Table 1.

Tricuspid valve surgery protocol

1. Surgical management of tricuspid valve regurgitation
Moderate to severe or severe tricuspid regurgitation	Always 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 surgery	Plus 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.