The article published in this edition of Journal of Cardiac Surgery, Arafat and colleagues discuss the results of their ten year clinical experience of concomitant tricuspid annuloplasty (TA) for moderate to severe tricuspid regurgitation (TR) during mitral valve surgery in patients with rheumatic (RMVD - n= 345; 61% had mitral regurgitation and 39% mitral valve stenosis) and degenerative (DMVD n= 135) mitral valve diseases, The objective of the observational non-randomized trial was to identify predictors of durability of TA for moderate to severe TR in patients with RMVD and DMVD undergoing mitral valve repairs and replacements. Valve repair was feasible in 12% in the RMVD group as compared to 52% in DMVD group (1). The TA was performed with flexible, rigid prostheses and the de Vega suture technique.

Tricuspid annuloplasty for moderate to severe TR (Class I, IIb) is the current standard of practice to restore the normal tricuspid annular dimension and function (1,2). The current controversy in atrioventricular surgery concerns the indication for concomitant TA in patients with moderate TR and significant annular dilatation of at least > 40 mm or at least 21 mm/m2 indexed for body surface area (Class IIb) during mitral valve surgery proposed by the American Heart Association/American College of Cardiology and European Society of Cardiology (1,2,3)