Surgical strategies for functional tricuspid regurgitation

Functional or secondary tricuspid regurgitation commonly is found in the setting of left-sided heart disease and, when severe, is associated with substantially poorer functional outcomes and survival if untreated. The traditional view that functional tricuspid regurgitation generally resolves with surgical correction of the primary lesions is no longer held. Data showing late development of severe tricuspid regurgitation in patients with mild regurgitation at time of mitral valve surgery have heralded a new era of aggressive intervention on the tricuspid valve. Tricuspid ring annuloplasty can be performed with minimal incremental morbidity and negligible additional mortality. Therefore, in addition to patients with severe regurgitation, annuloplasty is now also recommended for patients with risk factors for developing late tricuspid insufficiency (typically patients with moderate tricuspid regurgitation or severe annular dilation at time of left-sided cardiac procedures). In this work we review the current indications for tricuspid valve repair in patients undergoing other cardiac surgery operations and also the various options available to the surgeon.