Background: The pulsatile Aeson Total Artificial Heart (TAH) employs embedded sensors to autoregulate the response of the device to changing patient needs. These sensors are also used to monitor the Pulmonary Vascular Resistance (PVR) in patients supported by the TAH whose major contraindication to transplantation is an elevated PVR. The efficacy of this facility was evaluated during the course of a recent Bridge To Transplant study (NCT02962973). Methods: Pressure records from the right and left ventricular pressure sensors and pump output records are downloaded from the TAH and averaged at 30-day intervals. The effects of vasodilative medication provide guidance on the ongoing reversibility of the Trans Pulmonary Resistance (TPR), calculated as below. TPR = (mRightOutputPressure-mLeftInputPressure)/RightPumpOutput) This provides an estimate of the true PVR, as the measurements are made within the prosthesis, but the trends and responses to medication are helpful for medical decision-making (figure). Results: The BTT study comprised 3 patients aged 60, 35 and 54 years, with pre-implant Cardiac Index 2.1, 1.4 and 1.7 L/min/m2 and PVR values of 5.2, 4.4 and 6.0 Wood Units respectively. The average range of TAH outputs was 4.5 to 6.5 L/min. Patients were discharged at 68-, 48- and 48-days post implant and all experienced improved exercise capacities and resumed their daily activites. Medication included mild anticoagulation with enoxaparin 1 mg/kg and aspirin 100 mg daily. Implant durations were 243, 155, and 109 days, when all demonstrated a decrease in TPR and were considered transplant eligible (Table). The transplant procedures were uncomplicated. No right heart failure was observed. The first patient had late complications comprising pneumonia and multiorgan failure and died at 111 days post-transplant. The remaining two were doing well at 1 year follow-up. Conclusion: The integrated PVR monitoring system incorporated in the Aeson TAH provides a useful guide to manage patients with pulmonary hypertension and assess their transplant-eligibility. Table 1. - Transpulmonary Resistance Time Patient 1 Patient 2 Patient 3 Implant day 7.0 6.8 7.9 Post-implant day 30 5.6 5.5 7.0 Post-implant day 60 5.1 5.2 7.4 Post-implant day 90 5.5 5.1 6.5 Last day before Transplant 5.6 5.3 6.5 Values expressed in Wood Units