In conclusion, concomitant TA and mitral valve surgery in patients with burn-out rheumatic mitral valve disease will remain a challenge in the next half century. Intensive patient screening program in RHD endemic regions is required to capture reparable burn-out rheumatic mitral valve disease for early valve repair plus TA for moderate TR. The papers by Arafat, Farooq and their colleagues have stimulated timely discussion and incentives for a multicenter randomized controlled trials in rheumatic patients to provide further evidence for supporting the current surgical practice. We are looking forward to the five-year follow up results of the randomized trial for MVS plus TA in patients with degenerative mitral valve disease.