Functional tricuspid regurgitation is common in patients that undergo mitral valve surgery. Increase in pulmonary pressures leads to elevation in RV afterload which results in adverse ventricular remodeling, dilation of the tricuspid annulus, mal-coaptation of the valve's leaflets and the development of TR. Theoretically, correction of the mitral pathology could decrease the elevated pulmonic pressures and reverse the pathological processes affecting the TV [1].

However, the fate of secondary TR in patients that undergo surgical correction of MR is not clear. While some studies report the reversal of adverse RV remodeling and TR following MV surgery, others report of persistent abnormal right ventricular geometry and progressive valvar insufficiency [2,3].

As hemodynamically significant TR and RV dysfunction are associated with worse long-term prognosis and clinical outcomes [4,5], moderate functional TR or abnormal tricuspid annular diameter are indications for concomitant surgical correction, according to current guidelines [ 6]. However, the potential of non-severe TR to develop over time, even after correction of left-sided diseases is of concern.

Conflicting reports regarding the progression rate of uncorrected TR might stem from multiple reasons. Studies may differ in the etiologies of MR (such as rheumatic heart disease, degenerative MV disease, endocarditis or combined valvular disease), the degree of LV and RV dysfunction and pulmonic hypertension, among others. In the current meta-analysis, we apply strict inclusion and exclusion criteria to achieve a relatively homogenous patient population and to accurately estimate the rate of progression of functional TR following MR surgery. In addition, we compare the long-term effect of concomitant TV annuloplasty on the rates of worsening TR.