One of the most challenging forms of valvular heart disease is related to the TV. Regardless of the underlying pathology, when surgical intervention is necessary, biologic prosthetic valves appear to be the most suitable option due to the high prevalence of thrombotic events and the requirement for lifelong anticoagulation. Additionally, since most patients undergoing TV surgery are relatively young, the likelihood of reoperation is significant, given the high incidence of failure associated with biologic valves. Conversely, the mortality rate for redo surgeries is notably high, as many of these patients experience advanced right heart failure. In recent years, advancements in TAVR and the management of failed biologic aortic valves have contributed to a growing interest in the TVIV procedure.