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Background/Introduction Tricuspid valve infective endocarditis (TV IE) is seen less commonly than left-sided valvular IE and often carries a complicated course. It typically affects ‘at-risk’ patients e.g. intravenous drug users (IVDU), patients with cardiac implantable electrical devices (CIED) and patients with indwelling venous lines. The management always involves medical therapy with antibiotics, with surgery to be considered in specific settings e.g. large vegetations (>20 mm), persistent fever despite antibiotics, recurrent septic pulmonary emboli, severe right heart failure due to tricuspid regurgitation (TR). Surgical intervention remains topical and data for these patients is scarce.Purpose We describe baseline characteristics and outcomes for all patients treated for TV IE in our tertiary surgical hospital over a 10 year period 2014–2024.Methods Patients with tricuspid valve IE were obtained via our electronic care records and discharge patient databases. SPSS version 30 was used for analysis.Results 31 patients (mean age 41 ±19 y, female 43%) were treated for TV IE. 26% (8) patients had severe TR, 77% (24) were Staph. Aureus, 61% (19) were IVDU, and 9.7% (3) had HIV. Mean vegetation size was 16.9 ±7 mm, with 45% (14) patients having vegetations >20 mm. 19% (6) had persistent fever, 48% (15) septic PE, 26% (8) severe TR and 61% (19) were discussed at a heart team meeting. Only 1 patient had severe RHF.32% (10) patients had surgery for IE, of whom 2 patients had concomitant left-heart surgery. 7 patients had TV repair, 3 had TV replacement (2 bioprostheses, 1 mechanical, two concomitant mitral mechanical prostheses), and, also, one patient had percutaneous vegectomy.During a mean follow-up time 2.8 ±2.5 y, 39% (12) patients died from all-cause mortality. 38% (8/21) unoperated patients died during follow-up compared to 40% (4/10) operated patients (figure 1). 36% (5/14) patients with a vegetation >20 mm died compared to 41% (7/17) with smaller vegetations. IVDU did not affect survival with 68% (13/19) still alive compared to 50% (6/12) non-IVDU patients. Septic PE and severe TR were not associated with higher mortality. Both patients that underwent mechanical mitral valve replacement were IVDU and died during follow-up, one with confirmed valve thrombosis while the other died suddenly, at home, and had been non-compliant with warfarin.Abstract 1-015 Figure 1Conclusion In a typical TV IE patient group conventional recommendations for cardiac surgery were not associated with significantly higher mortality. Cardiac surgery was not associated with a mortality benefit. This small registry makes an argument for medical management, alone, in this patient group, with surgery reserved for highly selected cases.