BACKGROUND: Reports of minimally invasive tricuspid valve operations are rare. We reviewed our experience and results of tricuspid valve operation using mini-thoracotomy during an 11-year period. METHODS: Consecutive patients (n = 141) undergoing tricuspid valve operation using mini-thoracotomy were retrospectively analyzed. Access was through a 6-cm right thoracotomy and cardiopulmonary bypass was instituted by means of the femoral artery (n = 16) or ascending aorta (n = 125) with augmented venous return. In most cases, vacuum assist without caval occlusion and snaring the cavae was used to minimize mediastinal dissection. In all cases, the tricuspid valve operation was done with the heart unclamped, and the heart either beating or fibrillating. RESULTS: Seventy-three percent (103 of 141 patients) of the patients underwent combined mitral and tricuspid valve operations. The tricuspid valve was repaired instead of being replaced in 61% (86 of 141 patients). Previous sternotomy was present in 49% (69 of 141 patients). The average patient age was 64 years. Conversion rate to median sternotomy was only 3% (4 of 141 patients). The mean cardiopulmonary bypass time was 216 minutes. Thirty-day mortality was 2.1% (3 of 141 patients). Stroke occurred in 2.8% (4 of 141 patients), and reexploration for bleeding occurred in 5.6% (8 of 141 patients). The stroke rate was 3 of 16 patients (18.8%) using mini-thoracotomy through femoral cannulation versus 1 of 125 patients (0.8%) through aortic cannulation (p = 0.005). CONCLUSIONS: In this largest reported series of patients undergoing tricuspid valve operation, mini-thoracotomy provides excellent short-term morbidity and mortality in these high-risk patients while avoiding redo sternotomy with a low conversion rate. Mini-thoracotomy with aortic cannulation is an attractive alternative approach to the tricuspid valve, particularly in patients with previous sternotomy.