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. Left uncorrected at the time of left-sided valve surgery, mild or moderate degrees of second- ary TR may progress over time in approximately 25% of patients and result in reduced long-term functional outcome and survival.32 Risk factors for persistence or progression of TR include tricuspid annulus dilation (>40 mm diameter or 21 mm/m2 diameter indexed to body surface area on pre- operative TTE measured at end diastole; >70 mm diameter on direct intraoperative measure- ment of the intercomissural distance), degree of RV dysfunction or remodeling, leaflet tether- ing height, pulmonary artery hypertension, AF, and intra-annular RV pacemaker or implantable Several observational studies and one prospective RCT have demonstrated the benefit of tricuspid repair at the time of mitral valve surgery for progres- sive TR (Stage B) with tricuspid annulus dilation on echocardiographic and functional parameters, although data on outcomes such as survival and major adverse events are lacking.3 10,33 35 Because CLINICAL STATEMENTS AND GUIDELINES the severity of TR may be dynamic, dependent on the preload and pulmonary pressures, a past his- tory of signs or symptoms of right-sided HF indi- cates the propensity to develop more severe TR and should be considered an indication for con- comitant tricuspid valve repair. 3. In patients with symptomatic severe primary TR, reduction or elimination of the regurgitant vol- ume load by tricuspid valve surgery can allevi- ate systemic venous and hepatic congestion and decrease reliance on diuretics.11,12,20 Patients with severe congestive hepatopathy may also benefit from surgery to prevent irreversible cirrhosis of the liver. Quality and duration of long-term survival are related to residual RV function. 