Table 1

Tricuspid valve surgery protocol

1. Surgical management of tricuspid valve regurgitation
Moderate to severe or severe tricuspid regurgitationAlways
Following indications of clinical guidelines: symptoms or progressive RV dilatation/declining RV function.
Mild tricuspid regurgitation if mitral surgery or moderate tricuspid regurgitation if other cardiac surgeryPlus one of the following criteria:
  • Annulus >39 mm (21 mm/m2)

  • Permanent atrial fibrillation

  • Mitral rheumatic valve disease

  • Previous right heart failure

Plus two of the following criteria:
  • Severe right or left atrial dilatation

  • Ischaemic cardiomyopathy

  • RV remodelling/dysfunction or TV distortion

  • SPAP >60 mm Hg

2. Criteria for extended repair
  • Severe valve anatomy distortion: tenting area >1.0 cm2 and coaptation height >8 mm.

3. Criteria for prosthesis implantation
  • Severe valve anatomy distortion plus severe RV dilatation (apical four-chamber basal diameter ≥55 mm or medial diameter ≥50 mm) or moderate to severe dysfunction (visual EF or TAPSE <13).

  • When repair or advanced repair is not feasible due to substantive calcification/thickening/fibrosis of leaflets or annulus

  • EF, ejection fraction; RV, right ventricle; SPAP, systolic pressure pulmonary artery; TAPSE, tricuspid annular plane systolic excursion; TV, tricuspid valve.