252 Nursing and Allied Health Professions Investigator Award / Unmet needs and future directions around TAVI 1256 | BEDSIDE Family involvement in decisions concerning implantable cardioverter de?brillators: results from an international survey L.M. Hill 1 , S. McIlfatrick 2 , B. Taylor 3 , P.F. Slater 3 , T. Jaarsma 4 , A. Stromberg 4 , D. Fitzsimons 5 . 1 Queen?s University of Belfast and Belfast Health and Social Care Trust, Belfast, United Kingdom; 2 University of Ulster, Jordanstown, and All Ireland Institute of Hospice and Palliative Care, Belfast, United Kingdom; 3 University of Ulster, Jordanstown, United Kingdom; 4 Linkoping University, Linkoping, Sweden 5 Queen?s University of Belfast and All Ireland Institute of Hospice and Palliative Care, Belfast, United Kingdom Background: European and International expert guidelines recommend patients? with an Implantable Cardioverter De?brillator (ICD) and their families are informed about deactivation. Recent empirical studies demonstrate diverse professional opinion regarding the involvement of family in the discussion about deactivation to dying patients. Purpose: To determine the impact of family involvement on healthcare professionals? decision to discuss ICD deactivation. Methods: Data from a systematic review, retrospective case note review and ten case studies identi?ed social support as an important factor or Independent Variable (IV). The IV was classi?ed into three levels, before being randomly assigned within vignettes of a factorial survey. The anonymised survey consisted of six vignettes, a demographic questionnaire and an opportunity for participants to record their most ?recent case?. The survey was distributed electronically through a secure IT platform to healthcare professionals across Europe and America. Analysis included descriptive statistics, in addition to Multiple Regression and ANOVA to identify correlations between social support as an IV and two dependent variables. Thematic analysis was conducted on the qualitative data obtained from ?recent cases?. Results: A total of 1614 vignettes were completed by 269 professionals (168 nurses, 64 clinicians, 37 allied health professionals), mean age 46 years (range 26?65 years) with majority from Europe (n=217, 81%). Social support did not impact the likelihood of professionals? to discuss ICD deactivation (p=0.740). However, professionals who managed patients living with a family member who shared healthcare decisions with them, were signi?cantly more con?dent (p=0.014) in discussing deactivation, compared to professionals caring for patients with no family support. Almost half of participants (N=35; 44%) who provided a recent case documented family involvement. This ranged from a supportive shared role ?wife was terri?ed of seeing her husband shocked on his deathbed, contributing to a decision? (Healthcare Professional 1) to that of a surrogate decision-maker ?family made the decision to deactivate the ICD as death was clos? (Healthcare Professional 2). Conclusions: Family members can play an important role in the decision whether to deactivate an ICD, however this is contingent on their knowledge and previous involvement. Professionals should ensure families are involved in discussions and encourage shared decision-making. Further research is needed into the interventions required to support family members, ultimately improving end-of- life care for patients with an ICD. Acknowledgement/Funding: Work Supported by Public Health Agency, HSC Research and Development division. Awarded HFA Nurse Fellowship grant 2014 male, and the mean logistic EuroScore was 20�%. TAVI procedures were most commonly performed transfemorally (88%). A total of 207 patients (15.2%) had residual more-than-mild PVR after TAVI. Compared to patients with no/mild PVR (n=1158), those with more-than-mild PVR were more commonly male (55.6% vs. 40.3%, p<0.001), had a higher logistic EuroScore (22�% vs. 20�%, p=0.02), were more commonly treated through the transfemoral route (92.8% vs. 87.1%, p=0.02), and more commonly received the self-expanding CoreValve prosthesis (91.8% vs. 80.4%, p<0.001). In-hospital and 1-year mortality were signi?cantly higher in patients with more-than-mild PVR as previously reported (14.5% vs. 6.7%, p<0.001, and 30.8% vs. 19.8%, p<0.001, respectively). The worse outcome of patients with more-than-mild PVR persisted up to 5 years, with a 5-year mortality rate of 72.7% compared to 56.5% in patients with no/mild PVR (p<0.001). After adjustment for various confounders, residual more-thanmild PVR remained independently associated with mortality at 5 years (odds ratio 1.52, 95% con?dence interval 1.24?1.85, p<0.001). Conclusion: In the early TAVI experience using ?rst generation devices, residual more-than-mild PVR was common. The negative impact of PVR on in-hospital and one-year mortality persists up to 5 years, implicating that these patients should be followed-up closely and offered treatment options if possible. 1281 | BEDSIDE Delayed pacemaker requirement after transcatheter aortic valve implantation with Sapien 3 - How long should we monitor? F. De Torres Alba, G. Kaleschke, J. Vormbrock, M. Feurle, W. Stepper, R. Radke, S. Orwat, H. Reineke, D. Fischer, H. Deschka, G.-P. Diller, H. Baumgartner. University Hospital Muenster, Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, Muenster, Germany Introduction: How long pts remain at risk to develop conduction abnormalities (CAs) requiring pacemaker (PM) implantation after transcatheter aortic valve implantation (TAVI) and should therefore be monitored remains controversial. Methods: We studied the development CAs in 697 consecutive pts treated with Sapien 3 between January 2014 and January 2017. After excluding valve-in-valve procedures (n=15), transapical implantations (n=36) and pts with previously implanted PM (n=75) 574 pts remained for analysis. All patients were monitored for at least 7 days. Results: Of 574 pts, 193 (34%) developed new conduction abnormalities and 71 (12%) required a permanent PM after TAVI. CAs requiring PM implantation occurred intraprocedurally in 31pts (44%) while in the remaining 55% they developed with some delay although frequently within 48h (Figure). However, CAs requiring PM implantation occurred after 48h in still 21% (15 pts) and in 10% (7 pts) even after 5 days. We analyzed the presence of previous CAs and the development of new low grade CAs in pts still free from PM indications at 48h after TAVI (n=518) in order to identify characteristics that may predict delayed PM requirement (Table). A pre-existing right bundle branch block was the only characteristic signi?cantly associated with development of high grade CAs after 48h (26.7% vs 6.2%, p=0.014). Of the pts who developed high grade CAs requiring PM after 48h, 47% had no CAs prior to TAVI, and 27% had neither pre-existing CAs nor newly developed low-grade CAs within the ?rst 48h. Pts free of high grade CAs 48h after TAVR (N=518) UNMET NEEDS AND FUTURE DIRECTIONS AROUND TAVI 1280 | BEDSIDE Long-term impact of prosthetic valve regurgitation after transcatheter aortic valve implantation: a 5-year follow-up analysis from the German TAVI registry M. Abdel-Wahab 1 , N. Werner 2 , A. Linke 3 , H. Sievert 4 , P. Kahlert 5 , R. Hambrecht 6 , G. Nickenig 2 , K.E. Hauptmann 7 , S. Sack 8 , S. Schneider 9 , U. Gerckens 10 , G. Richardt 1 , R. Zahn 11 . 1 Heart Center, Segeberger Kliniken, Bad Segeberg; 2 University Hospital Bonn, Bonn; 3 Heart Center of Leipzig, Leipzig; 4 CardioVascular Center Frankfurt, Frankfurt am Main; 5 University of Duisburg-Essen, West German Heart Center, Essen; 6 Hospital Links der Weser, Bremen; 7 Krankenhaus der Barmherzigen Br黡er, Trier; 8 Municipal Hospital of Munich, Munich; 9 Stiftung Institut f黵 Herzinfarktforschung, Ludwigshafen; 10 St. Petrus Hospital, Bonn; 11 Hear Center Ludwigshafen, Ludwigshafen, Germany Background: Paravalvular prosthetic valve regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is becoming less frequent, but more than mild forms have been systematically associated with higher mortality at short- and intermediate-term follow-up. Little is known about the impact of PVR on long-term outcome after TAVI. Purpose: To examine the relationship between more-than-mild PVR after TAVI and long-term mortality. Methods: The German TAVI registry includes data on 1444 patients treated between January 2009 and June 2010 at 27 centres in Germany. Long-term followup at a mean duration of 4.5 years was obtained for 1378 patients (95.4%). Of these, the degree of residual PVR was available in 1365 patients, which constitute the population of the current study. Patients were divided based on PVR into those with no/mild forms and those with more-than-mild PVR. Results: The mean age of the study population was 81.8�1 years, 42.6% were Age (yrs) Gender (n of men, %) No previous CAs (n, %) ? Previous AVB1 (n, %) ? Previous RSB (n, %) ? Previous LSB (n, %) New postprocedural low grade CAs (n, %) No previous and no new postprocedural CAs within 48h (n, %) p No development of high grade CAs (N=503) Development of high grade CAs (N=15) 81�288 (57.2%) 327 (65%) 90 (17.9%) 31 (6.2%) 81 (16.1%) 128 (25.4%) 83�7 (46.7%)0.436 7 (46.7%) 3 (20%) 4 (26.7%) 3 (20%) 3 (20%) 0.385 0.436 0.144 0.741 0.014 0.721 0.771 236 (46.9%) 4 (26.7%) 0.188 Conclusion: In this study, in pts requiring PM implantation after TAVI, the high grade CAs occurred after 48h in 21% and even after 5 days in 10% of pts. More importantly, 27% of pts eventually requiring a PM had still no CAs at 48h. These results question the safety of early discharge and support monitoring for approximately 7 days.