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. Tricuspid valve repair is preferable to replacement, but replacement may be necessary if there is marked dilation of the annulus or intrinsic disease of the tricuspid leaf- Observational data have shown a lower operative risk with tricuspid valve repair than with replacement, but this may be related to patient selection, given that the latter would be inserted in patients with a severely dilated annulus and abnormal leaflets to prevent recurrent or residual regurgitation. The risks and benefits of tricuspid valve operation should be carefully considered in the presence of severe RV systolic dysfunction or irreversible pulmonary hypertension because of the possibility of RV failure after operation. 2. 