Anaesthetic Management of Redo Transcatheter Tricuspid Valve-in-Valve Implantation in a Patient with Right-Heart Failure and Severe Thrombocytopenia: A Case Report

Transcatheter tricuspid valve-in-valve replacement offers an alternative to high-risk redo surgery for failed tricuspid bioprostheses. We report a 36-year-old woman with severe right-heart failure, hepatic dysfunction, thrombocytopenia, and a mechanical mitral prosthesis after a previously abandoned transcatheter attempt. Redo implantation was performed under dexmedetomidine-ketamine sedation with spontaneous ventilation and a femoral nerve block. Transoesophageal echocardiography was avoided because of bleeding risk. Fluoroscopy and transthoracic echocardiography provided procedural guidance. Valve deployment was successful, the transvalvular gradient decreased and she was discharged on postoperative day 3, highlighting individualized management of competing haemorrhagic and thrombotic risks.