Functional Tricuspid Regurgitation and Ring Annuloplasty Repair

Functional tricuspid regurgitation (TR) primarily arises from asymmetric dilation of the tricuspid annulus in the setting of right ventricular dysfunction and enlargement in response to left-sided myocardial and valvular abnormalities. Even if the TR is not severe at the time of mitral valve surgery, it can worsen and even appear late after successful mitral valve surgery, which portends a poor prognosis. Despite data demonstrating inferior outcomes in the presence of residual TR, surgical repair for functional TR remains underused. Acceptance of TR, in the presence of tricuspid annular dilation, may be unacceptable. Surgical repair should consist of placement of a rigid or semirigid annular ring, which has been shown to provide superior durability as compared with suture and flexible band techniques. Finally, percutaneous annuloplasty for correction of functional TR may allow treatment of patients with recurrent TR at high risk of reoperation.