Surgery for functional tricuspid regurgitation: current techniques, outcomes and emerging concepts

Functional tricuspid regurgitation is the most frequent cause of tricuspid insufficiency and is often secondary to left-sided valve diseases. The correction of left-sided valve diseases without concomitant repair of functional tricuspid regurgitation is associated with significant late morbidity and mortality. This occurs on account of progressive right ventricular dysfunction and increasing need for reoperation. Recent years have seen a surge in surgery for functional tricuspid regurgitation. Several techniques are available to correct functional tricuspid regurgitation. These include the stitch annuloplasty, such as semicircular (classical De Vega repair) or simple lateral annuloplasty (Kay), novel techniques such as edge-to-edge or clover technique and suture bicuspidization technique, use of flexible and rigid prosthetic rings or 3D rings, flexible prosthetic bands, and use of artificial chordae with polytetrafluoroethylene sutures for anterior and septal ticuspid leaflet pathology. Whereas the short-term outcomes of these techniques are satisfactory, the majority are limited in the mid- and long term by unacceptably high rates of residual and/or recurrent regurgitation. A better understanding of the mechanisms of functional tricuspid regurgitation will help explain the failure of current techniques and be a help to modify existing surgical techniques or develop new techniques.