Accurately predicting the risks of surgical intervention in patients with degenerative mitral valve regurgitation is important given that current practice guidelines recommend early surgery on asymptomatic patients, provided they can be operated on with <1% mortality with a very high likelihood of a successful mitral valve repair.1 Therefore, it becomes imperative to identify those patients with a risk low enough to justify surgery before onset of symptoms. The guidelines also have a new indication for transcatheter edge-to-edge repair for patients with severe primary mitral regurgitation and prohibitive surgical risk. Some ongoing transcatheter edge-to-edge repair clinical trials require evaluation of surgical risk as prerequisite for inclusion, thus making it necessary to have means to reliably identify patients with a high surgical risk. The Society of Thoracic Surgeons (STS) predictive risk model used in current practice is limited in application in this regard, as it does not differentiate etiology of mitral valve disease. In this issue of the Journal of the American College of Cardiology, Badhwar et al2 present a specialized STS predictive risk model developed specifically for patients with degenerative mitral valve disease which will, no doubt, inform clinical decision making as well as clinical trial design and interpretation for years to come. Several key messages from the analysis by Badhwar et al2 require emphasis.