Don’t fix what’s not broken: tricuspid valve repair in the mitral patient

or not, the valve is not broken. Therefore, it should not be fixed. We might add one caveat to this. It may be prudent to place a tricuspid annuloplasty in patients with tricuspid annular dilatation and severe pulmonary hypertension and/or right ventricular dysfunction; however, there is little evidence to support this assertion. But why not “fix” it while you are there? Ten stitches, ten minutes, and you will have a valve that did not leak before and does not leak now, but that has a reduced circumference. This addition of a tricuspid valve procedure is not associated with an increase in operative mortality (9). However, the addition of a tricuspid valve annuloplasty to a mitral valve operation increases the likelihood of a patient requiring a permanent pacemaker before hospital discharge (5). Whether the risk of permanent pacemaker implantation increases two-fold or five-fold can be debated; however, it is certain that this risk increases with the addition of a tricuspid procedure. Permanent pacemakers in nonsurgical patients with de novo heart block or symptomatic bradycardia save lives and improve quality of life. The calculus, however, is different in cardiac surgery patients: the need for a permanent pacemaker after cardiac surgery is associated with reduced life expectancy (10). No cardiac surgical procedure is “free”. Adding a tricuspid valve annuloplasty and engendering the need for a permanent