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. 2022 Feb 12;43(7):654-662.
doi: 10.1093/eurheartj/ehab679.

TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery

Julien Dreyfus  1 , Etienne Audureau  2   3 , Yohann Bohbot  4   5 , Augustin Coisne  6   7 , Yoan Lavie-Badie  8 , Maxime Bouchery  9 , Michele Flagiello  10 , Baptiste Bazire  11 , Florian Eggenspieler  12 , Florence Viau  13 , Elisabeth Riant  1   14 , Yannick Mbaki  15 , Damien Eyharts  8 , Thomas Senage  16 , Thomas Modine  6 , Martin Nicol  1 , Fabien Doguet  17   18 , Virginia Nguyen  1 , Thierry Le Tourneau  19 , Christophe Tribouilloy  4   5 , Erwan Donal  15 , Jacques Tomasi  20 , Gilbert Habib  13   21 , Christine Selton-Suty  12 , Richard Raffoul  22 , Bernard Iung  23 , Jean-François Obadia  10 , David Messika-Zeitoun  24
Affiliations

TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery

Julien Dreyfus et al. Eur Heart J. .

Abstract

Aims: Isolated tricuspid valve surgery (ITVS) is considered to be a high-risk procedure, but in-hospital mortality is markedly variable. This study sought to develop a dedicated risk score model to predict the outcome of patients after ITVS for severe tricuspid regurgitation (TR).

Methods and results: All consecutive adult patients who underwent ITVS for severe non-congenital TR at 12 French centres between 2007 and 2017 were included. We identified 466 patients (60 ± 16 years, 49% female, functional TR in 49%). In-hospital mortality rate was 10%. We derived and internally validated a scoring system to predict in-hospital mortality using multivariable logistic regression and bootstrapping with 1000 re-samples. The final risk score ranged from 0 to 12 points and included eight parameters: age ≥70 years, New York Heart Association Class III-IV, right-sided heart failure signs, daily dose of furosemide ≥125 mg, glomerular filtration rate <30 mL/min, elevated bilirubin, left ventricular ejection fraction <60%, and moderate/severe right ventricular dysfunction. Tricuspid regurgitation mechanism was not an independent predictor of outcome. Observed and predicted in-hospital mortality rates increased from 0% to 60% and from 1% to 65%, respectively, as the score increased from 0 up to ≥9 points. Apparent and bias-corrected areas under the receiver operating characteristic curves were 0.81 and 0.75, respectively, much higher than the logistic EuroSCORE (0.67) or EuroSCORE II (0.63).

Conclusion: We propose TRI-SCORE as a dedicated risk score model based on eight easy to ascertain parameters to inform patients and physicians regarding the risk of ITVS and guide the clinical decision-making process of patients with severe TR, especially as transcatheter therapies are emerging (www.tri-score.com).

Keywords: Outcome; Surgery; Tricuspid regurgitation; Risk score.

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Figures

Graphical Abstract
Graphical Abstract
TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. AUC: area under the curve; TR: tricuspid regurgitation.
Figure 1
Figure 1
Discrimination and calibration of the risk score model. (A) Predicted in-hospital mortality rate according to the final risk score model. (B) Receiver operating characteristic curves from final multivariate risk score model, simplified risk score model, logistic EuroSCORE, and EuroSCORE II. (C) Calibration of the final multivariate risk score model: scores vs. probability of in-hospital mortality. (D) Calibration of the final multivariate risk score model: predicted vs. actual probability of in-hospital mortality. AUC: area under the curve.
Figure 2
Figure 2
Risk score value and distribution overall and according to the mechanism of tricuspid regurgitation. (A) Box plot of risk score value. Within each box, the horizontal line denotes the median value (50th percentile) and the cross the mean; boxes extend from the 25th to the 75th percentile of dataset. The whiskers mark the minimum and maximum values. (B) Number of patients presenting with each score value and trends. TR: tricuspid regurgitation.
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References

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