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

Dreyfus, Julien; Audureau, Etienne; Bohbot, Yohann; Coisne, Augustin; Lavie-Badie, Yoan; Bouchery, Maxime; Flagiello, Michele; Bazire, Baptiste; Eggenspieler, Florian; Viau, Florence; Riant, Elisabeth; Mbaki, Yannick; Eyharts, Damien; Senage, Thomas; Modine, Thomas; Nicol, Martin; Doguet, Fabien; Nguyen, Virginia; Le Tourneau, Thierry; Tribouilloy, Christophe; Donal, Erwan; Tomasi, Jacques; Habib, Gilbert; Selton-Suty, Christine; Raffoul, Richard; Iung, Bernard; Obadia, Jean-François; Messika-Zeitoun, David

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).