When Everything Else Fails: TricValve® in a Dialysis-Dependent Patient with Advanced Right Heart Failure

We report the case of a 72-year-old man with end-stage renal disease on maintenance dialysis and advanced right heart failure with severe tricuspid regurgitation, chronic atrial fibrillation, and cardiac cachexia. The patient presented with profound hypotension and cardiogenic shock, leading to recurrent failure of renal replacement therapy despite inotropic support. Given the prohibitive surgical risk, transcatheter edge-to-edge repair was deemed unsuitable due to extensive annular dilation, and the patient underwent urgent percutaneous caval valve implantation with the TricValve® system. The procedure was technically successful, resulting in immediate hemodynamic stabilization, improved tolerance of dialysis, and rapid clinical recovery. Follow-up imaging confirmed optimal device positioning without complications. To our knowledge, this represents the first TricValve® implantation in a dialysis-dependent patient in Europe, demonstrating the feasibility and therapeutic value of this approach in carefully selected high-risk patients with severe tricuspid regurgitation.