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

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.