Background and Aim:It has been widely acknowledged, that tricuspid valve repair is not solely done, and itis done along with accompanying repair procedures. Tricuspid valve disease has a directimpact on the severity of the disease. Identifying the risk of the disease or severity of valvelesions which is related to the outcome of the patient, and increase in life span has animportant role in surgical practice. Moreover, location and size of the lesion plays a key rolein the management of the valve to attain the best surgical approach. Several literature hasshown, that patients undergoing concomitant surgical procedures has a less impact ontricuspid valve than mitral and aortic valves, also described as a forgotten valve.[14,15,16]Logically, the patients become asymptomatic during the early onset of disease as the severityof the disease progress symptoms will appear, and the doctors also anonymous to its signsand symptoms so, this disease is hidden until the disease approaches in its severe stages. Andthese diseases also get less importance or attention than left sided heart diseases. Diseaseclassification is depends on the pathology of the valve. In heart, tricuspid valve plays a keyrole in distributing the deoxygenated blood to lungs. The tricuspid valve has three leaflets orcusps which access the regulation of blood flow and maintain the way of systemic circulation.If tricuspid valve damages, the deoxygenated blood regressing back to the right atrium whichalters in pressure and influences pulmonary circulation and systemic circulation. Not onlywith this, tricuspid valve shows major consequences while the patient is having left-sidedheart disorders. The orifice of tricuspid valve is rough and triangular, and is also larger thanthe mitral valve. Chordae tendineae originates from papillary muscles, which attaches to thecusps of the valve. During systole, right ventricle contracts, and the tricuspid valve closes,papillary muscles come in action to pull the chordae tendineae and prohibit the leaflets tofluctuate back into the right atrium and, the deoxygenated blood is pumped to the lungsthrough the pulmonary artery. The heart generates its own beat, and regulated by theelectrical activity of the impulses with coordination of the atrial and ventricular contractions.The purpose of the study is to find out the outcomes of Tricuspid Valve Repair whounderwent different surgical management techniques and the outcome of the patients byfollowing the applied tricuspid valve technique. As the valve annulus tension is smaller in theTricuspid Valve than that of mitral valve, the coordination between right ventricle wall andtricuspid valve alters and interacts in a weak manner, when the annulus dilatation and papillary muscle displacement takes place, tension in the annulus rises to neutralize theaction of the dilatation. Now a days, specialists has entered a common damage of TV carriedout by primary or secondary diseases. Select grasp the timing of surgery, surgical techniquesand postoperative care have an important influence on the course of treatment to attainsurgical results. Surgeons are unaware of the disease during early stages of the disease, whenthe disease is diagnosed to correct the disorders there are various procedures available.Commonly used procedure is traditional procedure or open heart surgery. Not only this, thereare other non-surgical techniques also performed depend on the severity of the disease.Extensively double valve replacement is performed, whereas tricuspid valve replacement isan aberrant procedure logically tricuspid valve repair is susceptible to repair and in TVRmortality rates are high. Persisting Tricuspid Regurgitation after the repair of other valveprocedures is associated with recurrent severe pulmonary hypertension or mitro-aortic disease,which causes the progression of right ventricular failure and annular dilatation. As it hasconsidered, severity of the tricuspid valve disease depends on Annular Dilatation. If TV isuntreated during the mitral valve repair, there will be a negative impression of significantresidual tricuspid regurgitation on the operative outcomes and survival of the patient, becausereoperations may cause high mortality rates. Surgical management of TR is often difficult,especially when it persists after a previous valve repair procedure. In severe tricuspid valvediseases, normally surgical management of the lesion is too difficult to repair. Repair will bedone in patients having mild or moderate lesions, replacement which is a rare procedure willbe suggested when the leaflets diminishes, and during fusion of the chordae.Material and Methods:To summarize the clinical experience of55patients who underwent Tricuspid ValveRepair from2011-2012associated with the concomitant surgical procedures with the meanage of the patients45.5±14.6years. The study was designed to test the hypothesis, thattricuspid procedures and left-sided heart surgical procedures given by any means wouldreduce the incidence of postoperative infectious complications, if the tricuspid lesion isobserved intra operatively. The secondary objective, was to evaluate the effect of RingAnnuloplasty method on overall morbidity and mortality compared with other tricuspid repairtechniques. All are derived, according to the severity of regurgitation area and New YorkHeart Association Classes. Intraoperative regurgitation area scrutinized by executing thesaline injection test. By the transthoracic echocardiographic findings, according to theDoppler findings on the four-chamber view from the cardiac apex describes the severity of TR. All tricuspid valve surgical procedures are done along with mitral and aorticrepair/replacement, septal defect patch repair and also moreover with other disorders. Basedon the degree of annular dilation and severity of regurgitation, tricuspid surgery is performedin52patients and in the3patients tricuspid regurgitation is disappeared while performing theleft chamber aberrancies. All procedures are open-heart surgical procedure associated withcardiopulmonary bypass to maintain the circulation and electrolyte balance, also for thestability of brain, lungs and kidney. Selected patients including tricuspid repair techniques areRing Annuloplasty is performed in28(14.5±8.23), Annuloplasty in9(5.0±2.74), KayAnnuloplasty method in4(2.5±1.29), De Vega Annuloplasty method in2(1.5±0.71), andValvuloplasty in9(5.0±2.74). Pulmonary hypertension in29patients (15.0±8.51). Surgicaland non-surgical complications from surgery to hospital discharge, were documentedprospectively and statically analyzed.Result:The follow-up period is36months. Open heart surgery was performed in55patientsand relieved in all patients. Among55patients, none of whom presented with stenosis of thetricuspid valve, all are existed with tricuspid valve regurgitation or insufficiency, which wasdiagnosed pre operatively in53patients and intra operatively in2patients while doinginjection test during associated procedures. There is no tricuspid replacement procedure inthis study. Tricuspid valve repair surgery was performed in52patients (P=0.458).Concomitant procedures consisted of mitral valve surgery in24patients (43.6%), doublevalve surgery in12patient’s (21.8%), Aortic Surgery in1patient (1.8%) Atrial septal defectrepair in10patient’s (18.1%), ventricular septal defect repair in6patient’s (10.9%), and leftatrial tumor excision in11patient’s (20%), CABG in2patient’s (3.6%), Tricuspid Ebstein’smalformation correction surgery in1patient (1.8%). Different techniques were performed,Ring Annuloplasty method was used in28patients (50.1%), Annuloplasty in9patients(16.3%), Kay Annuloplasty method in4patients (7.3%), De Vega Annuloplasty method in2patients (3.6%), Valvuloplasty in9patients (16.4%), and all patients were relieved anddischarged (P=0.000<0.05). It was observed that intraoperative complaints in4patients(7.3%), postoperative complaints in41patients (74.5%) and all are relieved. Pulmonaryhypertension occurred in29patients and relieved. With the help of advanced ultrafiltrationtechnology, surgeons can perform easily in order to achieve the satisfied outcome in patientsby reducing the burden on heart and lung mechanism and metabolism. During follow-up,most likely after3months, three patients experienced shortness of breath and chest tightness for a particular period of occurrence. All of the3patients have good result and recoveredfrom the signs and symptoms. All patients Cardiac function are at NYHA class I-II. Theoverall tricuspid surgical outcome rates were100%along with associated procedures. So,there is a significant benefit in tricuspid valve disease outcome while implementing theconcomitant procedures.Conclusions:Total55tricuspid valve repair surgery were performed consisted of concomitantprocedures. It was observed that tricuspid valve repair with different techniques wereperformed based on the condition of the valve diseases and pathology. Our study concludestricuspid repair techniques shows the good outcome rates while performed with concomitantprocedures. An annuloplasty ring was used particularly in severe annular dilation or severetricuspid regurgitation to prevent an annular dilation and tricuspid regurgitation. Anannuloplasty suture was used in moderate annular dilation or moderate tricuspid regurgitationto reduce annular dilation and regurgitation. Kay Annuloplasty method performed in tricuspidvalve disorder localized to the posterior leaflet, to complete posterior leaflet excision andplication of the involved portion of the annulus. The De Vega suture Annuloplasty methodwas used to plication of the annulus surrounding the anterior and posterior leaflets to repairthe annular dilation and tricuspid regurgitation. Valvuloplasty was used to open the valve byshaping or incision on the location where the valve cusps meet together or thickened.Abnormal function or coaptation of the tricuspid valve due to dilatation of the annulus maylead to regurgitation. Right ventricular myocardium and leaflets influences the mechanism ofannulus which plays the key role in the annular dilatation. Most patients with tricuspid valveinsufficiency or stenosis suffer from concomitant mitral and aortic valvular diseases. Theleaflet force or tension exerted on the annulus assigns the annular dilatation. Left sided heartdisorders with enlargement of chamber and regurgitation can result in right ventricularchamber enlargement, pressure overload, and Tricuspid annular dilation which results inTricuspid Regurgitation. Tricuspid valve regurgitation is secondary to right ventricularenlargement and elevated pulmonary pressures. TR most commonly caused by PulmonaryHypertension, in which PASP is a strong indicator of TR severity. Ebstein’s anomaly is a rarecongenital cardiac defect in which deformity and displacement of tricuspid valve leafletstakes place by separating the right sided heart chambers i.e., ventricle from atrium leading tosevere tricuspid insufficiency, right atrial dilation and a variable degree of right ventriculardysfunction. Its pathology defines conduction abnormalities, ventricular and atrial tachyarrhythmia. Valve repair or replacement is totally depends on the valve lesion. TVrepair is commonly indicated for severe TR who are undergoing MV surgery, concomitantTV repair with>4cm2of annulus diameter or moderate TR. Repair is also indicated for mildor moderate lesions, whereas during diminished leaflet, degenerative diseases and fusion ofchordae or endocarditis replacement will be the better choice. If tricuspid lesions are ignoredat the time of left-sided heart disease treatment, significant TR negatively impacts the perioperative outcomes, functional class and survival because redo operations for recurrent TRshows high mortality rates. Without treatment, TR becomes worse day by day leads tovarious severe symptoms, biventricular heart failure and slowly cause death. During the earlyonset of the disease, patients remain complete asymptomatic or experience fatigue andshortness of breath before developing unconcealed signs of Right-side heart failure. As thedisease progresses with severe right side heart failure results in severe TR, patients presentwith weight loss and cachexia, cyanosis and jaundice whereas Ascites, peripheral edema andanasarca may also be present.During Annuloplasty, mostly Ring will be the ideal repair method because it achievesannulus stability for a long period of time, and low incidence of grade3or4whereas it isrelatively fast and inexpensive procedure. When rings are not available, modified De VegaTechnique will be the suitable option by placing the pledgets in each bite of the suture fromanteroseptal commissure to the same level of coronary sinus. While performing theconcomitant procedures, there will be a good outcome, if the tricuspid valve lesions areidentified intra-operatively, because if the lesion is ignored during surgery, the valve willmay or may not dilate progressively and increases the right ventricular pressure results inenlargement of the right ventricle. The main goal is to execute the appropriate surgicalapproach to restore the function of the tricuspid valve and improve the lifespan of the patient.