A 77-year-old man with history of Tetralogy of Fallots and complete repair at the age of 20, developed severe tricuspid regurgitation associated with right ventricular (RV) dysfunction and renal insufficiency at the age of 73. Following a heart team discussion, he underwent tricuspid valve (TV) replacement with a 33 mm Epic™ tissue valve. His renal function normalized after the operation, but his hospital course was complicated by a sternal wound infection requiring resection of all the sternal wires and sternum.