Mitral regurgitation
Also known as: mitral valve disease · MR
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2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease
ACC/AHA · 2020
Mitral regurgitation is one of the valve lesions covered by the single US valvular heart disease guideline. Its mitral sections distinguish primary (degenerative) from secondary (functional) regurgitation, apply the same A-to-D staging framework used across the document, and address the evaluation, timing and choice of repair, replacement or transcatheter intervention. Metadata record only.
- Issued in December 2020 by the ACC/AHA Joint Committee and covers all four cardiac valves, including the mitral valve. source
- Supersedes the 2014 AHA/ACC valvular heart disease guideline and its 2017 focused update. source
- Valve disease stage is assigned from symptoms, valve anatomy, severity of dysfunction and the ventricular and pulmonary circulation response. source
2025 ESC/EACTS Guidelines for the management of valvular heart disease
ESC/EACTS · 2025
European guidance on mitral regurgitation forms part of the 2025 ESC/EACTS valvular heart disease guideline, which covers mitral regurgitation alongside the other native valve lesions. The 2025 revision reworks the indications and timing for interventional options across the valve disease spectrum, including wider consideration of transcatheter approaches, and stresses multidisciplinary Heart Team assessment. Metadata record only.
- Released at ESC Congress 2025 by the ESC and EACTS, replacing the 2021 valvular heart disease guideline. source
- Covers mitral regurgitation among the native valve lesions addressed, together with aortic, tricuspid and multivalvular disease. source
- A stated aim is to reduce undertreatment and inconsistent practice by clarifying appropriate indications and timing for intervention. source
US vs EU key differences
- Version currency differs by five years: the US valvular guideline dates to 2020, while the European guideline was rewritten by ESC/EACTS in 2025. source
- The 2025 ESC/EACTS guideline adds a Class I recommendation for early surgical repair in asymptomatic patients with severe primary mitral regurgitation. source
- The 2020 US guideline is more conservative in the same setting: for asymptomatic primary MR with preserved function (ejection fraction above 60% and end-systolic dimension under 40 mm) it offers only a Class 2b indication, triggered by progressive LV dilatation or a falling ejection fraction on serial imaging. source
- For secondary MR the US guideline attaches explicit COAPT-derived numeric limits to its Class 2a transcatheter edge-to-edge repair recommendation: ejection fraction 20–50%, end-systolic dimension 70 mm or less, and pulmonary artery systolic pressure 70 mmHg or less on optimal medical therapy. source
What changed recently
- EU2021 → 20252025-08-29
The 2025 guideline replaces the 2021 edition and moves mitral intervention earlier: repair surgery becomes a Class I option in selected asymptomatic primary mitral regurgitation, and transcatheter edge-to-edge repair is upgraded to Class I in symptomatic severe ventricular secondary regurgitation with reduced ejection fraction, with new recommendations added for atrial secondary regurgitation.
source ↗curation confidence 90% - US2014 (with 2017 Focused Update) → 20202020-12-17
Superseding the 2014 guideline and 2017 focused update, the 2020 guideline expands the role of transcatheter mitral repair and directs complex mitral surgery to comprehensive valve centres, while restructuring intervention thresholds around valve-related symptoms, ventricular consequences and life expectancy.
source ↗curation confidence 90%
See the full update feed for changes across every system.