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Nardi et al. Vessel Plus 2018;2:4 Vessel Plus
DOI: 10.20517/2574-1209.2017.35

Editorial Open Access

Early treatment of functional tricuspid regurgitation
at the time of mitral valve surgery: an increased risk

or an additional benefit?

Paolo Nardi, Calogera Pisano, Antonio Pellegrino, Fabio Bertoldo, Sabrina Ferrante, Monica Greci,
Sara Rita Vacirca, Marco Russo, Giovanni Ruvolo

Department of Cardiac Surgery, Tor Vergata University Policlinic, Rome 00133, Italy.

Correspondence to: Dr. Paolo Nardi, Department of Cardiac Surgery, Tor Vergata University Policlinic, Viale Oxford 81, Rome
00133, Italy. E-mail: pa.nardi4@libero.it

How to cite this article: Nardi P, Pisano C, Pellegrino A, Bertoldo F, Ferrante S, Greci M, Vacirca SR, Russo M, Ruvolo G. Early
treatment of functional tricuspid regurgitation at the time of mitral valve surgery: an increased risk or an additional benefit?
Vessel Plus 2018;2:4. http://dx.doi.org/10.20517/2574-1209.2017.35

Received: 9 Nov 2017 First Decision: 9 Feb 2018 Revised: 24 Feb 2018 Accepted: 7 Mar 2018 Published: 13 Mar 2018

Science Editor: Alexander D. Verin Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

INTRODUCTION
Functional tricuspid regurgitation (FTR) refers to tricuspid insufficiency occurring secondarily to left-
sided heart valve disease, especially mitral stenosis or regurgitation, in the absence of organic lesions of the
tricuspid valve. In the late 1960s, the observation that mitral valve surgery sometimes led to an improvement
in FTR suggested a conservative approach . On the contrary, in the 1970s, Carpentier et al. reported
[1]
[2]
excellent results with tricuspid valve repair, arguing for systematic repair of FTR.
With the increasing population of long-term survivors of prosthetic mitral valve replacement, it has been
observed that many patients developed late heart failure as the result of onset or progression of FTR in
a severe form. Severe FTR is associated with substantially poorer functional outcomes and survival if
untreated . Moreover, data showing late development of severe FTR in patients with mild or mild-to-
[3,4]
moderate regurgitation at the time of mitral valve surgery have more recently pushed towards early aggressive
intervention on the tricuspid valve in concomitance with the treatment of mitral valve disease. This raised
the question if FTR in the presence of a lesser degree of regurgitation should be treated during the first
operation, supporting Carpentier’s assertion that “surgical abstention” may be somewhat a dangerous policy.
Moreover, when patients require reoperation for tricuspid valve dysfunction, a high operative mortality has
been observed, mainly due to the irreversible right ventricular systolic or liver dysfunction . Increasing
[5-7]
data now support an early surgical treatment of FTR [8-11] .

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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