<h3>Purpose</h3> Implanting Centers (IC) provide higher standard of care for LVAD patients compared to other facilities. The study aimed to analyze the impact of the distance between the LVAD patient residency and IC on outcomes. <h3>Methods</h3> All patients discharged from 5 Italian Centers after LVAD implantation from 2010 to 2020 were divided into 2 groups by the distance from IC: A<100 Miles (n=175) and B>100 Miles (n=141). Patients were followed-up regularly by VAD Teams. Primary end-point was freedom from Adverse Events (AEs), a composite outcome including death and device-related complications. Secondary end-points included event rates for mortality and complications. <h3>Results</h3> Baseline clinical characteristics and indications for LVAD did not differ between the two groups (Table). Group A patients received more centrifugal flow pump (p=0.02). During a mean time of 23±18 months, Group B was more likely to receive Heart Transplantation compared to Group A (27% vs 14%, p=0.01). Freedom from AEs at 3 years was 51% and 43% for Group A and B, respectively (p=0.32), Fig A. Event-rates complications for patients on pump were similar between the two groups, as shown in Fig B. <h3>Conclusion</h3> A distance >100 Miles from IC does not represent a risk factor for worse outcomes at mid-term follow-up. Different factors (strict follow-up protocols and/or telemedicine) could justify satisfactory results independently from patient residency. The higher rate of heart transplantation in group B could be related to different allocation policies among IC.