Recommendations H. Recommendations on indications for intervention in tricuspid valve disease.

Recommendations	Classa	Levelb
Recommendations on tricuspid stenosis
Surgery is recommended in symptomatic patients with severe tricuspid stenosis.c	I	C
Surgery is recommended in patients with severe tricuspid stenosis undergoing left-sided valve intervention.d	I	C
Recommendations on primary tricuspid regurgitation
Surgery is recommended in patients with severe primary tricuspid regurgitation undergoing leftsided valve surgery.	I	C
Surgery is recommended in symptomatic patients with isolated severe primary tricuspid regurgitation without severe RV dysfunction.	I	C
Surgery should be considered in patients with moderate primary tricuspid regurgitation undergoing left-sided valve surgery.	IIa	C
Surgery should be considered in asymptomatic or mildly symptomatic patients with isolated severe primary tricuspid regurgitation and RV dilatation who are appropriate for surgery.	IIa	C
Recommendations on secondary tricuspid regurgitation
Surgery is recommended in patients with severe secondary tricuspid regurgitation undergoing left-sided valve surgery. 423,424,425,426,427	I	B
Surgery should be considered in patients with mild or moderate secondary tricuspid regurgitation with a dilated annulus (≥40 mm or >21 mm/m2 by 2D echocardiography) undergoing left-sided valve surgery. 423,425,426,427	IIa	B
Surgery should be considered in patients with severe secondary tricuspid regurgitation (with or without previous left-sided surgery) who are symptomatic or have RV dilatation, in the absence of severe RV or LV dysfunction and severe pulmonary vascular disease/hypertension. 418,433 e	IIa	B
Transcatheter treatment of symptomatic secondary severe tricuspid regurgitation may be considered in inoperable patients at a Heart Valve Centre with expertise in the treatment of tricuspid valve disease.f	IIb	C
2D: two-dimensional; LV: left ventricle/left ventricular; PMC: percutaneous mitral commissurotomy; RV: right ventricle/right ventricular. aClass of recommendation. bLevel of evidence. cPercutaneous balloon valvuloplasty can be attempted as a first approach if tricuspid stenosis is isolated. dPercutaneous balloon valvuloplasty can be attempted if PMC can be performed on the mitral valve. eIn patients with previous surgery recurrent left-sided valve dysfunction needs to be excluded. fTranscatheter treatment can be performed according to Heart Team at experienced valve centres in anatomically eligible patients in whom improvement of quality of life or survival can be expected.