Background. The purpose of this study was to review our experience with modified De Vega tricuspid annuloplasty versus ring annuloplasty for treating functional tricuspid regurgitation (TR). Methods. In all, 448 consecutive patients undergoing tricuspid annuloplasty with concomitant procedures between 2000 and 2012 were included. Modified De Vega annuloplasty was performed in 216 patients (group 1) and ring annuloplasty in 232 patients (group 2). Clinical and echocardiographic follow-up results were used to assess TR grade. Recurrent TR was defined as grade 2 or greater at echocardiography. Results. Preoperative clinical and echocardiographic characteristics were comparable in the two groups. Early mortality was similar (group 1, 0.9%, versus group 2, 1.3%; p < 0.67). Follow-up was available for 97%; New York Heart Association class and symptoms of right-side heart failure were significantly improved. Survival rates at 1 and 5 years were comparable (97% and 84% for group 1, and 96% and 82% for group 2, respectively). Postoperative echocardiography showed significant improvement in tricuspid valve function, with reduction in TR grade from 3.4 to 0.6, and no differences between groups. However, recurrence-free survival was better for group 2 than for group 1 (78.8% versus 74.5%; p < 0.62). Risk factors for recurrent TR included severity of preoperative TR, atrial fibrillation, and pulmonary hypertension. Conclusions. The modified De Vega tricuspid annuloplasty is acceptable for repair of functional TR and improvements in clinical and echocardiographic status on a long-term basis, although the long-term recurrence-free survival appeared to be lower than that for ring annuloplasty. (C) 2014 by The Society of Thoracic Surgeons