Association of TRI-SCORE with clinical outcomes after percutaneous tricuspid annuloplasty
Authors: Piris Sanchez A , Pardo Sanz A , Dominguez-Rodriguez L M , Salido Tahoces L , Mestre Barcelo J L , Tirado-Conte G , Hernandez Sanchez E , Fernandez-Golfin C , Garcia-Martin A , Gonzalez Gomez A , Monteagudo Ruiz J M , Hinojar Baydes R , Zamorano Gomez J L , Sanchez Recalde A 
Published: October 2024

Abstract

Background
Significant tricuspid regurgitation (TR) has been associated with excess mortality and heart failure. Functional TR is associated to progressive right ventricular remodeling and dysfunction, leading to comorbidities which elevate the perioperative mortality of isolated tricuspid regurgitation surgery, with an in-hospital mortality between 6-10% according to series. Transcatheter tricuspid annuloplasty is a promising therapeutic alternative in patients with high surgical risk. Appropriate risk stratification and patient selection is essential to ensure benefits of this intervention. European System for Cardiac Operative Risk Evaluation (EUROSCORE) II and the Society of Thoracic Surgeons (STS) score are widely spread in-hospital mortality risk scores in valvular surgery. TRI-SCORE is focused on isolated TR surgery; nevertheless, application of these scores to transcatheter annuloplasty has not been specifically studied yet.

Purpose
To analyze the utility of surgical scores (EUROSCORE-II, STS and TRISCORE) to predict all-cause mortality in patients undergoing transcatheter tricuspid annuloplasty.

Methods
A cohort of 49 patients with significant TR was followed up prospectively after the transcatheter tricuspid annuloplasty with Cardioband between 2019 and January 2024 (mean follow-up 18,43 ± 10,95 months). Every score was evaluated in all patients. According to the TRI-SCORE –– 6 points was the 75-percentile and taken as cutoff value –– we divided the cohort in two groups: a low score group (≤6 points) and a high score group (&gt;6 points). Survival was analyzed in the whole cohort and in both subgroups. The curves are depicted using Kaplan-Meier method and were compared using log rank test.

Results
The study included 49 patients, with mean age of 77,6 ± 7,67 years, 77,6% being women. All the patients had a secondary etiology of TR and 46,9% massive or torrential TR before the intervention. 49% had previous left heart surgery.
The median surgical risk values are represented in Table 1. All-cause mortality during follow-up occurred in 9 patients (18,3%). Survival analysis based on EUROSCORE II and STS did not find statically significant association (Table 1). TRI-SCORE had a hazard ratio (HR) of 1,59, also without statically significant association (CI 0.93 – 2.71; p 0.089). Survival analysis in high score group found an increased risk of all-cause mortality (HR 8.5; p 0.025). According to our findings TRI-SCORE &gt; 6 before the procedure confers significant risk of all-cause death (log rank p = 0.009). Figure 1.

Conclusions
Transcatheter tricuspid annuloplasty is a promising therapy for patients with significant TR regurgitation who are at high surgical risk. According to our findings, TRI-SCORE is an appropriate scoring model to predict all-cause mortality after percutaneous annuloplasty with band. It is not so for other surgical risk scores. Extended follow-up and broader experienced are needed to corroborate these results.Surgical scores: median and mortalitySurvival curves TRI-SCORE