The incidence of tricuspid regurgitation (TR) associated with left valvular disease is significant ranging from 8% to 35% of cases. ^, This is most common in conjunction with mitral valve disease but association with aortic valve pathology is not uncommon and frequently related to rheumatic valve disease and much rarer in association with degenerative mitral valve disease. In most cases, the tricuspid regurgitation is so called “functional”, in other words, secondary to dilatation of the annulus as a consequence of right ventricular (RV) dilatation and pulmonary hypertension. The functional tricuspid regurgitation is a progressive disease that does not always resolve with the correction of the left-side lesion. The recommendations that existed were generally conservative, late in timing, and reflective in large measure of the historically poor outcomes with Tricuspid Valve (TV) surgery in the context of delayed referral, advanced heart failure symptoms, and RV dysfunction

It has become evident that in a significant number of cases, secondary TR does not regressed after appropriate correction of the left-side disease leading to a more aggressive conduct. ^,

[…]