**1. Introduction**

The prevalence of moderate-to-severe tricuspid regurgitation (TR) increases with age, affecting about 4% of the patients aged 75 years and is observed in up to 0.6% of the general population [1].

Primary TR usually appears as a result of infective endocarditis, rheumatic heart disease, carcinoid syndrome, myxomatous disease, endomyocardial fibrosis, congenital heart disease, and other less frequent causes, such as thoracic trauma and iatrogenic damage [2].

Severe TR is associated with poor survival and worsening heart failure symptoms [1, 3–5].

The choice between a biological valve and a mechanical valve for the tricuspid position is still controversial [6].

The use of allograft substitutes or autografts is not uniform across European and American units and is greatly dependent on surgeons' individual experience and training [7].

Technical challenge and the lack of training in these techniques over the last 10 years, coupled with the absence of readily available homograft valves at many centers, has restricted the widespread use of this substitute, confining the "art" of homograft surgery to the hands of a small group of surgeons [8].

It is undeniable that when such factors as the severity of the destructive process or its extension to the valves are involved, the balance in the choice of the most suitable substitute is critically weighted toward homografts over conventional stented or mechanical prostheses [7].

Replacement of the tricuspid valve (TVR) using a homograft could provide favorable in-hospital and mid- to long-term clinical outcomes for patients with a variety of causes and age groups, despite slightly complex surgical technique compared with prosthetic valve replacement. This procedure might be useful, particularly in treating active bacterial endocarditis or young patients, in centers at which homograft tissue is available [9].
