Three different indications for left ventricular unloading in one patient with severe heart failure.

Background: The percutaneous microaxial flow pump (mAFP) is an established mechanical circulatory support (MCS) device for cardiogenic shock (CS) and can also stabilize hemodynamics during cardiac and noncardiac procedures. This case series describes the safety and feasibility of repeated mAFP use for three indications in a single patient. Methods: We retrospectively reviewed three consecutive mAFP deployments in one patient enrolled in the Hannover-Cardiac-Unloading-REgistry between October 2021 and August 2023. Indications included acute myocardial infarction-related CS (AMI-CS), ventricular tachycardia (VT) ablation one year later, and elective thyroidectomy for amiodarone-induced hyperthyroidism another year later. Results: A 62-year-old patient with ischemic cardiomyopathy (initial LVEF 34%) achieved hemodynamic stabilisation during AMI-CS, successful protected VT ablation without compromise, and stable perioperative support during thyroidectomy. No major adverse events occurred. Conclusions: Repeated mAFP use for AMI-CS, VT ablation, and high-risk surgery was feasible and safe, supporting its versatility in complex clinical care.