Conclusion
The comments in this document do not presume of answering the questions presented above, but to introduce in debate new issues, in order to stimulate a more in-depth discussion.
Tricuspid annular dilatation seems to play an important role as predictor of early and late outcomes after left-sided surgery, especially if other parameter such as leaflet coaptation and tethering are also present. However, controversial data regarding the role of prophylactic tricuspid valve repair concomitant with left-sided intervention make this procedure not as widespread as it could be. Nonetheless, with the advent of percutaneous tricuspid valve interventions, it turned into an interesting alternative approach in selected patients.
The decision-making process should be based on individual factors such as patient desire, clinical symptoms, response to medical management, quality of life, and life expectancy, as well as tricuspid valve morphology, currently available devices and procedural risks.