Baseline TRI-SCORE for risk stratification before tricuspid transcatheter edge-to-edge repair: A systematic review and meta-analysis

Authors

• Anan Abu Rmilah, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Internal Medicine, University of Iowa, Iowa City, IA, USA. Electronic address: anan-aburmilah@uiowa.edu.
• Thekrayat Asad, Department of Internal Medicine, Rochester Regional Health/Unity Hospital, New York, USA.
• Ameer Awashra, Department of Internal Medicine, Al-Najah University, Nablus, Palestine.
• Alaa Hmeedan, Department of Internal Medicine, Al-Najah University, Nablus, Palestine.
• Lana Khatib, Department of Internal Medicine, Al-Najah University, Nablus, Palestine.
• Abdalhakim Shubietah, Advocate Health - MidwestFollow
• Hossam Alzu'bi, Department of Cardiovascular Medicine, Advent health Orlando, FL, USA.
• Raad Al-Muhaisen, Department of Cardiovascular Medicine, Mount Sinai Medical Center, FL, USA.
• Ali Alzeghoul, Department of Internal Medicine, Magnolia Regional health center, Corinth, MS, USA.
• Alexandra Lackey, Department of Cardiovascular Medicine, Advent health Orlando, FL, USA.
• Jose Arias, Department of Cardiovascular Medicine, Advent health Orlando, FL, USA.

Recommended Citation

Rmilah AA, Asad T, Awashra A, et al. Baseline TRI-SCORE for risk stratification before tricuspid transcatheter edge-to-edge repair: A systematic review and meta-analysis. Cardiovasc Revasc Med. Published online June 17, 2026. doi:10.1016/j.carrev.2026.06.010

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: Transcatheter edge-to-edge repair (TEER) has expanded treatment options for severe tricuspid regurgitation (TR), but outcomes remain heterogeneous and patient selection remains challenging. TRI-SCORE, a disease-specific score developed for isolated tricuspid valve surgery, may help identify high-risk patients before tricuspid TEER. We performed a systematic review and meta-analysis evaluating the association between baseline TRI-SCORE and outcomes after tricuspid TEER.

Methods: MEDLINE and Embase were searched from inception through January 2026. Eligible studies included adults undergoing tricuspid TEER and reported outcomes according to baseline TRI-SCORE category, most commonly ≥6 versus <6. Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).

Results: Five observational studies including 2074 patients were included. Higher TRI-SCORE was associated with greater all-cause mortality at in-hospital/30-day (RR, 3.17; 95% CI, 1.71-5.89), 3-month (RR, 4.03; 95% CI, 2.62-6.17), 6-month (RR, 2.97; 95% CI, 2.05-4.32), and 1-year follow-up (RR, 2.62; 95% CI, 1.88-3.66). Higher TRI-SCORE was also associated with lower likelihood of residual TR grade ≤2 in-hospital (RR, 0.88; 95% CI, 0.81-0.97), at 30 days (RR, 0.86; 95% CI, 0.76-0.97), and at 3 months (RR, 0.75; 95% CI, 0.58-0.98). The composite of death and/or heart failure rehospitalization was more frequent in high-risk patients.

Conclusions: In patients undergoing tricuspid TEER, high baseline TRI-SCORE identifies advanced clinical risk associated with excess mortality, less frequent TR reduction, and more adverse events. TRI-SCORE may support interventional heart-team evaluation but should complement anatomy, right ventricular function, frailty, and hemodynamic assessment.

Type

Article

PubMed ID

42350254