Summary of existing society guidelines for tricuspid valve surgery for tricuspid regurgitation
| 2012 European Society of Cardiology Recommendations21 | 2014 American Heart Association/American College of Cardiology Recommendations20 |
| Class I | |
| Severe primary or secondary TR at the time of left-sided valve surgery (level of evidence C) | Severe primary or secondary TR at the time of left-sided valve surgery (level of evidence C) |
| Symptomatic isolated severe primary TR without evidence of right ventricular dysfunction (level of evidence C) | |
| Class IIA | |
| Surgery may be appropriate for moderate primary TR in patients at the time of left-sided valve surgery (level of evidence C) | Surgery may be appropriate for severe primary TR in patients unresponsive to medical therapy (level of evidence C) |
| Surgery may be appropriate for mild or moderate secondary TR in patients with annular dilation (≥40 mm or >21 mm/m2) at the time of left-sided valve surgery (level of evidence C) | Surgery may be appropriate for for mild or moderate secondary TR at the time of left-sided valve surgery if there is (A) dilation of the tricuspid annulus or (B) the patient has a history of right heart failure (level of evidence B) |
| Surgery may be appropriate for asymptomatic or mildly symptomatic patients with severe isolated primary TR and evidence of progressive RV dilation or decreased RV function (level of evidence C) | |
| In patients with previous left-sided valve surgery; stand-alone tricuspid surgery may be appropriate for patients with severe secondary TR and either symptoms or evidence of right ventricular dilation or dysfunction, in the absence of left-sided valve dysfunction, severe RV or LV dysfunction and severe pulmonary hypertension (level of evidence C) | |
| Class IIB | |
| Surgical tricuspid valve repair may be appropriate in patients with for mild or moderate secondary TR and pulmonary hypertension at the time of left-sided valve surgery (level of evidence C) | |
| In patients with previous left-sided valve surgery; surgical repair or replacement may be appropriate in patients with symptomatic severe TR in the absence of severe RV dysfunction or severe pulmonary hypertension (level of evidence C) | |
| Surgery may be appropriate for patients with asymptomatic or minimally symptomatic severe primary who have evidence of at least moderate right ventricular dilation or dysfunction (level of evidence C) | |
LV, left ventricle; RV, right ventricle; TR, tricuspid regurgitation.