Mechanical circulatory support (MCS) has become an essential intervention in the management of advanced heart failure, particularly when conventional therapies such as inotropic agents or intra-aortic balloon pump fail to provide adequate hemodynamic support. Additionally, patients presenting with acute cardiogenic shock may benefit from timely MCS initiation. However, the optimal timing of MCS deployment and the most appropriate device choice—whether extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD)—remain subjects of ongoing debate. In this report, we present two cases of patients who successfully underwent heart transplantation following early MCS implementation. These cases highlight the critical importance of early intervention, suggesting that prompt MCS initiation may significantly improve survival outcomes in select patients awaiting heart transplantation.

Alexandru Mihai Cornea is an experienced cardiothoracic surgeon with over 20 years of practice in cardiac surgery in Romania and more than a decade of dedicated involvement in heart and lung transplantation at the Mater Misericordiae University Hospital in Dublin, Ireland. Throughout his career, he has actively contributed to the advancement of cardiothoracic surgery, with clinical and academic interest in mechanical circulatory support, heart and lung transplantation, and the management of pulmonary hypertension. Dr. Cornea is a committed educator and researcher, serving as coauthor of seven specialized textbooks in cardiac surgery and contributing to numerous scientific articles and international presentations. His work has consistently focused on improving outcomes for patients with end-stage cardiac and pulmonary disease, especially in the fields of advanced heart failure and transplantation surgery.