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

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

Anan Abu Rmilah, Thekrayat Asad, Ameer Awashra, Alaa Hmeedan, Lana Khatib, Abdalhakim Shubietah, Hossam Alzu'bi, Raad Al-Muhaisen, Ali Alzeghoul, Alexandra Lackey, …
Cardiovascular revascularization medicine
06/17/2026
DOI: 10.1016/j.carrev.2026.06.010
PMID: 42350254

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Abstract

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. 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). 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. 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. [Display omitted] •Baseline TRI-SCORE predicts mortality after tricuspid TEER.•TRI-SCORE ≥ 6 identifies patients at higher early and 1-year risk.•High TRI-SCORE is linked to lower achievement of residual TR ≤2.•TRI-SCORE stratifies risk of death or heart failure rehospitalization.•TRI-SCORE may support patient selection and counseling before TEER
 meta-analysis Risk stratification Structural heart disease TEER Transcatheter edge-to-edge repair TRI-SCORE Tricuspid regurgitation

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