Transcatheter Tricuspid Valve Replacement and Liver Transplantation for Severe Tricuspid Regurgitation and Cirrhosis

BACKGROUND: The incidence of patients with cirrhosis and concurrent valvular heart disease is increasing. Moderate to severe tricuspid regurgitation (TR) is associated with increased mortality after liver transplantation (LT). Open cardiac surgery is recommended for patients with symptomatic severe TR, however LT candidates often face prohibitive surgical risk. CASE SUMMARY: A 45-year-old woman with advanced cirrhosis awaiting LT was diagnosed with severe functional TR due to anatomical tricuspid valve incompetence (TVI). The tricuspid valve anatomy was unsuitable for transcatheter tricuspid edge-to-edge repair, a technique previously described in cirrhotic patients before LT. The patient underwent a transcatheter tricuspid valve replacement (TTVR) followed by LT. DISCUSSION: LT recipients with TR secondary to anatomical TVI have significantly lower 1-year survival. Minimally invasive valve interventions are promising alternatives for patients who are not cardiac surgical candidates, such as LT recipients with advanced cirrhosis. TAKE-HOME MESSAGE: Transcatheter tricuspid valve replacement may facilitate LT in high-risk candidates with severe TR due to TVI.