LAUSR

Historically, extracorporeal membrane oxygenation (ECMO) as a bridge to heart transplantation was utilized in less than 1% of transplant recipients and had a 1‐year survival of 70%. Beginning in October 2018, the new heart allocation system significantly increased the usage of ECMO among heart transplant recipients from 1.6% to 6.5%. This represents a critically ill cohort that is temporized on ECMO to either help recover from cardiogenic shock or to allow completion of transplant workup and the final decision about transplant candidacy. This cohort requires a delicate balance between continued hemodynamic support on ECMO while minimizing the adverse effects and physical deconditioning from immobility. Two case reports discuss cannulation techniques that permit ambulation while on venoarterial (VA)‐ECMO. One report utilized the axillary artery and the other used a sternotomy and limited thoracotomy to achieve central cannulation. In our report, we present a minimally invasive approach to central cannulation that does not violate the pericardial space and allows for uninhabited planes at the time of subsequent heart transplantation.