361 VAD-Related Complications Do Not Influence Long-Term Post- Transplant Survival – An Analysis of the UNOS Database A. Healy, 1,2 B.C. Baird, 1 C. Weng, 1 J. Stehlik, 1,3 C.H. Selzman. 1,2 1 UTAH Cardiac Transplant Program, Salt Lake City, UT; 2 Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT; 3 Division of Cardiology, University of Utah, Salt Lake City, UT. Purpose: Although current VAD technology has proved more durable and less morbid than first generation devices, all mechanical devices are prone to device-related complications that can elevate their acuity prior to trans- plantation. This group of patients intuitively carries a higher risk profile than other Status IA VAD patients that are generally stable and utilize their “free” 30-day IA time. We sought to determine if the condition of the VAD patient influences post-transplant survival. Methods and Materials: The UNOS database was retrospectively ana- lyzed for 15,000 patients that were listed Status IA from 1998-2008. Post transplant survival and waitlist survival were compared between patients listed for VAD complications and those VAD patients that did not have VAD-related complications. All cause mortality was calculated using Ka- plan-Meier techniques and subsequently analyzed with Cox proportional hazard regression. Results: At both 1 and 10 years post-transplant, no differences in unadjusted and adjusted survival were identified in patients that had device complications com- pared to those without complications. Of the five specific complication entries – thromboembolism, infection, malfunction, malignant arrhythmias, and other – only device infection increased mortality risk more than the non-complicated VAD patient (34% at 1 year, 25% at 10 years, p0.01). Conversely, and perhaps unexpectedly, patients with device malfunction actually had a 22% increase in 10 year survival compared to those without dysfunction (p=0.05). Finally, patients with malignant arrhythmias had a trend of decreased 1 year survival, quite possibly due to the need for biventricular support. Conclusions: Long-term outcomes are not affected by the status IA listing cri- teria for patients bridged to transplant with VADs. Device infection portends a worse 1-year, but not 10-year survival. Bridge to transplant patients, despite serious device-related complications, still have excellent transplant outcomes. 362 Bridge to Candidacy: A Fulfilled Promise? S. Emani, 1 J.B. Young, 2 M. Acker, 3 A. Mangi, 4 J.C. Cleveland, 5 M.A. Miller, 8 D.C. Naftel, 6 J.K. Kirklin, 6 A. Cannon, 9 A.K. Hasan, 1 C.B. Sai-Sudhaker, 1 B. Sun. 71 Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, OH; 2 Medicine, Cleveland Clinic Foundation, Cleveland, OH; 3 Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA; 4 Cardiothoracic Surgery, Temple University, Philadelphia, PA; 5 Cardiothoracic Surgery, University of Colorado, Aurora, CO; 6 Surgery, University of Alabama, Birmingham, AL; 7 Cardiothoracic Surgery, Minneapolis Heart Institute, Minneapolis, MN; 8 Advanced Technologies and Surgery Branch, National Institutes of Health/Heart Lung and Blood Institute, Bethesda, MD; 9 Cardiac and Vascular Services, University of Colorado Hospital, Aurora, CO. Purpose: The use of left ventricular assist devices as a Bridge to Trans- plant Candicacy (BTC) is increasingly common for potentially reversible contraindications to transplant (Txpl). Success rates of Txpl in this group are reported to be low. Our goal was to study the characteristics of successful Txpl in BTC patients. Methods and Materials: INTERMACS was searched for BTC patients implanted between June 2006 and March 2010. Patients were categorized by contraindication. Multivariate analysis was performed to identify pre- dictors of early vs. late Txpl. Results: 629 patients were identified as BTC. Collectively, 35% were successfully Txpled, with 18% being Txpled at 6 months. Groupings of patients are shown below. Multivariate analysis revealed obesity, alcohol abuse, and “other co-morbidity” as predictors of late Txpl. Recent PE and limited cognition were predictive of early Txpl while current infection and depression trended towards predictive. These predictors were used to group BTC patients by likelihood of success. Contraindication % of 629 % Txpl at 6 mths Large BMI 17.0% 7% Renal dysfunction 12.7% 13% Pulmonary hypertension 11.6% 18% Still smoking 9.9% 18% Limited social support 6.5% 12% Malnutrition/cachexia 4.6% 21% Alcohol Abuse 3.7% 0% Severe Diabetes 3.3% 14% Current Infection 3% 11% Limited cognition/understanding 2.9% 22% Risk of current infection 1.3% 25% Severe depression 0.5% 0% Frailty 8.3% 8% Other comorbidity 6.4% 3% Pulmonary disease 3.5% 9% Avanced age 3.2% 20% Recent pulmonary embolus (PE) 0.5% 67% Conclusions: The overall Txpl rate of 35% is consistent with previously reported data. Aggressive efforts should be made to improve BTC success rates, especially for medically reversible contraindications such as obesity, for which aggressive strategies may have the largest impact. 363 Continuous-Flow LVAD Destination Therapy Versus Orthotopic Heart Transplantation in Patients above 65 Years of Age S. Melnitchouk, 1 U. Jorde, 2 H. Takayama, 1 N. Uriel, 2 P. Colombo, 2 J. Yang, 1 D. Mancini, 2 Y. Naka. 11 Department of Cardiac Surgery, Columbia University Medical Center, New York; 2 Department of Cardiology, Columbia University Medical Center, New York. Purpose: Continuous-flow left ventricular assist devices (LVAD) are used as Bridge-to-Transplant (BTT) in heart transplant candidates and as Destination Therapy (DT) in patients who are not candidates for orthotopic heart transplanta- tion (OHT). The purpose of this study was to compare survival and postoperative outcomes following implantation of a continuous-flow LVAD (Heartmate II) versus performing OHT in patients above 65 years of age. Methods and Materials: Study included patients older than 65 years who underwent either de novo OHT or implantation of continuous-flow desti- nation LVAD between 4/2005 and 11/2010. Preoperative demographic data, survival, and major postoperative adverse events in both groups were collected and evaluated. Results: 19 LVAD patients and 28 OHT patients were studied. Patients who underwent LVAD implantation were significantly older (LVAD vs OHT (median, range): 72 [66 – 78] vs 68 [66 – 72], p = 0.0013). Thirty day, 6 months, and 12 months survival were 88.9% vs 96.4%, 83.0% vs 85.7%, and 83.0% vs 81.0% in the LVAD and OHT groups, respectively. One-year survival was comparable between both groups (log-rank test p  0.928). ICU stay and total length of postoperative stay were significantly longer in the LVAD group (median 8 days and 31.5 days in the LVAD group vs 4 days (p=0.0006) and 18.5 days (p=0.018) in the OHT group). Postoperative adverse events were comparable between both groups. S125 Abstracts