Limitations
In addition to this being a single-center, retrospective study, there are several other limitations. The first is the wide heterogeneity of patient surgical data between the subgroups because of the variance in practice patterns from surgeon to surgeon and our team preferring to perform TVr using endoscopic approach. Second, objective assessments of tricuspid valve and right heart function are currently not available. Third, the updated surgery techniques began in 2015, the follow-up time was short. Long-term outcomes are needed to confirm its durability. Despite all these drawbacks, to our knowledge, the present study includes one of the largest population of patients undergoing RITS with mid-to-long term outcomes.