What question did this study set out to answer?

To present a novel approach for treating severe tricuspid regurgitation in a high-risk patient.

February 28, 2026Open Access

Transcatheter bicaval valve implantation for severe tricuspid regurgitation in a patient with multiple pacemaker leads – case report

Q: What does this research mean for the field?

Transcatheter bicaval TricValve implantation can be successfully performed and provides meaningful symptomatic relief in high-risk patients with severe tricuspid regurgitation, even in the presence of multiple pacemaker leads. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Transcatheter bicaval TricValve implantation improved symptoms from NYHA IV to I and prevented rehospitalizations at 8 months in a high-risk patient with severe tricuspid regurgitation and multiple pa

Key Points

To present a novel approach for treating severe tricuspid regurgitation in a high-risk patient.
Describing a case of a 72-year-old man with multiple comorbidities and pacemaker leads.
Performing an endovascular TricValve procedure for severe tricuspid regurgitation.
Monitoring clinical outcomes and rehospitalization rates over an 8-month period.
Patient improved from NYHA class IV to class I postoperatively.
No rehospitalizations were recorded during the 8-month follow-up.
Demonstrates successful TricValve implantation in patients with complex cardiac anatomy.

Structured PICO

Does endovascular TricValve implantation improve symptoms and reduce rehospitalizations in a high-risk patient with severe tricuspid regurgitation and multiple pacemaker leads?

Population

72-year-old man with severe tricuspid regurgitation, Chagas disease, permanent pacemaker, cardiac resynchronization therapy (multiple pacemaker leads), heart failure with reduced ejection fraction (HFrEF), and NYHA class IV symptoms with recurrent hospitalizations for edema and ascites (n=1).

Intervention

Endovascular TricValve procedure (transcatheter heterotopic bicaval valve implantation).

Outcome

Symptomatic improvement (NYHA class) and freedom from rehospitalization.

Transcatheter heterotopic bicaval valve implantation (TricValve) can be successfully performed and provide meaningful symptomatic relief in high-risk patients with severe tricuspid regurgitation and complex right-sided anatomy, including multiple pacing leads.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Tricuspid regurgitation is often underdiagnosed and carries a poor prognosis when severe, while conventional surgery poses high risk in elderly patients with comorbidities. We report the case of a 72-year-old man with Chagas disease, permanent pacemaker, cardiac resynchronization therapy, and heart failure with reduced ejection fraction, who presented with NYHA class IV symptoms and recurrent hospitalizations for edema and ascites. Given the elevated surgical risk, an endovascular TricValve procedure was performed. The patient improved to NYHA class I in the early postoperative period and remained clinically stable without rehospitalizations at 8-month follow-up. The TricValve system is emerging as a therapeutic option for high-risk surgical candidates, improving quality of life and reducing admissions. To the authors knowledge, this is first case of TricValve implantation in a patient with multiple pacemaker leads. This case underscores the growing role of transcatheter therapies as effective alternatives. • TricValve implantation can be successfully performed even in the presence of multiple pacing leads, expanding treatment options for patients with complex right-sided anatomy. • Transcatheter heterotopic bicaval valve implantation may provide meaningful symptomatic relief and reduce rehospitalizations in high-risk patients with severe tricuspid regurgitation.