Introduction: The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. Methods: In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. Results: In total, 324 deceased patients were included. Median age was 82 years (IQR 76–87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0–8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. Conclusions: This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death.

Tricuspid transcatheter edge-to-edge repair (T-TEER) is an emerging treatment option in symptomatic patients with severe tricuspid regurgitation (TR) and high surgical risk. TEER devices can become infected. An 87-year-old female with previous admissions for heart failure was diagnosed with massive atrial-secondary TR. The case was discussed in the Heart-Team meeting. Based on her surgical risk (Society of Thoracic Surgeons score: 15.3%), it was decided to perform tricuspid transcatheter edge-to-edge repair (T-TEER). Six months later, the patient was readmitted for fever, chills, tachycardia, hypotension, and peripheral hypoperfusion with skin lividity. Blood cultures were positive for methicillin-resistant Staphylococcus epidermidis. Transesophageal echocardiography revealed torrential TR and a large 27- × 23-mm hypoechoic mass attached to a Pascal device. Surgical risk was prohibitive. We opted for medical treatment (daptomycin 12 mg/kg/d and rifampicin 1200 mg daily). The patient developed progressive signs of uncontrolled sepsis and ultimately died. Infectious endocarditis after TEER is rare, but it has a high mortality rate. There are no reports on how to approach T-TEER-related infective endocarditis.