Percutaneous Treatment of Multivalvular Disease Including Refractory Tricuspid Regurgitation in a Frail Elderly Patient.

BACKGROUND

This clinical vignette highlights the feasibility of a comprehensive transcatheter strategy for managing advanced multivalvular heart disease in a frail elderly patient.

CASE SUMMARY: A 79-year-old woman with prior surgical aortic valve replacement, chronic atrial fibrillation, and multiple comorbidities presented with worsening heart failure. Physical examination demonstrated anasarca with signs of left and right heart failure. An echocardiogram demonstrated severe stenosis of a prior bioprosthetic aortic valve, with a valve area of 0.64 cm2, functional mitral regurgitation, and torrential tricuspid insufficiency. Stepwise management included percutaneous valve-in-valve transcatheter aortic valve replacement, edge-to-edge mitral repair, and transcatheter tricuspid valve placement, leading to marked clinical improvement and reversal of congestion. These interventions stabilized the patient's renal function and enhanced her overall functional status.

DISCUSSION: This case underscores the potential role of transcatheter interventions in high-risk patients, indicating that advanced age and frailty, in addition to procedural success, critically influence long-term outcomes.

TAKE-HOME MESSAGE: Frailty and associated comorbidities remain pivotal challenges and require diligent postprocedural follow-up, but they are not absolute contraindications for percutaneous treatment.