Antonio Colombo is one of the most influential figures in the history of interventional cardiology. With a career spanning nearly five decades, he has combined technical innovation with intellectual rigor, shaping procedural standards, therapeutic strategies, and the mindset of generations of clinicians. From his early adoption of dual antiplatelet therapy and intravascular imaging, to his vocal critique of "luminology" and overuse of stents, Colombo has consistently challenged orthodoxy in favor of evidence, precision, and patient benefit. His leadership roles at major institutions in Milan, his participation in landmark clinical trials, and his editorial contributions have left a lasting imprint on cardiovascular medicine. Yet beyond the achievements lies a distinctive clinical philosophy-one that values humility over confidence, questions over assumptions, and judgment over routine. In this profile, enriched by an extended interview, Colombo shares insights on complication management, mentorship, imaging, structural heart interventions, and work-life balance. His reflections not only capture the evolution of interventional cardiology but also serve as a compass for its future. This article is both a tribute to a pioneer and an invitation to think more deeply about what it means to be a thoughtful, effective, and evolving physician in a high-stakes, rapidly changing field.
BACKGROUND: Tricuspid regurgitation (TR) leads to progressive right ventricular (RV) dysfunction and adverse clinical outcomes. Orthotopic transcatheter tricuspid valve replacement (TTVR) has emerged as a therapeutic option for eliminating TR in patients not amenable to surgery or edge-to-edge repair. The aim of this study is to evaluate mid-term (6-month) real-world outcomes of orthotopic TTVR in patients with severe symptomatic TR. METHODS: In this single-center retrospective analysis, 13 high-risk patients (NYHA III-IV) with severe functional TR underwent TTVR with either Evoque or Lux-Valve Plus. Patients with severe RV dysfunction or pulmonary hypertension (PASP >60 mmHg) were excluded. Follow-up included transthoracic echocardiography (TTE) and clinical evaluation at discharge, 30 days, and 6 months. The primary endpoint was all-cause mortality or heart failure hospitalization at 6 months; secondary endpoints included procedural success, TR reduction, NYHA improvement, major bleeding, and new pacemaker implantation. RESULTS: Thirteen patients were included in the study. Mean age was 72.9 +/- 12.1 years; 69% were female. TR was torrential/massive in 85%. Procedural success was 100%, with no major bleeding or intraprocedural death. One periprocedural death (day 6) occurred due to sepsis, and a late death at day 31 followed heart failure hospitalization. At 6 months, 11 patients remained alive; all surviving patients had no/mild TR and improved to NYHA I/II. RV function measured by RV FAC showed a non-significant decline; while RVS TDI and TAPSE showed a non-significant improvement. CONCLUSIONS: Orthotopic TTVR is feasible and effective in high-risk patients with symptomatic severe TR, showing high procedural success, durable reduction in regurgitation, and meaningful functional recovery at 6 months.
BACKGROUND: Multi-organ dysfunction is increasingly recognized as a common feature in patients with heart failure (HF) and significant tricuspid regurgitation (TR). This study evaluated the prognostic value of the MELD-XI score in patients undergoing transcatheter tricuspid edge-to-edge repair (T-TEER). METHODS: This sub-analysis of the Transcatheter Tricuspid Valve Repair in Spain (TRI-SPA) registry included patients treated with T-TEER between May 2020 and April 2025. Patients were stratified into mild-to-moderate (9.44-13.3) and moderate-to-severe (>= 13.4) hepatorenal dysfunction assessed by MELD-XI score. The primary endpoint was a composite of all-cause mortality and heart failure (HF) hospitalization at 2 years. RESULTS: Of 508 patients who underwent tricuspid TEER, 259 were included (mean age 77 +/- 8 years, 62% women). 194 (75%) were classified as having mild-to-moderate hepatorenal dysfunction (MELD-XI 9.44-13.3) and 65 (25%) as moderate-to-severe (MELD-XI >= 13.4). The higher MELD-XI group included more men (50.8% vs. 25.8%, P<0.001) and showed a greater comorbidity burden by higher prevalence of diabetes (29.2% vs. 17.5%, P0.043), arterial hypertension (76.9% vs. 59.8%, P0.013), and chronic kidney disease (76.9% vs. 22.2%, P<0.001). Patients with moderate-to-severe hepatorenal dysfunction exhibited greater left and right ventricular remodeling and more advanced TR severity, with a higher prevalence of massive or torrential TR (64.6% vs. 45.6%, P0.009). Procedural success was achieved in 83.1% of the cohort, with a trend toward lower frequency in patients with MELD-XI >= 13.4 (85.6% vs. 75.8%, P0.075). At 2 years, event-free survival for the primary endpoint was 47.5% in MELD-XI >= 13.4 versus 80.3% in MELD-XI 9.44-13.3 (P<0.001). CONCLUSIONS: Patients with moderate-to-severe hepatorenal dysfunction experienced substantially higher two-year mortality and HF hospitalization rates than those with lower MELD-XI score.
