Evaluating the Benefit of Concurrent Tricuspid Valve Repair During Mitral Surgery

Inclusion Criteria:

   - Undergoing MVS for degenerative MR* with (a) Moderate TR as determined by
   transthoracic 2D echocardiography, or (b) Tricuspid annular dimension ≥ 40 mm (index:
   ≥21mm/M2 BSA) and none/trace or mild TR, determined by echocardiography.

   - Age ≥ 18 years

   - Able to sign Informed Consent and Release of Medical Information forms

      - "Degenerative mitral valve disease refers to a spectrum of conditions in which
      morphologic changes in the connective tissues of the mitral valve cause
      structural lesions . . ., such as chordal elongation, chordal rupture, leaflet
      tissue expansion, and annular dilation typically resulting in mitral
      regurgitation due to leaflet prolapse." This definition excludes rheumatic heart
      disease. (Anyanwu AC, Adams DH. (2007) Etiological classification of degenerative
      mitral valve disease: Barlow's disease and fibroelasticity deficiency. Semin
      Thorac Cardiovasc Surg; 19(2): 90-6).

Exclusion Criteria:

   - Functional MR

   - Evidence of sub-optimal fluid management (e.g., lack of diuretics, weight in excess of
   dry weight) in the opinion of the cardiology investigator

   - Structural / organic TV disease

   - Severe TV regurgitation as determined by preoperative transthoracic echocardiography
   (TTE)

   - Implanted pacemaker or defibrillator, where the leads cross the TV from the right
   atrium into the right ventricle

   - Concomitant cardiac surgery other than atrial fibrillation correction surgery (PVI,
   Maze, LAA closure), closure of PFO or ASD, or CABG

   - Cardiogenic shock at the time of randomization

   - STEMI requiring intervention within 7 days prior to randomization

   - Evidence of cirrhosis or hepatic synthetic failure

   - Severe, irreversible pulmonary hypertension in the judgment of the investigator

   - Pregnancy at the time of randomization

   - Therapy with an investigational intervention at the time of screening, or plan to
   enroll patient in additional investigational intervention study during participation
   in this trial

   - Any concurrent disease with life expectancy < 2 years

   - Unable or unwilling to provide informed consent

   - Unable or unwilling to comply with study follow up in the opinion of the investigator