752 Should Advanced Age Be a Contra-Indication to LVAD Implant: A Community Hospital Experience

with refractory Stage D heart failure. Methods and Materials: MEDAMACS (n 168) enrolled adult patients with CHF on optimal therapy, LVEF 30%, and 2 hospitalizations in the past year or 1 hospitalization and 1 high risk feature. Echo-determined severity of TR (none, mild, moderate, severe) was reported in 166 of 168 patients. With an endpoint of survival free of inotrope dependence, mechanical circulatory support (MCS), or heart transplantation, we tested the predictive value of at least moderate TR in adjusted analyses. Results: Moderate TR was present in 30% and severe TR in 15% of the study cohort. The presence of greater than moderate TR was associated with right atrial pressure (p 0.0006), pulmonary artery mean pressure (p 0.03), TR velocity (p 0.01), inspiratory collapse of the inferior vena cava (p 0.01), RVD(p 0.04), peripheral edema (p 0.0003), hepatosplenomegaly (p 0.01), low platelets (p 0.05), and total bilirubin (p 0.03). Over a mean follow-up of 154 days, 64 events were recorded including long term inotropic support (9), MCS (16), cardiac transplantation (17), and mortality (22). In univariate analysis, at least moderateTR was associated with increased risk (OR 3.1; 95% CI 1.6, 6.0; p 0.0006). After multivariate adjustment, tricuspid regurgitation remained independently associated with survival free of transplant, MCS, or inotropic dependence (OR 3.5; 95% CI 1.5, 8.6; p 0.004). Conclusions: Tricuspid regurgitation is common and carries prognostic import in Stage D Heart Failure. Given the importance of TR when considering left ventricular assist device support, future studies should investigate the reversibility of this lesion.