Background: There is an ongoing debate whether the tricuspid valve (TV) should be repaired with a suture annuloplasty or a prosthetic ring. Methods: Two hundred thirty-seven patients underwent a modified De Vega tricuspid annuloplasty for tricuspid regurgitation (TR) as part of the cardiac surgical procedure. Follow-up information was obtained for 230 patients, with a mean follow-up time of 6.5 +/- 3.2 years. Analysis is based on Doppler echocardiographic evaluation. Survival and development of recurrent TR were evaluated by Kaplan-Meier analysis. Risk factors for recurrent TR were identified and analyzed by multivariable ordinal longitudinal methods. Results: No deaths had occurred at the time of follow-up. Early predischarge echocardiography quantified TR as 1+ in 227 patients (95.8%), 2+ in 8 patients (3.4%), and 3+ in 2 patients (0.8%). No patients had TR classified as 4+. The mean TR grade decreased from 3.4 +/- 0.2 preoperatively to 1.6 +/- 0.6 on predischarge echocardiography (P < 0.01). During follow-up, the most recent echocardiogram showed TR was 1+ in 88.3% of patients, 2+ in 10.4% of patients, 3+ in 1.3% of patients, and 4+ in 0% of patients, with a small increase in mean TR compared with predischarge echocardiography. No patient required TV reoperation. Risk factor analysis revealed that higher preoperative regurgitation grade, higher systolic pulmonary arterial pressure (sPAP), and preoperative New York Heart Association (NYHA) grade IV were independent predictors of recurrent TR. Five-year actuarial freedom from congestive heart failure (CHF) and late TR were 86.7% +/- 2.4% and 88.5% +/- 0.2%, respectively. Conclusions: A modified De Vega suture annuloplasty was effective at eliminating TR and producing right ventricular (RV) reverse remodelling at 5-year follow-up, although TR tends to increase with time.