Approaches to the management of functional tricuspid regurgitation.

Functional tricuspid regurgitation (FTR) is an acquired valvular abnormality that is most frequently encountered during the evaluation and operative management of left-sided heart failure and left heart valve disease. Observational studies have demonstrated that uncorrected significant FTR during mitral valve surgery can result in inferior early and late outcomes due to progression of FTR and underlying right heart failure. The 2012 ESC/EACTS and 2014 ACC/AHA guidelines strongly encourage the surgical correction of greater than mild tricuspid regurgitation or tricuspid annular dilation greater than 4 cm in patients undergoing left-sided valve surgery. Prospective randomized trials are needed to bolster the evidence behind the current recommendations. Percutaneous therapies in development may eventually result in less invasive options for treating FTR.