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.