TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation
Julien Dreyfus, Xavier Galloo, Maurizio Taramasso, Gregor Heitzinger, Giovanni Benfari, Karl-Patrick Kresoja, Fernando M. Juarez-Casso, Hazem Omran, Yohann Bohbot, Christos Iliadis, Giulio Russo, Yan Topilsky, Marcel Weber, Luis Nombela‐Franco, Alessandra Sala, Andrea Eixerés‐Esteve, Bernard Iung, Jean‐François Obadia, Rodrigo Estévez‐Loureiro, Elisabeth Riant, Erwan Donal, Jörg Hausleiter, Luigi P. Badano, Thierry Le Tourneau, Augustin Coisne, Thomas Modine, Azeem Latib, Fabien Praz, Stephan Windecker, José Luis Zamorano, Ralph Stephan von Bardeleben, Gilbert H L Tang, Rebecca T. Hahn, John G. Webb, Denisa Muraru, Mohammed Nejjari, Vincent Chan, Michele De Bonis, Manuel Carnero, Georg Nickenig, Roman Pfister, Christophe Tribouilloy, Volker Rudolph, Juan A. Crestanello, Philipp Lurz, Philipp E. Bartko, Francesco Maisano, Jeroen J. Bax, Maurice Enriquez‐Sarano, David Messika–Zeitoun, TRIGISTRY investigators, Julien Dreyfus, Xavier Galloo, Maurizio Taramasso, Gregor Heitzinger, Giovanni Benfari, Karl-Patrick Kresoja, Fernando M. Juarez-Casso, Hazem Omran, Yohan Bohbot, Christos Iliadis, Giulio Russo, Yan Topilsky, Marcel Weber, Luis Nombela‐Franco, Alessandra Sala, Andrea Eixerés‐Esteve, Bernard Iung, Jean‐François Obadia, Rodrigo Estévez‐Loureiro, Elisabeth Riant, Pascal Lim, Baptiste Bazire, Erwan Donal, Jörg Hausleiter, Luigi P. Badano, Thierry Le Tourneau, Augustin Coisne, Thomas Modine, Yoan Lavie‐Badie, Fabien Doguet, Gilbert Habib, Christine Selton‐Suty, N Ajmone-Marsan, Azeem Latib, Lukas Stolz, Fabien Praz, Stephan Windecker, José Luís Zamorano, Ralph Stephan von Bardeleben, T. Ruf, Gilbert H L Tang, Rebecca T. Hahn, Edith Lubos, John A. Webb, Joachim Schöfer, Neil Fam, Alexander Lauten, Giovanni Pedrazzini, Josep Rodés‐Cabau
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 < .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.