Surgical treatment is performed for selected patients with TR at the time of surgery for left-sided valve lesions to treat severe TR (Stages C and D) and to prevent later development of severe TR in patients with progressive TR (Stage B). Surgical intervention should be considered for selected patients with isolated TR (either primary TR or second- ary TR attributable to annular dilation in the absence of pulmonary hypertension or dilated cardiomyopathy). Intervention for severe isolated TR had a high reported operative mortality rate (up to 8% to 20%), but most of these interventions were performed after end-organ However, outcomes of patients with severe primary TR are poor with medical management. There is renewed interest in earlier surgery for patients with se- vere isolated TR before the onset of severe RV dysfunc- tion or end-organ damage.2,11,12,18,19,22 This interest is attributable to 1) an increasing number of patients pre- senting with right-sided HF from isolated TR,23 25 advanced surgical techniques, and 3) better selection processes, resulting in a lower operative risk with docu- mented improvement in symptoms (Figure 10).11,12,15 19 There is growing interest in the development of cath- eter-based therapies for these patients with severe iso- Recommendation-Specific Supportive Text 1. Severe TR of either a primary or secondary etiol- ogy may not improve predictably after treatment of the left-sided valve lesion and reduction of RV afterload; as such, severe TR should be addressed as part of the index procedure.1,2,28 31 Reoperation for severe, isolated TR after left-sided valve surgery is associated with a perioperative mortality rate of Tricuspid valve repair does not add appreciably to the risks of surgery.1,2,28 31 There has been a significant increase in the number of tricuspid valve repairs performed for this indica- tion over the past decade. 