Tricuspid valve annuloplasty at the time of mitral valve surgery: is it justified in all cases?

Tricuspid regurgitation after mitral valve surgery is common and it may affect long-term survival and quality of life. The pathophysiology of this lesion after mitral valve surgery in patients without preoperative tricuspid regurgitation remains elusive in most cases. Correcting a tricuspid annulus of >= 40 mm by means of an annuloplasty at the time of mitral valve surgery in patients without tricuspid regurgitation has been proposed as a potential preventative measure but this value of annular dilatation has been challenged in patients with degenerative mitral regurgitation who undergoes mitral valve repair. In addition, even when this approach is used, recurrent tricuspid regurgitation is quite high in long term studies. Further studies on functional tricuspid regurgitation are needed to elucidate its mechanism following heart valve surgery and newer approaches to correct it are needed. At present, I believe that tricuspid annuloplasty should be performed at the time of mitral valve surgery whenever there is moderate or severe tricuspid regurgitation and in patients with atrial fibrillation or dilated right ventricular cavity (systolic diameter >= 30 mm) even in the absence of significant tricuspid regurgitation.