Introduction: Favorable outcomes with continuous flow devices (CFD) have enticed clinicians to implant CFD in patients smaller than the suggested body surface area (BSA) criteria of >1.5 m 2 . Despite limited data, the VAD community is using CFD in patients down to a BSA of 0.7m 2 . For this reason, we sought to examine the use of CFD in adults with BSA ≤1.5 m 2 and compare outcomes to adult patients with BSA >1.5m 2 . Methods: CFD implants in adults (>18 years) from 04/2008 to 09/2014 were identified using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database. Patients were divided into two cohorts based on BSA. Patient characteristics and post implant outcomes including mortality, transplant, and adverse events were compared between the two cohorts. Results: Of adults (11142) undergoing CFD implants 2% (239) had BSA of ≤1.5m 2 ; BSA median 1.4m 2 [0.76 – 1.5 m 2 ]. One patient had BSA <1.0m 2 , 6% (15) 1.0-1.2m 2 and 93% (223) >1.2-1.5m 2 . Pre-implant patient characteristics were similar between the two groups except gender and INTERMACS profile [Table]. Overall survival (p=0.8) and favorable outcomes at 1-year were similar between the two groups; however, fewer patients with BSA ≤1.5m 2 were transplanted (p<0.01) [Figure]. There were more bleeding events and infection; however, less renal dysfunction and right heart failure in patients with BSA ≤1.5m 2 [Table]. Conclusion: CFDs can be safely used in smaller adult patients. The outcomes are favorable but clinicians must be mindful that the adverse event profile is different in smaller patients. These results are reassuring for the recent trend in the VAD community for placing CFDs in smaller patients.