Background: Ventricular assist devices (VAD) are commonly used as a bridge to cardiac transplantation in patients with extremely poor ventricular function. More recently, destination therapy has been another indication for those who are not eligible for heart transplantation. The insertion of these devices has been associated with problematic and recurrent gastrointestinal (GI) bleeding. Angiodysplasia bleeding of the upper GI tract has been particularly challenging and requires further investigation to identify the most optimal therapy. Objective: To determine the most effective endoscopic and medical therapy of angiodysplasia bleeding in patients with VAD. Retrospective review of all patients with VAD and upper GI bleeding due to angiodysplasias from 2006 to 2010. Data collected included endoscopic and medical therapies, number of blood products given, coagulation parameters, surgical intervention and outcomes. Setting: Tertiary referral center with high volume VAD implantation. A total of 4 of patients were identified (2 males and 2 females). All 4 patients had non-pulsatile VAD (Thoratec Heartmate II). Average length of stay was 75 days. Location of bleeding was duodenal in 1 patient and gastric in 3 patients. Average number of blood transfusions required was 44.5 units. Average number of endoscopies was 4.5. Average INR at time of bleed was 1.41. All four patients were alive at 30 days after VAD implantation and 2 were alive at 6 months. All deaths were not directly related with GI bleeding (sepsis with severe ESRD and sudden cardiac arrest on same day of discharge). All 4 patients required APC in addition to Octreotide to control bleeding (See Table 1). GI bleeding in patients with VAD due to angiodysplasia is problematic and difficult to treat. It is associated with significant morbidity and blood transfusion requirements, particularly gastric angiodysplasia bleeding. Traditional endoscopic therapies seems not be that effective in this type of lesions. Combination therapy with intravenous octreotide and endoscopic argon plasma coagulation appears to be a successful approach but further prospective studies are needed.Table: [1366]