Valve repair for functional tricuspid valve regurgitation: anatomical and surgical considerations

Functional tricuspid regurgitation (TR) primarily arises from asymmetric dilation of the tricuspid annulus in the setting of right ventricular dysfunction and enlargement in response to left-sided myocardial and valvular abnormalities. Even if TR is not severe at the time of mitral valve surgery, TR can worsen and even appear late after successful mitral valve surgery, which portends a poor prognosis. Despite data demonstrating inferior outcomes in the presence of residual TR, surgical repair for functional TR remains underused. However, "benign neglect" of TR, especially in the presence of tricuspid annular dilation, is unacceptable. Surgical repair should consist of placement of a rigid or semirigid annular ring, which has been shown to provide superior durability compared with suture and flexible band-based therapies. Finally, minimally invasive and percutaneous approaches for correcting functional TR may increase the delivery of therapy and allow treatment of patients with recurrent TR at high risk for reoperation.