The surgical treatment of tricuspid regurgitation (TR) is still the object of debate in terms of its timing and surgical techniques. Particularly in the most recent years, there has been an increasing interest in this field and the series reported by Kim et al 1 provide some important data regarding the preoperative predictors of outcome in patients submitted to tricuspid valve (TV) surgery for primary or secondary severe TR. In this study the great majority of TV surgery was carried out during left-sided valve surgery, reflecting an advanced stage of the disease. A minority of the patients had isolated tricuspid repair or replacement, either for severe primary TR or late tricuspid insufficiency following left-sided valve surgery. Although half of the patients were in New York Heart Association (NYHA) functional class III or IV, hospital mortality was very low. Nevertheless, major complications occurred in 20% of the patients after repair and in 33% of the cases after replacement. Moreover, at a median follow-up time of 63 months, 22.2% of the patients in the repair group and 25% of those in the replacement group died, reflecting the significant complexity of the patients and the advanced stage of their pathology. Predictors of mortality and adverse events were identified. Interestingly the surgical technique (repair vs replacement) and the aetiology of TR (primary vs secondary) had apparently no influence on the outcome. On the other hand, age, gender, NYHA functional class, liver cirrhosis and a number of laboratory markers (haemoglobin, albumin, glomerular filtration rate) were identified as important risk factors for all-cause mortality and for the composite end-point of death, tricuspid reoperation and congestive heart failure. These findings emphasise once more that survival after TV surgery is affected more by preoperative factors like advanced heart failure symptoms, comorbidities and end-organ dysfunction than by the type of …