Mitigating and Anticipating Periprocedural Risks of Transcatheter Pulmonary Valve Replacement in the Elderly.

BACKGROUND: Transcatheter pulmonary valve replacement (TPVR) has a different complication profile than surgical pulmonary valve replacement, and consensus guidelines on this topic are lacking. CASE SUMMARY: We describe a case of an 81-year-old man who underwent balloon valvuloplasty and TPVR for pulmonary stenosis and regurgitation. A guidewire was placed across a prior coronary stent in the left anterior descending artery during balloon valvuloplasty. Following TPVR, he developed acute diastolic heart failure, a delayed pericardial effusion, and suspected infective endocarditis. WHY BEYOND THE GUIDELINES: Peri and postprocedural complications are not addressed in guidelines. DISCUSSION: We discuss strategies to identify and address peri and postprocedural TPVR complications. TAKE-HOME MESSAGE: Through a proactive approach, peri and postprocedural TPVR complications can be managed successfully.