. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S206 Abstracts Background: Radial access for PCI consistently offers more favourable results, when compared with femoral access. However, among patients with absent bilateral radial pulses it remains unclear whether the clinical benefits observed with transradial intervention are transferrable to ulnar access. The Case: A 65-year-old man with severe peripheral vas- cular disease, bilateral aorto-iliac bypass grafting, severe LV dysfunction (EF 33%) and progressive crescendo angina came forward for invasive assessment. In the absence of bilateral radial pulses, access was gained into his right ulnar artery using a standard 5-in-6F Terumo radial Glidesheath. Fore- arm angiography demonstrated an occluded radial artery, with the ulnar artery being the dominant forearm ves- sel (image available). Coronary angiography demonstrated angiographically equivocal LMCA and proximal LAD dis- ease, an unobstructed circumflex and a chronically occluded dominant RCA. Using a 6F IL3.5 guide a pressure wire study of the LAD and LMCA was performed; at steady state FFR measured 0.55 in the mid LAD. PCI was performed; 2.75 x 24 Promus Element (LAD), 3.5 x 18 Xience Xpedition (LAD- LMCA). OCT confirmed an excellent intravascular result (images available). Despite accurate placement of a Terumo Radial band, ‘turned around’ to cover the ulnar puncture site, a small haematoma developed. He recovered well and was dis- charged home the following day. Conclusion: Among patients with absent bilateral radial pulses, the ulnar artery may represent a suitable alterna- tive. Further studies are required to fully understand the role of transulnar intervention. Finally, given the current lack of specifically designed ulnar closure bands, ulnar haematoma remains a significant problem. http://dx.doi.org/10.1016/j.hlc.2016.06.484 483 Tricuspid Valvuloplasty is an Effective Treatment for Bioprosthetic Tricuspid Valve Stenosis N. Gaikwad * , S. Townsend, K. Poon, C. Raffel, C. Hamilton-Craig, G. Scalia, D. Burstow, D. Radford, D. Walters The Prince Charles Hospital, Brisbane, Australia Background: Balloon valvuloplasty as is rarely used for the treatment of tricuspid stenosis from multiple aetiologies, as an alternative to surgical valvotomy. We present a single centre experience at The Prince Charles Hospital. Methods: 6 procedures were performed in stenotic bio- prosthetic valves, between 2009-2016. Indications for the procedure were signs and symptoms of right heart failure with tricuspid stenosis. Cases were obtained from the catheri- sation laboratory database. Further information was obtained by chart reviews and procedural reports. Results: Valvuloplasty balloons used were 2 Cristal bal- loons (Balt, France), 1 Nucleus balloon (Numed, US) and 3 Inoue balloons (Toray, Japan). All cases were performed via the femoral approach. Mean invasive gradients pre proce- dure were 11.6 mmHg (+/-3.34). Post procedure gradients were 4.5mmHg (+/- 1.14). 2 patients had severe tricuspid regurgitation post procedure, and were managed medically with good symptomatic relief. No other post-procedural complications were seen. Two patients had a recurrence of severe tricuspid stenosis. One of these had transcathe- ter tricuspid valve implantation 3 years post valvuloplasty with a Sapien S3 valve (Edwards Lifesciences, Inc., Irvine, California). One patient had surgical tricuspid valve replace- ment for increasing gradient with symptoms within 4 months of the procedure. Mean gradient at 1 year was 6mmHg on transthoracic echocardiography. One patient with multiple comorbidities, and shock with multiorgan failure prior to index procedure died at 22 days after procedure. Conclusion: Tricuspid valvuloplasty is an effective percu- taneous procedure for the treatment of symptomatic biopros- thetic tricuspid valve stenosis. http://dx.doi.org/10.1016/j.hlc.2016.06.485 484 Tropoelastin-Bound Plasma-Activated Stents Strikingly Reduce Thrombogenicity While Simultaneously Inhibiting Neointimal Hyperplasia S. Wise 1,* , M. Santos 1,2 , P. Michael 1 , J. Hung 1 , A. Weiss 3,4 , M. Bilek 2 , M. Ng 1,5 1 Heart Research Institute, Newtown, Australia 2 School of Physics, The University of Sydney, Camperdown, Australia 3 Charles Perkins Center, The University of Sydney, Camperdown, Australia 4 School of Life and Environmental Sciences, The University of Sydney, Camperdown, Australia 5 Royal Prince Alfred Hospital, Camperdown, Australia Background: The innate thrombogenicity and limited bio- compatibility of metallic stents has led to suboptimal safety outcomes and dependence on problematic dual antiplatelet regimens. We have developed a novel plasma-activated stent coating (PAC) that simultaneously promotes endothelialisa- tion while inhibiting neointimal hyperplasia and strikingly reducing stent thrombogenicity. Methods and Results: PAC is an integrated carbon/ nitrogen-based polymer layer which facilitates covalent attachment of bioactive molecules, thereby enabling func- tionalisation of the stent surface by binding of recombinant human tropoelastin (TE). TE is a major regulator of vascular biology in vivo. In comprehensive in vitro analysis, PAC+TE surfaces dramatically enhance endothelial cell attachment and proliferation, while simultaneously inhibiting smooth muscle cell proliferation to the same degree as sirolimus, with strikingly low thrombogencity. Translated to custom 316L stainless steel stents (BMS), PAC is an uninterrupted coating, highly resistant to delamination following crimp- ing and expansion (FigA). In an established rabbit model of bilateral iliac artery stenting (FigB), PAC+TE stents showed a significant reduction in neointimal area at 7 days (32.6±7.8%;p<0.001) relative to BMS. At 28 days this reduction was sustained (36.7±3.9%;p<0.001). In a baboon ex vivo shunt model of acute thrombogenicity, PAC+TE stents