A 59 year old man with severe myxomatous mitral regurgitation is asymptomatic, with a left venricular ejection fraction of 45% and an end systobc diameter index of 2.9 cm/m2. The most appropriate treatment is

Surgery for chronic, nonischemic, severe MR is indicated once symptoms occur, especially if valve repair is feasible. Other indications for early consideration of mitral valve repair include recent-onset AF and pulmonary hypeension, defined as a PA pressure >=50 mmHg at rest or >=60 mmHg with exercise. Surgical treatment of chronic, nonischemic severe MR is indicated for asymptomatic patients when LV dysfunction is progressive, with LVEF falling below 60% and/or end-systolic dimension increasing beyond 40 mm. ( Harrison&;s principle of internal medicine,18th edition,pg no.1936 )