Table 3.

RV function in risk stratification for surgical intervention in severe TR.

Summary of key points

Where TR is the consequence of a failing RV surgical correction is unlikely to be beneficial. Evidence of significant right heart failure with chronic systemic venous hypertension typically reflects end-stage disease. Conventional surgical intervention carries high mortality and those who might survive often show little symptomatic improvement. Where TR is a primary event and RV dilatation is not excessive and RV function remains preserved then surgical correction is likely to be beneficial. Where TR is the result of primary RA dilatation or RV pacing lead interference and where RV dilatation is not excessive and RV function remains preserved, then lead repositioning/extraction or surgical correction is likely to be beneficial. Where TR is the result of residual regurgitation due to a combined aetiology of progressive TV annular dilatation and pulmonary hypertension, then in the absence of significant pulmonary vasculopathy and excessive RV dilatation and where RV function remains relatively preserved, surgical correction may be beneficial.In patients considered unsuitable for conventional TV surgery, emerging technologies such as transcatheter approaches may have a role.