Management of Acute Right Ventricular Failure After High-Risk Transcatheter Tricuspid Valve Replacement

BACKGROUND: Transcatheter tricuspid valve replacement using the EVOQUE system is approved for patients with symptomatic severe tricuspid regurgitation refractory to optimal medical therapy. However, data on the incidence and management of postprocedural right ventricular (RV) failure remain limited. CASE SUMMARY: We describe a case of acute RV failure after transcatheter tricuspid valve replacement in a patient with preexisting pulmonary hypertension and prior tricuspid transcatheter edge-to-edge repair. The patient developed hemodynamic compromise requiring vasoactive and pulmonary vasodilator therapy but ultimately had a favorable recovery. DISCUSSION: Pressure overload from tricuspid regurgitation elimination triggered RV dysfunction, emphasizing the importance of extended monitoring and tailored hemodynamic support. The ratio of the tricuspid annular plane systolic excursion and the pulmonary artery systolic pressure can be a useful noninvasive tool for risk stratification and to help diagnose RV failure. TAKE-HOME MESSAGE: This case highlights the importance of vigilant postprocedural monitoring in high-risk patients and emphasizes the need for tailored hemodynamic management strategies.