Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is a life-saving method for patients with low-output failure after cardiac surgery. Although the use of VA-ECMO after cardiac surgery is rapidly evolving, in-hospital mortality remains high [1]. VA-ECMO therapy efficiently improves organ perfusion and oxygenation. However, the advantages of VA-ECMO for peripheral perfusion are associated with drawbacks on cardiac hemodynamics and coronary perfusion. VA-ECMO support increases left ventricular afterload due to retrograde blood flow in the aorta towards the left ventricle, resulting in further increased left ventricular filling pressures and distension of the left ventricle on top of the already high pressures and volume of the failing left ventricle.
