Surgical indications and techniques
Moderate-or-severe TR was always corrected during MV surgery. Mild TR was treated if systolic dimension of the annulus was >24 mm9. All patients underwent surgery through a median sternotomy. TV repair was accomplished using De Vega annuloplasty, flexible bands (Sovering MiniBand, SMB50, Sorin, Saluggia, Italy; Cosgrove-Edwards, Edwards Lifesciences, Irvine, CA, USA; Duran, Medtronic, Inc, Minneapolis, MN, USA), or a rigid incomplete ring (MC3, Edwards Lifesciences, Irvine, CA, USA). Myocardial protection was achieved using intermittent warm antegrade and retrograde blood cardioplegia.