Risk assessment for continuous flow left ventricular assist devices: Does the destination therapy risk score work?: An analysis of over 1,000 patients

Jeffrey J. Teuteberg, Greg A. Ewald, Robert M. Adamson, Katherine Lietz, Leslie W. Miller, Antone J. Tatooles, Robert L. Kormos, Kartik S. Sundareswaran, David J. Farrar, Joseph G. Rogers

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47 Scopus citations


Objectives: This study sought to assess the utility of the Destination Therapy Risk Score (DTRS) in patients with continuous flow left ventricular assist devices (LVAD). Background: The DTRS was developed to predict the risk of 90-day in-hospital mortality with pulsatile flow LVAD as destination therapy (DT). Despite ongoing use in patients with continuous flow devices, its utility has not been studied in such populations. Methods: The DTRS was determined in 1,124 patients with the continuous flow HeartMate II (Thoratec Corporation, Pleasanton, California) LVAD as a bridge to transplant (BTT, n = 486) and DT (n = 638) and 114 DT patients with the pulsatile flow HeartMate XVE (Thoratec Corporation). Patients were divided into risk groups based on DTRS: low (0-8), medium (9-16), and high (>16). Results: The 90-day in-hospital mortality for low-, medium-, and high-risk groups was 8%, 7%, and 16%, respectively, for BTT patients; 9%, 12%, and 19%, respectively, for DT patients; and 11%, 18%, and 25%, respectively, for XVE DT patients. The high-risk groups had more than a 2-fold increased risk of mortality compared with the low-risk groups. However, the area under the receiver-operating characteristic curve for 90-day in-hospital mortality yielded modest values ranging from 0.54 to 0.58 for the HeartMate II BTT and DT groups, respectively. Survival rates over 2 years were statistically significantly different as stratified by the 3 DTRS groups for patients implanted for DT but not for BTT. Conclusions: DTRS provides poor discrimination of mortality for BTT patients and only modest discrimination for DT patients receiving continuous flow LVAD.

Original languageEnglish (US)
Pages (from-to)44-51
Number of pages8
JournalJournal of the American College of Cardiology
Issue number1
StatePublished - Jul 3 2012
Externally publishedYes

Bibliographical note

Funding Information:
Drs. Ewald, Miller, Tatooles, and Rogers are consultants for Thoratec Corporation. Dr. Adamson is a speaker for Thoratec Corporation. Dr. Miller also receives research support from Thoratec Corporation. Dr. Tatooles also received research grants from Thoratec Corporation and Heartware . Drs. Sundareswaran and Farrar are employees of Thoratec Corporation. Dr. Farrar is also a stockholder in Thoratec Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.


  • left ventricular assist device
  • mechanical circulatory support
  • risk stratification


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