Beyond annuloplasty: Anatomy-based tricuspid valve repair for right ventricular dysfunction

OBJECTIVES Functional tricuspid regurgitation in the setting of right ventricular (RV) remodelling remains one of the least standardized challenges in valvular surgery. Surgeons are often confronted with complex anatomy and limited formal training in advanced tricuspid reconstruction. This review seeks to consolidate the evolving surgical knowledge base and provide a structured reference for the full spectrum of repair strategies beyond annuloplasty. METHODS A targeted literature review was performed to identify key reports on surgical tricuspid valve interventions. These were synthesized narratively to outline the principles, indications, and anatomical rationale for current techniques, including edge-to-edge repair, leaflet augmentation, papillary muscle relocation, approximation, suspension, bundling, and annular repositioning. RESULTS Collectively, these approaches form a growing surgical armamentarium aimed at restoring normal leaflet geometry and subvalvular alignment in the setting of RV dilatation. Understanding the interplay between annular, leaflet, and subvalvular distortion is essential for achieving functional and durable repair that can rival evolving transcatheter options. CONCLUSIONS This review unifies previously scattered concepts into a practical framework for anatomy-guided tricuspid reconstruction, offering surgeons an accessible reference for managing complex, RV-dependent tricuspid valve disease.