Introduction
The number of heart-lung transplants (HLT) remained static during the last five years, with 59 procedures in 2017.1Currently, most of the HLTs are performed on patients with severe pulmonary hypertension associated with congenital heart disease, followed by idiopathic pulmonary arterial hypertension (IPAH) and cystic fibrosis (CF). There is also a small trend showing an increasing number of HLTs performed for idiopathic interstitial pneumonia (IIP).2 Some of these patients are critically ill on the waiting list, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be used as a bridge to transplantation. The evidence to support this strategy is limited but evaluation of the outcomes is crucial, especially with the new heart status allocation system.3 Traditionally, ambulation was considered too dangerous with femoral cannulation. We present the case of a 56-year-old male with interstitial lung disease (ILD) and severe secondary pulmonary hypertension, who was successfully bridged to HLT with ambulatory femoral VA-ECMO.