Predicting outcomes in tricuspid interventions: risk scores and decision tools

Transcatheter tricuspid valve interventions (TTVI) have emerged as a therapeutic option for patients with symptomatic tricuspid regurgitation (TR) who remain highly symptomatic despite optimized medical therapy. Clinical outcomes after TTVI depend both on the risk profile of the individual patient and on procedural success. Several clinical, laboratory, and imaging-based scoring systems have been developed over the last decade to aid patient selection, guide timing of referral and counsel patients and their families. This narrative review summarizes contemporary risk models across the diagnostic-therapeutic pathway. For patients managed conservatively, simple clinical tools such as the 4A score and the Tricuspid Regurgitation Impact on Outcomes-right ventricular score have been validated to predict heart-failure hospitalisation and mortality. The model for end-stage liver disease score, originally developed for liver disease, may identify patients with end-organ dysfunction who are unlikely to survive surgery. For those considered for isolated tricuspid valve surgery, the Society of Thoracic Surgeons calculator and the TRI-SCORE provide calibrated estimates of peri-operative mortality, while the recently proposed TRIVALVE and haemoglobin–albumin–lymphocyte–platelet scores focus on patients undergoing transcatheter repair. Finally, anatomical scores such as GLIDE help predict procedural success for transcatheter edge-to-edge repair. Understanding the strengths and limitations of each model is essential to individualize care, facilitate shared decision making and optimize outcomes.