Background: The operative mortality of elderly patients with severe mitral regurgitation (MR) is relatively higher than younger patients. The purpose of this study was to evaluate the outcome of nonsurgical treatment in elderly patients with severe mitral regurgitation. Methods: 50 consecutive patients who were diagnosed severe degenerative MR (vena contracta width >6 mm) at the age of 65 years or more (mean age 76짹7 years, 19 male) were reviewed retrospectively. Patients underwent serial clinical and echocargiographic examinations and medical management. Results: 1. In elderly severe MR patients, ejection fraction was under 55% at the time of diagnosis. 2. Effective regurgitant orifice area of NYHA functional class III/IV group was larger than class I/II group. (see table) 3. Overall 5 year survival rate of death from any cause was lower than expected survival rate of same aged group from Korean Census data (60.5짹0.08 % vs 82.1%). 4. 5 year survival rate of NYHA class III/IV was lower than NYHA class I/II (29.6짹15.1% vs. 80.9짹0.08%, P=0.006). 5. NYHA class I/II patients showed similar 5 year survival rate compared to expected survival rate of same aged group (80.9짹0.08% vs 82.1%). Conclusion: In elderly patients with mild symptomatic severe MR, careful medical management can maintain the 5 year survival rate similar to the same aged general population.