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A review of our experience with tricuspid valve replacement over a 7.5-year period is presented. Isolated disease of the tricuspid valve was encountered infrequently [8 of 87 patients] and was due to a variety of causes. In the remaining cases, the tricuspid disease was associated with rheumatic valvular disease of the mitral and/or aortic valves. The hospital mortality for the entire group of patients was 22%, and the late mortality during a mean follow-up of 32 months was 16%. Operative and late mortality were clearly affected by the severity of myocardial dysfunction present preoperativley. Problems related to the prosthetic valves and to anticoagulant therapy were relatively few. Our present indications for replacement of the tricuspid valve and presented. Earlier operative intervention in patients with tricuspid valvular disease should improve the early and long-term results.

Patients with valvular heart disease, particularly aortic and mitral incompetence, may have significant derangement of myocardial function, often in the absence of significant symptoms, which directly affects early and late survival and functional status following valve replacement. With declining hospital mortiality rates and improved valvular prostheses, consideration must be given to valve replacement in patients of this type in order to preserve myocardial function. This should improve long-term survival and the functional results following valve replacement. Attention should be directed to identifying and closely observing patients of this type, perhaps with noninvasive techniques, and proceeding with valve replacement before irreversible myocardial damage has occured.