Early surgical intervention for severe degenerative mitral regurgitation before symptoms, atrial fibrillation, and ventricular dysfunction are associated with excellent clinical outcomes. Besides complexity of leaflet lesion and repair quality, surgical timing also significantly affects repair durability. Early surgical intervention should therefore be recommended to reduce recurrent mitral regurgitation.

Total arch replacement can be safely performed in patients with AAD and preoperative mild renal dysfunction. Preoperative renal dysfunction is a risk factor for postoperative RRT, and eGFR is useful for predicting the requirement for postoperative RRT. Our surgical strategy for total arch replacement and stented elephant trunk for patients with AAD and mild preoperative renal dysfunction has excellent early outcomes.