Background: The aim of this study was to evaluate the operative risk in triple (aortic, mitral and tricuspid) valve surgery after 16 years of experience. Methods: there were 504 patients who underwent triple valve surgery at our Clinic. All of them were in functional classes III and IV according to NYHA classification. Pulmonary hypertension was registered in 73% (113/504). In the aortic position reconstructive surgery was performed in only 9 patients (1,8%) while in mitral it was done in22% (113/504). We routinely used transseptal approach to the mitral valve. Reconstructive surgery of tricuspid valve was the rule (Carpentier's annuloplasty in 76 pts, our modification of De Vega's annuloplasty in 425 pts and resection - suture in 2 pts). In 6 pts (1,2%) an additional tricuspid commisurotomy was done. Aortic valve replacement was done using five different types of bileaflet prostheses (BP): St Jude Medical, CarboMedics, Duromedics, Sorin Bicarbon, ATS Medical in 493 pts (98%) and Star Edwards ball valve (SE) in 2 pts. For the mitral position we used SE in 196 pts (39%). BP in 180 pts (36%) and bioprostheses in 22 pts (4,4%). In only 1 patient we have to replace the tricuspid valve by Xenomedica biological prosthesis. Results: The 30-day postoperative mortality was 3,6% (18/504) and the causes of death were: cardiac insufficiency in 7 pts, rhythm disturbances in 4 pts, hepatorenal insufficiency in 3 pts, cardiopulmonary insufficiency in 3 pts and pulmonary haemorrhage in 1 pt. Conclusion: patients with triple valve disease can be operated with low operative risk due to good myocardial protection, transseptal approach to the mitral valve, correct choice of artificial heart valve and broad use of constructive surgical procedures particularly in mitral and tricuspid position.