Evaluation and Operative Indication of Functional Tricusid Regurgitation

Operative indication for functional tricuspid regurgitation (TR) remains controversial. According to the guidelines, it is determined based on severity of TR, symptoms, annular diameter, pulmonary hypertension and right ventricular (RV) function. However, there are many problems in the guidelines, such as difficulties in determining symptoms, quantification of TR severity and evaluation of RV function. There are many echocardiographic parameters of RV function, but any of them have not been established. Surgical treatment for functional TR is classified into two patterns; one is tricuspid annuloplasty concomitant with mitral valve surgery and the other is “isolated” tricuspid valve surgery. We should consider them as different disease entities because they show totally different clinical characteristics and prognosis. RV function is critical especially in isolated tricuspid valve surgery. In clinical settings, “isolated” tricuspid valve surgery has not been enough performed. Poor outcomes of “isolated” tricuspid valve surgery has been related to our reluctance to perform tricuspid surgery. There have been controversial issues in operative indication and its optimal timing and selection of operative procedures in patients with “isolated” TR. I would like to discuss these issues based on previous studies and our experience in the real world of our daily practice.