TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation
Authors: Dreyfus Julien , Galloo Xavier , Taramasso Maurizio , Heitzinger Gregor , Benfari Giovanni , Kresoja Karl-Patrick , Juarez-Casso Fernando , Omran Hazem , Bohbot Yohann , Iliadis Christos , Russo Giulio , Topilsky Yan , Weber Marcel , Nombela-Franco Luis , Sala Alessandra , Eixerés-Esteve Andrea , Iung Bernard , Obadia Jean-François , Estevez Loureiro Rodrigo , Riant Elisabeth , Donal Erwan , Hausleiter Jörg , Badano Luigi , Le Tourneau Thierry , Coisne Augustin , Modine Thomas , Latib Azeem , Praz Fabien , Windecker Stephan , Zamorano Jose Luis , von Bardeleben Ralph Stephan , Tang Gilbert H L , Hahn Rebecca , Webb John , Muraru Denisa , Nejjari Mohammed , Chan Vincent , De Bonis Michele , Carnero-Alcazar Manuel , Nickenig Georg , Pfister Roman , Tribouilloy Christophe , Rudolph Volker , Crestanello Juan , Lurz Philipp , Bartko Philipp , Maisano Francesco , Bax Jeroen , Enriquez-Sarano Maurice , Messika-Zeitoun David ,   TRIGISTRY investigators, Dreyfus Julien , Galloo Xavier , Taramasso Maurizio , Heitzinger Gregor , Benfari Giovanni , Kresoja Karl-Patrick , Juarez-Casso Fernando , Omran Hazem , Bohbot Yohan , Iliadis Christos , Russo Giulio , Topilsky Yan , Weber Marcel , Nombela-Franco Luis , Sala Alessandra , Eixerés-Esteve Andrea , Iung Bernard , Obadia Jean-François , Loureiro Rodrigo Estevez , Riant Elisabeth , Lim Pascal , Bazire Baptiste , Donal Erwan , Hausleiter Jörg , Badano Luigi , Tourneau Thierry Le , Coisne Augustin , Modine Thomas , Lavie-Badie Yoan , Doguet Fabien , Habib Gilbert , Selton-Suty Christine , Ajmone-Marsan Nina , Latib Azeem , Stolz Lukas , Praz Fabien , Windecker Stephan , Zamorano Jose Luis , von Bardeleben Ralph Stephan , Ruf Tobias , Tang Gilbert H L , Hahn Rebecca , Lubos Edith , Webb John , Schofer Joachim , Fam Neil , Lauten Alexander , Pedrazzini Giovanni , Rodés-Cabau Josep , Muraru Denisa , Nejjari Mohammed , Michelena Hector , Gavazzoni Mara , Solís Jorge , Flagiello Michele , Radu Costin , Mbaki Yannick , Tomasi Jacques , Senage Thomas , Chan Vincent , Rahmouni Kenza , Alessandrini Hannes , Eyharts Damien , Viau Florence , Himbert Dominique , Sievert Horst , Eggenspieler Florian , Nicol Martin , De Bonis Michele , Carnero-Alcazar Manuel , Nickenig Georg , Pfister Romain , Tribouilloy Christophe , Rudolph Volker , Crestanello Juan , Lurz Philipp , Bartko Philipp , Maisano Francesco , Bax Jeroen , Enriquez-Sarano Maurice , Messika-Zeitoun David 
Published: August 2023

Abstract

Background and aims
Benefit of tricuspid regurgitation (TR) correction and timing of intervention are unclear. This study aimed to compare survival rates after surgical or transcatheter intervention to conservative management according to a TR clinical stage as assessed using the TRI-SCORE.

Methods
A total of 2,413 patients with severe isolated functional TR were enrolled in TRIGISTRY (1217 conservatively managed, 551 isolated tricuspid valve surgery, and 645 transcatheter valve repair). The primary endpoint was survival at 2 years.

Results
The TRI-SCORE was low (≤3) in 32%, intermediate (4–5) in 33%, and high (≥6) in 35%. A successful correction was achieved in 97% and 65% of patients in the surgical and transcatheter groups, respectively. Survival rates decreased with the TRI-SCORE in the three treatment groups (all P &lt; .0001). In the low TRI-SCORE category, survival rates were higher in the surgical and transcatheter groups than in the conservative management group (93%, 87%, and 79%, respectively, P = .0002). In the intermediate category, no significant difference between groups was observed overall (80%, 71%, and 71%, respectively, P = .13) but benefit of the intervention became significant when the analysis was restricted to patients with successful correction (80%, 81%, and 71%, respectively, P = .009). In the high TRI-SCORE category, survival was not different to conservative management in the surgical and successful repair group (61% and 68% vs 58%, P = .26 and P = .18 respectively).

Conclusions
Survival progressively decreased with the TRI-SCORE irrespective of treatment modality. Compared to conservative management, an early and successful surgical or transcatheter intervention improved 2-year survival in patients at low and, to a lower extent, intermediate TRI-SCORE, while no benefit was observed in the high TRI-SCORE category.