Can Paracorporeal Bi-VAD Improve the Outcome of a Patient Candidate for Heart Transplant?

Background: Postcardiotomy cardiogenic shock (PCCS) is a critical condition with high mortality. When biventricular dysfunction occurs, veno-arterial ECMO alone may not provide adequate unloading. Paracorporeal BiVAD can offer balanced support as a bridge to heart transplantation. Case: A 61-year-old woman developed PCCS following bioprosthetic aortic valve replacement. Despite VA-ECMO and intra-aortic balloon pump support, biventricular failure persisted. A paracorporeal BiVAD was implanted, achieving rapid hemodynamic and pulmonary improvement. After 7 days of BiVAD support, she underwent successful orthotopic heart transplantation. At 1-year follow-up, the patient remains alive without graft rejection or vasculopathy. Conclusion: Early conversion from VA-ECMO to BiVAD may improve outcomes in refractory PCCS with biventricular failure, serving as an effective bridge to transplantation.