Long term results of tricuspid valve replacement, were evaluated by echocardiographic and clinical means retrospectively on 55 patients hospitalized at the Montreal Heart Institute between 1969 and 1993. Twenty seven percent were male and 73% female. Taking into account differences in means of myocardial protection the whole population was divided in 2 groups. Group 1: 19 patients from 1969 to 1980. Group 2: 36 patients - from 1981 to 1994. Forty seven patients (85%) received a bioprosthesis and 8 (15%) a mechanical valve. Forty one (74%) had another surgical procedure and 60% (33 patients) were re-operations. Mortality at 30 days is 23% (13 patients) -15% group 1 and 27% group 2. Twenty six patients (72%) of group 2 were re-operations compared with 7 (36%) for group 1 (p = 0.026). Risk factors of operative mortality were: high systolic pulmonary pressure (0.051), bypass time (0.012) and abnormal ejection fraction (0.025). Mean time of follow up is 113.8 months completed at 95%. Six patients were re-operated; 4 for failure of bioprosthesis 11.5 years (mean) after initial surgery. Forty three percent of patients presented with an amelioration of NYHA class. 26% in class I and 50% in class II. Mean gradient across the tricuspid valve was 4.1 +/- 1 mm Hg. Twenty two over 42 patients (50%) died during follow up: 75 months after surgery.