A 59 yr old man with severe myxomatous mitral regurgitation is asymptomatic,wi wia left ventricular ejection fraction of 45% and an endsystollic diameter index of 2.9cm/m2 . The most appropriate treatment is

Ref Harrison 19 th ed pg 1545 Valve repair for ischemic MR is associated with lower periopera- tive moality rates but higher rates of recurrent MR over time. In patients with ischemic MR and significantly impaired LV systolic function (EF <30%), the risk of surgery is higher, recovery of LV per- formance is incomplete, and long-term survival is reduced.