With the implementation of the new allocation system in the United States on October 18, 2018, patients requiring temporary mechanical circulatory support (tMCS) have the highest priority, a shorter waitlist time, and a higher frequency of heart transplantation (HT).¹ Unsurprisingly, there has been a significant rise in the use of tMCS following the policy change including use of the intraaortic balloon pump (IABP).¹ Transfemoral IABP implantation is the most utilized form of percutaneous tMCS while awaiting HT and implantation of durable left ventricular assist device (LVAD). However, this approach leaves patients bed-bound and increases deconditioning and frailty while awaiting transplantation. An alternative approach utilizing percutaneous axillary arterial implantation has shown promise to maintain IABP support while awaiting HT/LVAD and offers mobility.² However, adverse events are frequent and include need for exchange or repositioning (37%), hematoma (5%), infection (9.2%), and bleeding requiring transfusion (2.6%) and even migration into the left ventricle.^2,3 Unique complications, including upper extremity and mesenteric ischemia are also possible.

Beyond this, the need for a unique skillset for axillary IABP implantation limits widespread use and availability. By contrast, the femoral approach is readily available, requires less specialized techniques, and has lower complication rates.⁴ Preliminary experience from two centers using similar protocol showed that ambulation of such patients is both safe and feasible.^5,6 Accordingly, we undertook ambulation of patients with femoral IABP while awaiting heart transplantation at our center. Herein, we report our experience with ambulation of patients with a novel nonrestrictive ambulation protocol which facilitated greater ambulation distances, increased patient satisfaction and required fewer resources. We also include media demonstrating the process of ambulation at our center to enable other centers undertake same.