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