Valvular Heart Disease Scores

TRI-SCORE Calculator – Tricuspid Regurgitation Surgical Risk

Clinical calculation support · Verify results before clinical use

TRI-SCORE Assessment

Estimate in-hospital mortality risk after isolated tricuspid valve surgery. Enter preoperative patient characteristics.

0of 12 points

Clinical and demographic variables

Age ≥70 years

Age at the time of the planned isolated tricuspid valve operation.

+1 point

Age (years)

NYHA functional class III–IV

Preoperative New York Heart Association functional class.

+1 point

Class I–II0 points

Class III–IV+1 point

Signs of right-sided heart failure

Severe jugular venous distension, ascites, and/or marked peripheral oedema.

+2 points

Absent0 points

Present+2 points

Daily furosemide dose ≥125 mg

Total daily furosemide dose, using the original score's threshold.

+2 points

<125 mg/day0 points

≥125 mg/day+2 points

Renal, hepatic, and ventricular function

Glomerular filtration rate <30 mL/min

The original TRI-SCORE used the Cockcroft–Gault estimate. Enter serum creatinine and body weight to calculate creatinine clearance.

+2 points

Sex for Cockcroft–Gault

Body weight (kg)

Serum creatinine (mg/dL)

Calculated Cockcroft–Gault CrCl

CrCl = [(140 − age) × weight] / (72 × serum creatinine); multiply by 0.85 for female patients. The score threshold is <30 mL/min. This is a calculated estimate, not a measured GFR.

Complete age, sex, weight, and creatinine to calculate CrCl and classify this component.

Elevated total bilirubin

Above the upper reference limit of the local laboratory, as specified by the original TRI-SCORE calculator.

+2 points

Not elevated0 points

Elevated+2 points

Left ventricular ejection fraction <60%

LVEF assessed visually or by the biplane method of disks (modified Simpson’s rule).

+1 point

LVEF (%)

LVEF below 60% contributes 1 point; LVEF of 60% or higher contributes 0 points.

Moderate or severe right ventricular dysfunction

Semi-quantitative multiparametric assessment: TAPSE <17 mm and/or tissue Doppler S′ <9.5 cm/s and/or markedly reduced RV function on visual assessment.

+1 point

No moderate/severe dysfunction0 points

Moderate/severe dysfunction+1 point

0TRI-SCORE

Predicted in-hospital mortality after isolated tricuspid valve surgery

Not calculated

Complete the required patient data to calculate the score.

Clinical interpretation The TRI-SCORE is intended to support perioperative risk assessment in adults with severe non-congenital tricuspid regurgitation considered for isolated tricuspid valve surgery. It is not a stand-alone treatment decision tool.

Risk factor	Points	Contribution
Complete the required inputs to view the score breakdown.

Predicted mortality percentages are the original model's score-specific estimates. They are not individualized guarantees and may not be calibrated to every contemporary centre or population.

About the TRI-SCORE

The TRI-SCORE is a disease-specific clinical risk score developed to predict in-hospital mortality after isolated tricuspid valve surgery in adults with severe, non-congenital tricuspid regurgitation. The original derivation cohort included 466 patients from 12 French centres (2007–2017); in-hospital mortality was 10%.

The simplified score contains eight preoperative variables and ranges from 0 to 12 points. Variables with an odds ratio between 1 and 2 receive 1 point; variables with an odds ratio of 2 or greater receive 2 points.

Variables and scoring

Variable	Definition	Points
Age	≥70 years	1
NYHA class	III–IV	1
Right-sided HF signs	Severe JVD, ascites and/or marked peripheral oedema	2
Furosemide	Daily dose ≥125 mg	2
Renal function	GFR/CrCl <30 mL/min (Cockcroft–Gault)	2
Total bilirubin	Above local laboratory reference threshold	2
LVEF	<60%	1
RV dysfunction	Moderate/severe	1

Original predicted in-hospital mortality

TRI-SCORE	Predicted mortality	Observed mortality in derivation cohort
0	1%	0%
1	2%	4%
2	3%	1%
3	5%	0%
4	8%	10%
5	14%	18%
6	22%	25%
7	34%	32%
8	48%	33%
≥9	65%	60%

Important application notes

Use preoperative values and clinical findings relevant to the planned operation.
The original development population was adults undergoing isolated surgery for severe non-congenital TR; do not assume the same calibration for congenital disease, concomitant procedures, transcatheter interventions, or non-operative populations.
Right-sided HF signs and RV dysfunction require clinical and echocardiographic assessment; the calculator cannot replace clinician judgement.
For bilirubin, the original online score specifies elevation above the laboratory threshold rather than a universal numeric cut-off.
The Cockcroft–Gault calculation uses actual body weight in the conventional equation; clinical appropriateness of weight selection in extremes of body habitus requires judgement.

References

Dreyfus J, Audureau E, Bohbot Y, et al. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. European Heart Journal. 2022;43(7):654–662. doi:10.1093/eurheartj/ehab679. https://doi.org/10.1093/eurheartj/ehab679

Kim DY, Kim J, Cho I, et al. Validation of TRI-SCORE for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asian Patients. Journal of the American Heart Association. 2024;13(8):e032929. doi:10.1161/JAHA.123.032929. https://doi.org/10.1161/JAHA.123.032929

2025 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal. 2025. The guideline encourages use of risk scores assessing RV and secondary organ dysfunction in isolated severe tricuspid valve disease and discusses TRI-SCORE alongside the STS isolated tricuspid valve risk calculator. European Heart Journal guideline

External validation cohort. Validation of the TRI-SCORE in patients undergoing surgery for isolated tricuspid regurgitation. 2023. Retrospective cohort of 252 patients; reported C-statistic 0.87 for in-hospital mortality. PubMed record

Official TRI-SCORE reference calculator. Variable definitions and operational notes, including the definition of right-sided HF signs, Cockcroft–Gault renal estimate, and RV dysfunction parameters. ext.tri-score.com

Clinical disclaimer: This calculator is provided for educational and clinical decision-support purposes. It estimates in-hospital mortality based on the original TRI-SCORE model and must not be used as the sole basis for deciding whether to operate, choosing surgery versus transcatheter therapy, or determining an individual patient's prognosis. Decisions should be made by a multidisciplinary Heart Team considering anatomy, RV and LV function, end-organ status, frailty, comorbidities, procedural factors, local outcomes, and patient preferences.