S266 The Journal of Heart and Lung Transplantation, Vol 37, No 4S, April 2018 ( 662) LVADs as Bridge to Candidacy in the UK S.M. Shaw , 1 R. Venkateswaran, 1 S.N. Rushton, 2 R. Hogg, 2 N. Al-Attar, 3 S. Lim, 4 S. Schueler, 5 J. Parameshwar, 6 N. Banner. 7 1 Heart and Lung Transplant, Manchester University NHS Foundation Trust, Manchester, United Kingdom; 2 Statistics and Clinical Studies, NHSBT, Bristol, United Kingdom; 3 Golden Jubilee National Hospital, Glasgow, United Kingdom; 4 Queen Elizabeth Hospital, Birmingham, United Kingdom; 5 Cardiothoracic Surgery, Freeman Hospital, Newcastle, United Kingdom; 6 Papworth, Cambridge, United Kingdom; 7 Harefield Hospital, London, United Kingdom. Purpose: Long term ventricular assist devices (VADs) may reverse some con- traindications to heart transplant, the Bridge to Candidacy (BTC) strategy; however, the clinical effectiveness of BTC has not been firmly established. We used the UK’s comprehensive national VAD database to compare survival on support and rate of transplantation of BTC with BTT (Bridge to Transplant). Methods: We studied adult patients implanted between Jan 07 and Dec 15. BTC was assigned by one or more following criteria: 1) Pulmonary Hypertension (PASP) >60mmHg and PVR >5 WU, 2) eGFR <40ml/min/1.73m 2 , 3) BMI >32. Other cases were BTT (UK does not implant for Destination Therapy). Competing risks methodology was used where transplant, death and explant were competing outcomes while on support. Cumulative incidence functions were compared between groups using the method of Gray. Results: 306 of 540 had complete data of which 149 were BTC (49%). Overall, survival on support was similar between BTC and BTT groups (61 vs 65% at 1 year respectively p=0.6). However, survival on support was significantly worse for patients with eGFR <40 versus those with eGFR >40 (30 days comparison 71% vs 89% respectively, p=0.001; at 1 year 51% vs 65%, p=0.03; at 2 years 28% vs 46%, p=0.008). Conversely, in patients with severe pulmonary hypertension or high PVR there was a trend towards improved early survival (p=0.07 at 30 days and 1 year). There were no significant differences in the rate of transplant for BTC and BTT or any subgroup (including low eGFR p=0.8 up to 5 years) although a trend for a lower cumulative incidence of transplant for BMI>32 vs BMI<32 (18% vs 37% respectively transplanted by 5 years, p=0.09). Conclusion: BTC was common in the UK (49% implants) and appears clini- cally effective given survival on support and rate of transplant was compara- ble with BTT. Low eGFR patients had a worse survival, but were transplanted at the same rate. High BMI patients may be less likely to be transplanted. High PA pressure & high PVR may confer lower early risk (possibly reflect- ing better right ventricular function). ( 663) Outcomes of Patients Bridged with LVAD to a Repeat Heart Transplant as Compared to Medical Management: Analysis of the UNOS Database S. Fugar , 1 A.K. Okoh, 2 D. Eshun, 3 M. Schultheis, 2 C. Gidea, 2 M. Russo, 2 M. Zucker, 2 M. Camacho. 2 1 Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL; 2 Cardiothoracic Surgery, RWJ Barnabas 99 patients (53%), either at the bedside (92 patients, 49%) and during cardio- pulmonary resuscitation (43 patients, 23%), or in theatre in the remnant 86 patients (47%). In detail, 165 patients (89%) were supported on veno-arterial extracorporeal membrane oxygenation, 32 (17%) on temporary left ventricular assist devices and 21 (11%) on temporary biventricular assist devices. Results: The ECLS was intended as bridge to recovery in 49 cases (26%), bridge to a permanent mechanical circulatory support in 43 cases (23%), bridge to heart transplantation in 30 cases (16%). Mortality during ECLS support was 19% (36 patients), 30-day mortality was 30% (55 patients); 105 patients (57%) were discharged from the hospital. Recovery of native cardiac function was observed more often in females, patients requiring lower flows, and those with an acute etiology and lower level of organ failure serum markers. Otherwise, male gender, a higher duration of support and higher level of malperfusion and inflammatory serum markers were associated with an increased mortality. Conclusion: ECLS allows survival to be maximized in patients who are otherwise untreatable and face an extremely severe prognosis. ECLS offers a substantial chance of recovery in a specific subset of patients, often represent- ing the only required therapy, or a safe bridge to other heart failure treatments. ( 661) Electrocardiogram-synchronized Rotational Speed Modulation System Can Reduce the Recirculation Due to Aortic Insufficiency in LVAD Support K. Iizuka , 1 D. Akiyama, 1 Y. Takewa, 1 T. Tsukiya, 1 T. Mizuno, 1 T. Nishimura, 2 E. Tatsumi. 1 1 Department of Artificial Organs, National Cerebral and Cardiovascular Center, Osaka, Japan; 2 Department of Cardiovascular Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan. Purpose: Aortic Insufficiency (AI) is a worrisome problem in left ventricu- lar assist device (LVAD) support. The reduced pressure in the left ventricle (LV) causes larger pressure difference on aortic valve, which can lead to increasing recirculation from LVAD to LV. We have previously developed Electrocardiogram(ECG)-Synchronized Rotational Speed Modulation System (ESRSM), which can change the rotational speed of LVAD synchro- nously to ECG cycle, thus enabling to change pump flow dynamically like pulsatile pump. We hypothesize that the enhance of the pulsatility can prevent the continuous larger pressure difference, resulting in reducing the LVAD-LV recirculation. The aim of this study was to reduce the recirculation by con- trolling the pressure difference using ESRSM in acute animal experiments. Methods: Six goats underwent LVAD (EVAHEART) implantation. Cardiac dysfunction was induced by continuous infusion of beta-blockade. The AI model was established by placing a temporary inferior vena cava filter in the aortic valve. Hemodynamic values were evaluated in the three modes of the ESRSM, Co-pulse mode, Counter-pulse mode, and Continuous mode (Figure). Recirculation rate was also evaluated, which indicates the rate of the recirculation to LVAD output. Results: The Co-pulse mode and the Counter-pulse mode increased the pulse pressure, and successfully decreased the pressure difference between the aorta and the LV with significant difference. Although the mean pressure differ- ence tended to be less in the Co-pulse mode, the recirculation rate was more decreased in the Counter-pulse mode. The pressure difference was not associ- ated with the recirculation rate at the respective moment in acute model. Conclusion: The ESRSM successfully enhanced the pulsatility, and decreased the pressure difference, which can be expected chronic effects. The Counter- pulse mode can reduce the recirculation rate even in the acute experiment, being expected quick effect.