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

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.