In this short but informative case series, the authors describe a novel way of performing transcatheter tricuspid valve-in-valve replacement (TTVR) in 4 women who required lifelong anticoagulation with vitamin K antagonists (VKA) without reversal or bridging (INR at the time of procedure 2.0-3.5).

The authors utilized only venous access closed at the end of the procedure with the Abbott Proglide percutaneous suture. In addition, the procedures were done with only trans-thoracic echo, so they did not require general anesthesia.

Given the concerns with preventing peri-procedural thrombotic events in patients requiring lifelong VKA, this approach may allow for performing TTVR with therapeutic INRs without a significant risk of bleeding complications.

All editors: Konstantin Averin, MD, MS