These findings support the strategy of correcting mild-to-moderate functional TR at the time of MV replacement to maintain TV function and improve clinical outcomes.

In the present cohort, preoperative anemia, renal/hepatic dysfunction, right ventricular dilatation, and significant postoperative tricuspid regurgitation were associated with poor outcomes. Timely surgery is advisable in patients with severe isolated tricuspid regurgitation before the development of anemia, organ dysfunction, or right ventricular dilatation.