In Reply Dr Slipczuk and colleagues fail to appreciate several important corollaries of the evidence presented in our study detailing the benefits of early surgery in patients with mitral regurgitation due to flail leaflets. First, in the absence of published randomized trials, comparative effectiveness research remains a national priority for comparing contemporary therapeutic modalities.1 The analyses of our large study population, both overall and in all subsets, using unmatched and matched comparisons, demonstrated that early surgery was associated with better survival and less heart failure than watchful waiting.
Suri RM, Enriquez-Sarano M. Surgery vs Watchful Waiting for Mitral Regurgitation—Reply. JAMA. 2013;310(19):2099-2100. doi:10.1001/jama.2013.282164