Tricuspid Annuloplasty Decision by Annular Size — EECC MCQ

Correct answer: D — Yes — concomitant TV annuloplasty should be considered when the tricuspid annulus is dilated ≥40 mm (or >21 mm/m²), even with only moderate TR, as progressive annular dilatation predicts TR worsening after left-sided surgery; the incremental surgical risk is low

The 2025 ESC/EACTS VHD Guidelines recommend concomitant TV intervention during left-sided cardiac surgery when: (1) severe TR is present (Class I); (2) moderate TR WITH tricuspid annular dilatation ≥40 mm (or ≥21 mm/m² indexed to BSA) (Class IIa) — even without severe TR, progressive annular dilatation predicts worsening TR over time, and late isolated TV surgery carries significantly higher mortality than concomitant repair. The annular dimension is a key decision driver because: once the annulus dilates beyond ~40 mm, the normal saddle-shaped geometry is lost and self-perpetuating annular dilatation occurs (leading to progressive TR despite resolution of the primary cause). Surgical annuloplasty with a rigid or semi-rigid ring is the standard repair technique. The incremental operative mortality of adding TV annuloplasty to CABG or mitral surgery is <1%.

Reference: ESC/EACTS (2025): VHD Guidelines