Fifty-five chronic intravenous drug abuse (IVDA) patients with intractable right-sided endocarditis underwent tricuspid valve excision without valve replacement (n = 53) or tricuspid and pulmonic valve excision without replacement (n = 2). Follow up ranged from nine to 29 years. Six patients (11%) died soon after surgery, due to the infection. Forty-nine (89%) were cured and survived; of these, 24 (50%) returned to IVDA. Eleven patients died between six months and 24.5 years after surgery; of these deaths, 10 (90%) were related to IVDA. Among six patients who had a prosthesis inserted at a second operation, four died, two due to IVDA. The remaining 38 patients have survived for between nine and 29 years. Of these survivors, 35 have a trivalvular heart, and one has a bivalvular heart. Actuarial survival rate at 29 years was 60%. Only three patients required digitalis and diuretics. In conclusion, a trivalvular or bivalvular heart has proven to be the best surgical alternative for IVDA patients with incurable right-sided heart endocarditis.