**Abstract**

Symptomatic tricuspid valve diseases are associated with a high risk of heart failure and poor prognosis. The current valve substitutes still carry the risk of associated complications. Allografts have been considered a valuable surgical option for decades since the first reports were introduced. The challenging surgical technique along with controversial results and homograft shortage discourage surgical society from wider use of allografts in tricuspid surgery. The largest world surgical experience with mitral allograft in the treatment of tricuspid valve disease is described in the study. A total of 20 patients underwent tricuspid valve replacement by mitral homograft in two clinics from October 2021 to February 2023. Surgical technique and initial results are presented in the chapter. There was no early mortality, postoperative bleeding, myocardium infarction, stroke, or sternal wound infection. Two patients needed permanent pacemaker implantation after redoing surgery before discharge. In the follow-up period, two patients suffered from a relapse of infective endocarditis in 3 and 6 months postoperatively with moderate homograft dysfunction, none of them underwent reintervention. There was no late mortality or permanent pacemaker implantation in the follow-up period. Satisfactory clinical and hemodynamic results, reproduceable technique and accessibility make homografts plausible valve substitutes in tricuspid surgery.

**Keywords:** allograft, mitral valve, tricuspid valve, endocarditis, valve prosthesis
