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

Julien Dreyfus 1 Etienne Audureau 2, 3 Yohann Bohbot 4 Augustin Coisne 5 Yoan Lavie-Badie 6 Maxime Bouchery 7 Michele Flagiello 8 Baptiste Bazire 9 Florian Eggenspieler 10 Florence Viau 11 Elisabeth Riant 1 Yannick Mbaki 12, 13 Damien Eyharts 6 Thomas Senage 14 Thomas Modine 15 Martin Nicol 1 Fabien Doguet 16 Virginia Nguyen 1 Thierry Le Tourneau 14 Christophe Tribouilloy 4 Erwan Donal 12, 13 Jacques Tomasi 12 Gilbert Habib 11, 17 Christine Selton-Suty 18 Richard Raffoul 9 Bernard Iung 9 Jean-François Obadia 8 David Messika-Zeitoun 19 
Abstract : 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).
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Submitted on : Monday, May 30, 2022 - 2:35:27 PM
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Julien Dreyfus, Etienne Audureau, Yohann Bohbot, Augustin Coisne, Yoan Lavie-Badie, et al.. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. European Heart Journal, Oxford University Press (OUP), 2022, 43 (7), pp.654-662. ⟨10.1093/eurheartj/ehab679⟩. ⟨hal-03379641⟩

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