Conclusion
We found the echocardiographic mitral valve complexity score to bemoderately correlated with the previously published surgical complexity score. This moderate correlation demonstrates that TEE is a feasible imaging modality to predict the surgical mitral valve complexity score; importantly, with minimal additional risk, given that preoperative TEE is already common practice prior to scheduling MV surgery. Using preoperative TEE to determine the MV complexity score can allow for early stratification, rather than awaiting intraoperative evaluation on the open, cross-clamped heart during cardiopulmonary bypass. Accordingly, by potentially decreasing surgical time and allowing for referral of patients with complex degenerative MV disease to surgeons and hospitals with extensive experience in MV repair, preoperative complexity scoring has the potential to improve patient experience and postoperative outcomes.