Transcatheter Tricuspid Valve Replacement in High-Risk Elderly Patients

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.