, has changed radically in industrialized
countries and so has the average age of the heart disease population
progressively increased. Simultaneously with the rapid advancement of
transcatheter alternatives to surgical approaches, surgical community is
looking for less invasive techniques to provide a fair reference to
these changing needs (2).</div><div>Mitral valve surgery is one of these operations that has a significant
margin for progress, both through conservative vs replacement surgical
strategies, and through technical improvement to optimize the results
inherent to the operation itself.</div><div>Muncan and colleagues address this in their study by showing that repair
in the older population can achieve excellent results (3).</div><div>In their comparison series using a large database, the authors reported
that survival and freedom from reoperation were not significantly
different between repair and replacement.</div><div>The finding is inspiring, because mitral disease due to insufficiency in
the elderly population has historically suffered from lower repair
rates, possibly due to existing evidence suggesting they are less
durable.</div><div>The report is an encouragement to prefer the repair option even in
elderly patients whenever possible.</div><div>In expert hands, Mitral pathology can be repaired effectively and
safely. The presence of a deficiency alone should not limit repair
operations in a specialized environment ensuring good survival and other
favorable results when compared to those of replacement. Taken together,
the report encourages the expansion of mitral repair options in centers
of excellence.</div><div>Under a rigorous evaluation of the comparative effectiveness between
surgical and less invasive alternatives, it is all the more critical
that the surgical community fulfills the maximum benefit that the
surgical approach can offer.</div><div>The authors should be congratulated for challenging conventional wisdom
and encouraging us to critically evaluate potential options for mitral
valve repair in case of insufficiency</div><div>1 Hines GL, Kolwitz CE. Charles Bailey and the Early History of Mitral
Valve Surgery. Cardiol Rev. 2021 Jul-Aug 01;29(4):163-164</div><div>2 Ramlawi B. The Era of Catheter-Based and Minimally Invasive Cardiac
Surgery. Methodist Debakey Cardiovasc J. 2016 Jan-Mar;12(1):3.</div><div>3 Muncan B, Amabile A, Kalogeropoulos AP, Geirsson A, Krane M. Midterm
Outcomes of Mitral Valve Repair versus Replacement in Elderly Patients A
Propensity Score-Matched Analysis. J Card Surg, JOCS-2022-ORIG-1238</div>