Thus, the enrollment criteria in COAPT trial (LVEF between 20% and 50%, LVESD 70 mm, pulmonary artery systolic pressure 70 mmHg, and persistent symptoms [NYHA class II, III, or IV] while on optimal GDMT) are the current standard selection criteria for TEER for secondary MR. Observational studies have suggested that a greater reduction in MR sever- ity with TEER is associated with greater LV and LA reverse remodeling.1 8,48,49 The exact anatomy and mechanism of MR also needs to be taken into consideration when determining candidacy for transcatheter repair. 2. There is no proof that surgical correction of chronic secondary MR is effective in prolonging life, but observational studies and a substudy of the randomized STICH trial suggest that it is wise to address the mitral valve during CABG for severe CAD when secondary MR is severe. Although it may be hoped that the revascular- ization will recruit hibernating myocardium and reduce chronic secondary MR, this has not been demonstrated, and failing to correct chronic severe secondary MR may leave the patient with severe residual MR. The risks and benefits of additional surgical interventions should be weighed in patients with LV systolic dysfunc- For patients with secondary MR under- going operation for other valve disease, see Section 10.2 (Timing of Intervention for Mixed Valve Disease). 3. MR may develop in patients with preserved LV systolic function who have progressive LA dila- tion, leading to enlargement of the mitral annu- lus and malcoaptation of the leaflets.51,52 This may arise in conditions such as HF with preserved LVEF, restrictive cardiomyopathy, and nonobstruc- tive hypertrophic cardiomyopathy. 