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At our institution, the majority of left ventricular assist devices are placed on an emergency basis. Few of these patients require discontinuation of device support due to undetected conditions during abbreviated preoperative evaluation. Survival before and after transplant is comparable with those of patients who undergo nonurgent left ventricular assist device placement or medical therapy.

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A risk factor summation score may predict which LVAD patients will require prolonged inotropic support following heart transplantation. However, survival in high-risk (elevated score) LVAD patients following heart transplantation is comparable to low-risk groups, favoring the continued practice of LVAD implantation as a bridge to transplantation even in high-risk patients.

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e11531 Background: MRI of the breast (BR) is useful in patients (pts) with dense BR in extent of disease evaluation (EOD) and high risk screening. The purpose of this study was to investigate whether MRI breast cancer (BC) detection was associated with BR density in elderly pts. Methods: Retrospective review included pts age >69 diagnosed with BC at our institution between 2/2001 and 12/2005 and their concurrent BR MRIs as well as clinical and pathologic factors. BR density was defined as mild (M) if BR were fatty/mildly dense, and dense (D) if BR were moderately/extremely dense. MRI data was coded for the number of additional sites beyond the known cancer site. Results: MRI occurred in 113 BR in 59 pts; 5 pts had unilateral MRI. 3 pts had bilateral BC. The mean age was 74 (range 69-84). Median tumor size was 1.2 cm (range 0.06-2.6, n=54). 27 pts (46%) had M density and 32 (54%) had D density. In 51/62 (82%) the index lesion was mammographically detected, and in 11 (17%) it was mammographically occult. The majority of BR MRIs 36/62 (58%) identified no additional sites. Biopsy was performed for 18/29 (62%) of the additional sites and 6 cancers were found (PPV of 33%). MRI detected an additional site of BC in 6/62 (9.7%) diseased BR and a new BC in 4/51 (7.8%) screened BR. Pts with D density had more additional MRI sites 18/33 (54.6%) as compared with M density 8/29 (27.6%) p = 0.04. However, D density was not associated with increase in BC detection; 4/33 (12%) D vs 2/29 (7%) M density, p =0.67. BR conserving surgery was performed in 46 pts and mastectomy in 16. We did not find a correlation between additional sites on MRI and final mastectomy, p=0.56. Conclusions: In our study the majority of pts had mammographically evident BC at the time of diagnosis and unifocal BC on MRI. We found that although 54% of our pts had dense BR, the additional detection of BC in the BR by MRI was the same as in pts with mild density. However, we found that increased density was associated with an increased detection of additional lesions on MRI. [Table: see text]