Transcatheter tricuspid edge-to-edge repair in frail older adults: a cardiogeriatric framework for integrated care

Sep 30, 2026

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Severe tricuspid regurgitation is a major driver of morbidity in older adults with heart failure, yet frailty makes conventional surgery or replacement too risky, contributing to therapeutic inertia and progressive functional decline. Transcatheter tricuspid edge-to-edge repair (T-TEER) provides a less invasive, guideline-supported option for previously inoperable patients. This narrative review synthesizes current evidence and examines cardiogeriatric challenges across frailty, cognition, diagnostics, procedure planning, and multidisciplinary coordination. It also details an integrated HF model combining geriatrics, advanced nursing, and telemonitoring.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Introduction

A neglected burden in ageing populations

The paradigm shift toward percutaneous therapy

The cardiogeriatric perspective

Aging Clinical and Experimental Research (2026) 38:34 [https://doi.org/10.1007/s40520-025-03291-2](https://doi.org/10.1007/s40520-025-03291-2) REVIEW Transcatheter tricuspid edge-to-edge repair in frail older adults: a cardiogeriatric framework for integrated care Rémi Esser1 · Marc Harboun1 · Marlène Esteban1 · Marine Larbaneix1 · Christine Farges1 · Guillaume Akuda1 · Abdelkrim Hamdi1 · Alejandro Mondragon1 · Sophie Nisse Durgeat2 · Olivier Maurou1 · Vincenzo Palermo3 Received: 2 November 2025 / Revised: 4 December 2025 / Accepted: 8 December 2025 © The Author(s) 2025 Abstract Severe tricuspid regurgitation (TR) is increasingly recognised as a major cause of morbidity in older adults with heart failure (HF) . Conventional surgical repair or replacement carries prohibitive risks in frail patients, leading to therapeutic inertia and progressive loss of function. The development of transcatheter tricuspid edge-to-edge repair (T-TEER) offers a less invasive, guideline-supported option for selected individuals previously considered inoperable. This narrative review summarises contemporary evidence and explores the specific challenges of T-TEER in frail older adults through a cardiogeriatric lens. It integrates epidemiology, diagnostic complexity, frailty and cognitive assessment, procedural considerations, and multidisciplinary coordination. Randomised trials and real-world registries consistently demonstrate symptomatic and functional improvements with acceptable procedural risk in octogenarians. Drawing on the experience of the Cardiogeriatric Department, Hôpital La Porte Verte (Versailles, France), this review outlines an integrated model embedding geriatrics, advanced nursing, and telemonitoring (Satelia® Cardio) within HF care. This approach aligns with the Age-Friendly Health Systems framework and the ESC 2021 Heart Failure Guidelines, emphasising functional preservation and patient-centred priorities. Keywords Tricuspid regurgitation · Transcatheter repair · Frailty · Older adults · Heart failure · Cardiogeriatrics · T-TEER · Integrated care Introduction Right-sided valvular disease, particularly tricuspid regurgitation (TR), has long been regarded as the “forgotten valve disease” [1] . Traditionally viewed as a secondary consequence of elevated pulmonary pressures due to left-sided heart failure (HF) or pulmonary hypertension, TR is now recognised as a distinct entity and an independent predictor of mortality and rehospitalisation in older adults [2, 3] . The prevalence of moderate-to-severe TR rises exponentially with age, affecting approximately 8–10% of individuals 􀀍 Rémi Esser[remi.esser@lpv.univi.fr](remi.esser@lpv.univi.fr) 1 Cardiogeriatric Department, Hôpital La Porte Verte, Versailles, France 2 Medical Affairs, NP MEDICAL, Bordeaux, France 3 Cardiology Department, Centre Cardiologique Marie Lannelongue, Le Plessis Robinson, France over 75 years [4] . In this population, right-sided dysfunction often coexists with atrial fibrillation, renal impairment, and frailty, amplifying both clinical and functional burden. A neglected burden in ageing populations Older patients with HF often present with right-sided congestion—oedema, ascites, and fatigue—yet remain undertreated. These symptoms are frequently misattributed to physiological ageing or non-cardiac comorbidities such as venous insufficiency, malnutrition or deconditioning [5] . Consequently, diagnosis is delayed, functional status deteriorates, and repeated admissions ensue. Prognostic analyses confirm that severe untreated TR confers an annual mortality exceeding 10%, independent of left-ventricular ejection fraction [3] . Despite such outcomes, fewer than 1% of elderly patients with significant TR undergo surgical correction, largely due to the prohibitive peri-operative risk (10–15% in octogenarians) and the presence of frailty, sarcopenia, and cognitive 1 3 impairment [6] . This therapeutic gap has fostered a pervasive

FAQs

Why is severe tricuspid regurgitation especially challenging in frail older adults?

Conventional surgery or replacement carries prohibitive peri-operative risk in frail patients, leading to delayed diagnosis and a decline in functional status with recurrent admissions.

What does T-TEER offer compared with surgical repair or replacement?

T-TEER is a less invasive, guideline-supported transcatheter option that can reduce regurgitation with acceptable procedural risk in selected individuals previously considered inoperable.

How does a cardiogeriatric framework change treatment planning?

It incorporates frailty, cognition, nutrition, and social context into decision-making, reducing the risk of overtreating robust patients while ensuring timely care for frail yet motivated individuals.

Sep 30, 2026

Upload by Oliver