The value of preoperative risk scores prior to tricuspid valve interventions: The TRI-SCORE and beyond

Tricuspid regurgitation (TR) is increasingly recognized as a condition associated with poor clinical outcomes, including reduced quality of life, progressive right-sided heart failure, and increased mortality. Its heterogeneous etiologies and systemic consequences, affecting both cardiac and extracardiac organs such as the kidneys and liver, make patient management particularly challenging. Accurate risk stratification and timely intervention are therefore essential. The 2025 European Society of Cardiology and European Association for Cardio-Thoracic Surgery Guidelines acknowledge the multifaceted nature of TR and emphasize the need for evaluation in expert centers through multidisciplinary Heart Team discussions. In this context, the TRI-SCORE, initially developed to predict in-hospital mortality after isolated tricuspid valve (TV) surgery, has been incorporated into the guideline decision-making algorithm as a key risk assessment tool to support therapeutic selection. This simple eight-variable model demonstrated excellent prognostic predictive performance and has been validated across several international cohorts of patients conservatively treated or who underwent a surgical or transcatheter intervention. Compared with other surgical scores such as EuroSCORE II, Model for End-Stage Liver Disease (MELD)/MELD-XI, or the Society of Thoracic Surgeons isolated TV surgery model, the TRI-SCORE is disease-specific, simple, and offers superior predictive value. It helps identify patients most likely to benefit from intervention, providing a practical framework for integrating disease stage, procedural risk, and expected benefit. Both surgical and transcatheter therapies may improve prognosis when performed early, whereas delayed referral at advanced stages offsets their potential benefit. The systematic use of TRI-SCORE within the Heart Team can therefore refine patient selection, guide the timing of intervention, and support personalized, lifetime management of TR.