Article Text

Download PDFPDF
Original research
Validation of the TRI-SCORE in patients undergoing surgery for isolated tricuspid regurgitation
  1. María Anguita-Gámez1,
  2. María A Giraldo1,
  3. Luis Nombela-Franco1,
  4. Andrea Eixeres Esteve2,
  5. Gregorio Cuerpo3,
  6. Jose Lopez-Menendez4,
  7. Juan Carlos Gomez-Polo1,
  8. Gabriela Tirado-Conte1,
  9. Berenice Torres4,
  10. Alvaro Pedraz Prieto3,
  11. Pilar Jimenez-Quevedo1,
  12. María Jesus Lopez-Gude2,
  13. Patricia Mahia1,
  14. Javier Cobiella1,
  15. José Luis Zamorano5,
  16. Isidre Vilacosta1,
  17. Luis Maroto1,
  18. Manuel Carnero-Alcázar1
  1. 1 Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
  2. 2 Department of Cardiac Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
  3. 3 Department of Cardiac Surgery, Gregorio Marañón General University Hospital, Madrid, Spain
  4. 4 Department of Cardiac Surgery, Hospital Universitario Ramon y Cajal, Madrid, Spain
  5. 5 Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
  1. Correspondence to Dr Luis Nombela-Franco, Interventional Cardiology, Hospital Clinico Universitario San Carlos, Madrid 28040, Spain; luisnombela{at}; Dr Manuel Carnero-Alcázar; manuelcarneroalcazar{at}


Introduction Estimation of peri-procedural risk in patients with tricuspid regurgitation (TR) undergoing isolated tricuspid valve surgery (ITVS) is of paramount importance. The TRI-SCORE is a new surgical risk scale specifically developed for this purpose, which ranged from 0 to 12 points and included eight parameters: right-sided heart failure signs, daily dose of furosemide ≥125 mg, glomerular filtration rate <30 mL/min, elevated bilirubin (with a value of 2 points), age ≥70 years, New York Heart Association Class III–IV, left ventricular ejection fraction <60% and moderate/severe right ventricular dysfunction (with a value of 1 point). The objective of the study was to evaluate the performance of the TRI-SCORE in an independent cohort of patients undergoing ITVS.

Methods A retrospective observational study was performed in four centres, including consecutive adult patients undergoing ITVS for TR between 2005 and 2022. The TRI-SCORE and the traditional risk scores used in cardiac surgery (Logistic EuroScore (Log-ES) and EuroScore-II (ES-II)) were applied for each patient, and discrimination and calibration of the three scores were evaluated in the entire cohort.

Results A total of 252 patients were included. The mean age was 61.5±11.2 years, 164 (65.1%) patients were female, and TR mechanism was functional in 160 (63.5%) patients. The observed in-hospital mortality was 10.3%. The estimated mortality by the Log-ES, ES-II and TRI-SCORE was 8.7±7.3%, 4.7±5.3% and 11.0±16.6%, respectively. Patients with a TRI-SCORE ≤4 and >4 had an in-hospital mortality of 1.3% and 25.0%, p=0.001, respectively. The discriminatory capacity of the TRI-SCORE had a C-statistic of 0.87 (0.81–0.92), which was significantly higher than both the Log-ES (0.65 (0.54–0.75)) and ES-II (0.67 (0.58–0.79)), p=0.001 (for both comparisons).

Conclusion This external validation of the TRI-SCORE demonstrated good performance to predict in-hospital mortality in patients undergoing ITVS, which was significantly better than the Log-ES and ES-II, which underestimated the observed mortality. These results support the widespread use of this score as a clinical tool.

  • Tricuspid Valve Insufficiency
  • Cardiac Surgical Procedures

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • LN-F and MC-A are joint senior authors.

  • Twitter @mariaangui95, @ConteTirado, @PJimenezQueved1, @manuel_carnero

  • MA-G and MAG contributed equally.

  • Contributors The authors of this paper specifically contributed to the following aspects: (1) Conception and design or analysis and interpretation of data: M Anguita Gámez, MA Giraldo, LN-F and MC-A. (2) Drafting of the manuscript or revising it critically for important intellectual content: all authors. (3) Final approval of the manuscript submitted: all authors. LN-F and MC-A are responsible for the overall content of this manuscript as guarantor. Rest of the authors: Drafting the work or revising it critically for important intellectual content; and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests LN-F holds a research grant (INT19/00040) from the Spanish Ministry of Science and Innovation (Instituto de Salud Carlos III). GT holds a research training contract “Rio Hortega” (CM21/00091) from the Spanish Ministry of Science and Innovation (Instituto de Salud Carlos III). LN-F is a proctor for Abbott Vascular, Edwards Lifesciences and Products & Features. PJ-Q is a proctor for Abbott Vascular and Products & Features. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.