If the heart continues to dilate, long-term durability of the repair is moot; the survival of the patient is limited.9,12,21 43 5. In an RCT of mitral valve repair versus mitral valve replacement in patients with severe isch- emic MR, there was no difference between repair and mitral valve replacement in survival rate or LV remodeling at 2 years. However, the rate of recurrence of moderate or severe MR over 2 years was higher in the repair group than in the replacement group, leading to a higher incidence of HF and repeat hospitalization. The lack of apparent benefit of valve repair over valve replacement in secondary MR versus pri- mary MR, with less durable repairs in secondary MR, highlights that primary and secondary MR Figure 9. Secondary MR. Colors correspond to Table 2. *Chordal-sparing MV replacement may be reasonable to choose over downsized annuloplasty repair. AF indicates atrial fibrillation; CABG, coronary artery bypass graft; ERO, effective regurgitant orifice; GDMT, guideline-directed management and therapy; HF, heart failure; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; MR, mitral regurgitation; MV, mitral valve; PASP, pulmonary artery systolic pressure; RF, regurgitant fraction; RVol, regurgitant volume; and Rx, medication. CLINICAL STATEMENTS AND GUIDELINES 8. TRICUSPID VALVE DISEASE 8.1. Classification and Stages of TR Trace to mild degrees of TR of no physiological con- sequence are commonly detected on TTE in subjects with anatomically normal valves. However, significant or worsening TR is associated with poor long-term Primary disorders of the tricuspid appa- ratus that can lead to more significant degrees of TR include rheumatic disease, IE, congenital disease (Eb- stein s), myxomatous changes, and other problems af- fecting the tricuspid valve leaflets (blunt chest trauma, carcinoid, drugs, and radiation) (Table 19). 