Tricuspid Annuloplasty: Is It a Step That Should Not Be Ignored in Mitral Valve Surgery?
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Updated: Jan 18, 2026

Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Mustafa Sabri Bayram1, Serkan Yildirim1, Mehmet Işik1
1Necmettin Erbakan University School of Medicine, Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram 42100, Konya.
Objectives:
Tricuspid regurgitation (TR) is commonly encountered in patients with left-sided valve disease and often progresses postoperatively if left unaddressed. While mitral valve replacement (MVR) alone may improve left heart parameters, concomitant tricuspid ring annuloplasty (TRA) might prevent right-sided deterioration.
Methods:
This retrospective study analysed 129 patients undergoing MVR between 2016 and 2019. Patients were divided into 2 groups: isolated MVR (n = 71) and MVR + TRA (n = 58). Long-term echocardiographic outcomes were compared, including LVDD, LVSD, LVEF, LA diameter, IVS thickness, pulmonary flow rate, PAP, and TI degree.
Results:
Both the groups showed regression in left heart dimensions postoperatively; however, left ventricular ejection fraction (LVEF) significantly decreased in the MVR-only group (P < .001) while it remained stable in the MVR + TRA group (P =0.598). Severe tricuspid insufficiency occurred in 12% (95% CI 5%-21%) of patients undergoing isolated MVR and 0% (95% CI 0%-6 ) of those undergoing MVR + TRA (P < .001). The mean difference in the change of pulmonary artery pressure (ΔPAP) between the groups was 12.0 mmHg (95% CI 6.5-17.3, P = .002), and both pulmonary artery pressure and left atrial diameter significantly decreased postoperatively in the MVR + TRA group.
Conclusions:
Performing TRA during MVR surgery offers significant protective effects against TI progression and right heart overload. Even in cases with mild TI but annular dilation, simultaneous TRA may be a rational and beneficial strategy to ensure long-term cardiac stability.
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