Redo -tricuspid valve replacement, technical consideration; valve in valve insertion

: With increasing life expectancy, as the general population ages, reoperation for valvular heart disease continue to increase. Structural failure of bioprosthesis and progression of native valve disease are leading causes of reoperation in tricuspid position (1). Reoperation is technically more difficult than primary operation and has been associated with higher mortality due to adhesion, the presence of more advanced cardiac pathology and the existence of more frequent co-morbidity. Peripheral cannulation, right thoracotomy and alternative surgical technique can be used to decrease mortality and morbidity