Recommendations for MR surgery
Recommendation	Grade of recommendation	Level of evidence
Symptomatic patients with severe acute MR	I	C
Symptomatic patients with severe chronic primary MR and normal left ventricular function	I	B
Asymptomatic patients severe chronic primary MR and left ventricular function (EF 30-60% and/or end-systolic diameter ≥ 40 mm)	I	B
Plasty is preferable to mitral replacement in severe chronic primary MR patients	I	B
Plasty or mitral replacement is indicated in patients with severe chronic primary MR and patients undergoing concomitant heart surgery	I	B
Mitral replacement is preferable to plasty in patients with chronic secondary MR of ischemic etiology	I	A
Mitral plasty may be considered for chronic primary (non-rheumatic) MR, normal ventricular function, and new atrial fibrillation or pulmonary hypertension (resting PASP > 50 mmHg)	IIa	B
Plasty or mitral replacement may be considered for symptomatic patients with chronic primary MR and FE ≤ 30%	IIb	C
Mitral plasty via catheter may be considered for symptomatic patients (FC III/IV) with chronic primary MR and prohibitive surgical risk	IIb	B
Mitral plasty may be considered for symptomatic patients (FC III/IV) with chronic secondary (functional) MR who are refractory to clinical treatment and cardiac resynchronization	IIb	C
For symptomatic patients with severe MR due to degeneration of a bioprosthesis or previously implanted valve rings and prohibitive surgical risks, percutaneous mitral replacement at a specialized center may be considered	IIb	C
Asymptomatic patients with severe MR and preserved left ventricular function (LVEF > 60% and end systolic diameter < 40 mm)	III	C
Plasty or mitral replacement may be considered for patients with moderate MR who are undergoing concomitant myocardial revascularization surgery	III	A

EF: ejection fraction; FC: New York Heart Association functional class; LVEF: left ventricular ejection fraction; MR: mitral regurgitation; PASP: pulmonary artery systolic pressure.