A 67-year-old male presented in cardiogenic shock and multi-system organ failure requiring emergent venous-arterial extracorporeal membrane oxygenation (ECMO). He was deemed ineligible for heart transplantation and a left ventricular assist device (LVAD) was thought to be high risk due to persistent right heart failure. To determine if he could tolerate left ventricular support alone, a trans-septal cannula was placed via the left femoral vein. Transition from veno-arterial ECMO to isolated left-sided support allowed for risk assessment for LVAD implantation and extubation, providing the patient an opportunity to participate in further clinical decision making.
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