The optimal timing of tricuspid valve surgery for asymptomatic or minimally symptomatic patients with severe primary TR has not been established. Extrapolation from limited experi- ences reported for patients with stable carcinoid heart disease and patients with a flail tricuspid leaflet, as well as application of the manage- ment principles adopted for patients with severe MR, suggest that serial assessments of RV size and function might trigger consideration of cor- rective surgery in selected patients with severe primary TR when a pattern of continued deterio- ration can be established and the surgical risk is In otherwise healthy patients without other comorbidities, such as patients with severe TR attributable to trauma, the surgical risk associated with tricuspid valve operation is low (<1% to 2% operative mortality Figure 10. Tricuspid regurgitation. Colors correspond to Table 2. GDMT indicates guideline-directed management and therapy; HF, heart failure; PAP, pulmonary artery pressure; PH, pulmonary hypertension; RV, right ventricular; TR, tricuspid regurgitation; and TV, tricuspid valve. CLINICAL STATEMENTS AND GUIDELINES rate) in the absence of RV dysfunction or pulmo- nary hypertension. 6. Isolated tricuspid valve surgery for severe TR his- torically has been performed relatively late in the natural history of the disease, when patients have become symptomatic with signs of right-sided HF. Unadjusted mortality rates for isolated tricuspid valve surgery have therefore exceeded those reported for isolated aortic or mitral valve surgery, and this trend has been even more pronounced for reoperative tri- cuspid surgery late after left-sided valve surgery.1,2,39 This high reoperative mortality rate is likely related to the advanced nature of RV failure encountered at the time of the second procedure, residual pulmo- nary hypertension, LV dysfunction, and other valve abnormalities. 