# Skin grafting while preconditioning with microaxial flow pump: case report of a successful bridge to candidacy approach

## TL;DR

A patient with severe heart failure and skin ulcers was successfully treated using a microaxial flow pump to improve circulation and enable skin grafting before heart transplant.

## Contribution

Demonstrates successful use of mAFP to precondition a patient for heart transplant via improved wound healing and decongestion.

## Key findings

- mAFP enabled effective decongestion and microcirculation improvement in a complex heart failure patient.
- Split-thickness skin grafting was successfully performed during mAFP support, leading to wound healing.
- The patient eventually underwent successful heart transplantation after being listed as high urgency.

## Abstract

Microaxial flow pumps (mAFP) are a well-established treatment modality for patients in cardiogenic shock, significantly improving haemodynamic and end-organ-function. In complex heart failure patients currently ineligible for advanced heart failure therapies, such as durable left ventricular assist device (dLVAD) implantation or heart transplantation (HTx), mAFP can serve as a preconditioning tool in a bridge-to-candidacy strategy.

A 61-year-old male patient with known dilatative cardiomyopathy and multiple comorbidities presented in cardiogenic shock, accompanied by end-organ dysfunction, fluid overload, and the need for moderate catecholaminergic support. Bilateral lower limb stasis dermatitis with infected ulcers excluded advanced heart failure surgery. Initial management included high-dose diuretics, paracenteses and pleural drainage. To further improve microcirculation and optimize conditions for ulcer treatment, ongoing haemodynamic support was escalated through the implantation of a full-support transaxillary mAFP. Comprehensive wound care was initiated with successful split-thickness skin grafting during ongoing mAFP support. Given favourable wound healing, the patient underwent uncomplicated dLVAD implantation. Early postoperative right heart failure necessitated continued inotropic support. Following high-urgency HTx listing the patient was successfully transplanted eight months later.

Medium-term full-support mAFP provided robust circulatory output, enabling effective decongestion and wound healing in a bridge-to-candidacy approach.