Transcatheter Tricuspid Valve Replacement in High-Risk Elderly Patients: Procedural Feasibility, Complexity, and Delayed Conduction Disturbances.
TL;DR
The feasibility of TTVR in elderly patients with complex anatomy is demonstrated and effective in selected elderly high-risk patients with severe TR and challenging anatomy and delayed conduction disturbances as a clinically important complication requiring extended rhythm surveillance are highlighted.
Abstract
Background
Severe tricuspid regurgitation (TR) is associated with substantial morbidity and mortality and remains undertreated in elderly patients with prohibitive surgical risk. Transcatheter tricuspid valve replacement (TTVR) has emerged as a therapeutic option for anatomies unsuitable for transcatheter edge-to-edge repair. CASE SUMMARY We report 2 elderly high-risk patients with torrential symptomatic TR who underwent orthotopic TTVR using transfemoral venous access. The first patient, a 94-year-old woman with prior mitral annuloplasty and a transvalvular pacemaker lead, underwent successful TTVR with complete elimination of TR and rapid symptomatic improvement. The second patient, an 84-year-old man with severe leaflet tethering and complex anatomy, underwent successful valve implantation but subsequently developed delayed complete atrioventricular block requiring leadless pacemaker implantation.
Discussion
These cases demonstrate the feasibility of TTVR in elderly patients with complex anatomy and highlight delayed conduction disturbances as a clinically important complication requiring extended rhythm surveillance. TAKE-HOME MESSAGES TTVR is feasible and effective in selected elderly high-risk patients with severe TR and challenging anatomy. Delayed conduction abnormalities may occur several days after implantation and warrant structured rhythm monitoring.