265 Long Term Follow Up with the Impella Recover Left Ventricular Assist Device K. Brehm, 1 M.P. Siegenthaler, 2 C. Hehrlein, 3 T. Strecker, 4 M. Bechtel, 5 M. Weyand, 4 H.H. Sievers, 5 F. Beyersdorf, 1 1 Department of Cardiothoracic Surgery, University Medical Center Freiburg, Freiburg, Germany; 2 Department of Cardiac Surgery, University of Pittsburgh, Pittsburgh; 3 Department of Cardiology, University Medical Center Freiburg, Freiburg, Germany; 4 Center of Cardiac Surgery, Friedrich-Alexander- University Erlangen-Nuremberg, Erlangen, Germany; 5 Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany Purpose: Low output syndrome (LOS) after cardiac surgery or after myocardial infarction is one of the leading causes of death. The current standard treatment for patients with LOS is the intra-aortic balloon pump (IABP). However, for high-risk IABP patients, mortality remains high. We have shown previously, that the Impella Recover left ventricular assist device reduces the in-hospital mortality in these critically ill patients. We evaluated long-term survival rates and quality of life to test the hypothesis that successful support with the Impella device can lead to long-term survival and a better quality of life. Methods and Materials: Sixteen patients (mean age: 649 years) surviving the initial hospital stay after treatment with an Impella Recover device for LOS between March 2002 and January 2006 were followed up until July 2007. Fourteen patients were supported with an Impella Recover for acute cardiogenic shock after cardiac surgery, two for acute myocardial infarction. Long-term survival was analyzed using time from implantation to the occurrence of death. Results: Four patients (25%) died after discharge with a mean survival time of 232351days. The remaining twelve patients (75%) showed a good long-term survival with a good quality of life (2423points), measured with the Minnesota living with heart failure questionnaire. In most patients an improvement of the left ventricular function measured by the ejection fraction was observed. Conclusions: Mechanical circulatory assistance using an Impella Recover is an efficient approach in treating patients with LOS regarding their good long-term survival and their benefit in their quality of life. 266 High Sensitivity C-Reactive Protein Predicts Survival in Patients Receiving Mechanical Assist Device Therapy J.C. Teeters, 1 W.H. Hallinan, 2 H.T. Massey, 2 L. Chen, 11 Department of Cardiology, University of Rochester Medical Center, Rochester, NY; 2 Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY Purpose: Cardiac transplant is the gold standard for end-stage heart failure, but donor shortage has made mechanical circulatory device support (MCDS) a surrogate for, or bridge to transplant. Due to the cost and risk of comorbidities, selection of patients for MCDS remains difficult. The purpose of this study is to determine whether high sensitivity C-reactive protein (hs-CRP) levels predict 30-day survival in patients undergoing MCDS for refractory heart failure. Methods and Materials: We performed a prospective study of patients receiving MCDS over an 18 month period. In this time, 43 patients received MCDS, and 35 had hs-CRP levels drawn. Patients were followed for 30 days for adverse events. We also collected data on infections, blood transfusions, electrolytes and liver function. Results: In the 30 days after MCDS, 10 of the 35 patients died (multi-system organ failure [8], hemorrhage [1], and bowel infarct [1]). The difference in hs-CRP levels obtained within 24 hours prior to MCDS between survivors (68 mg/L) and those who died (130 mg/L) was significant (p=0.04). No difference was found in the number of infections or blood transfusions. There was also no difference in basic metabolic or liver function tests. The only other significant difference was a mean age of 54 amongst survivors and 66 in those who died (p=0.001). However, hs-CRP level was found to be independent of age using regression analysis. Conclusions: Hs-CRP is a potential marker for survival in patients undergoing MCDS. Using levels over 130 mg/L as a cut-off, we found a specificity and negative predictive value of 81% in predicting 30-day mortality. This was independent of any logical confounders, and given the ease of acquisition and minimal risk to the patient, it is a useful tool to identify patients who will most benefit from MCDS. Further multi-centered trials to confirm this finding are needed to support using hs-CRP in screening candidates for MCDS, and to determine when in the course of their disease patients are most suitable for device consideration. 267 ECMO To Salvage Severe Cardiogenic Shock in Advanced Heart Failure and Transplantation D. Marelli, 1 J.A. Kobashigawa, 1 J.D. Moriguchi, 1 I. Shuvayev, 1 S.Y. Wong, 1 T. Kahn, 1 J.K. Patel, 1 R. Beygui, 1 F. Esmailian, 1 H. Laks, 1 M.D. Plunkett, 1 A. Ardehali, 11 Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA Purpose: Extracorporeal membrane oxygenation (ECMO) can be rapidly deployed to salvage patients in extremis due to cardiogenic shock. The setting of heart transplantation may require such therapy for advanced heart failure (pre), acute graft failure (intra), and rejection (post, early or late). Methods and Materials: Thirty-eight patients who were supported on ECMO for the above indications between January 2000 and December 2007 were reviewed. ECMO was instituted either periph- erally (femoral vessels) or centrally (right atrium and aorta) if feasible for severe bi-ventricular failure. Half the patients experienced cardiac arrest prior to institution of ECMO. ECMO was deployed in the intensive care unit in a majority of these patients (85%). Results: Clinical Characteristics N= 38 Mean Age (years) 44.4 % Male 60.5 % Expired on ECMO 42.1 % Weaned/Bridged, but Expired 18.4 % Discharged 39.5 Mean # Days Supported 7.2 Diagnosis: Cardiac Failure Graft Failure 4 Early Rejection 7 Late Rejection 14 Acute Viral Myocarditis 1 End-Stage (CHF) 12 Outcome by Diagnosis Diagnosis Total Expired on ECMO Weaned or Bridged, but Expired Discharged* % indicates proportion based on diagnosis Graft Failure 4 3 0 1 (25%) Early Rejection 7 2 3 2 (29%) Late Rejection 14 5 1 8 (57%) Acute Viral Myocarditis 1 0 0 1 (100%) End-Stage (CHF) 12 6 3 3 (25%) Total 38 16 7 15 (39%) *Two were transplanted; 40% had pre ECMO cardiac arrest S156 Abstracts The Journal of Heart and Lung Transplantation February 2008