Surgical management of tricuspid valve endocarditis, especially in patients with positive serology for HIV and hepatitis C, is complicated by the inappropriateness of reconstruction and late complications of mechanical prostheses and bioprostheses. The late results of mitral homograft replacement of the tricuspid valve have been satisfactory, but evidence of moderate and severe regurgitation appears in some patients. Five patients with complications of native tricuspid valve endocarditis had mitral homograft replacement of the tricuspid valve by a novel surgical modification. The homograft was implanted with the anterior leaflet orientated to the septum, the papillary muscles exteriorized and sutured to the right ventricular wall, the posteromedial muscle anteriorly, and the anterolateral muscle inferiorly. The annular attachment was reinforced with a rigid mitral annuloplasty ring in the anti-anatomical relationship. The experience, to date, has revealed satisfactory function on echocardiographic assessment.