Heart retransplantation remains a controversial issue, due to the overall shortage of donor organs. Many patients put on the waiting list for retransplantation, decompensate rapidly, and do not survive. The use of veno-arterial
extracorporeal life support remains an option in such emergency situations as bridge-to-recovery or bridge-to-
transplantation therapy. In peripheral femoral configuration, veno-arterial
extracorporeal life support improves the patient's condition by relieving
low-cardiac output but immobilizes him or her for an uncertain period of time. The upper-body cannulation is an alternative approach, which allows to maintain the patient awake and mobile. We present two cases of midterm circulatory support as a bridge to heart retransplantation, using upper-body cannulation veno-arterial
extracorporeal life support. Two male patients, presenting with progressive cardiac decompensation due to severe graft rejection, were placed on upper-body veno-arterial
extracorporeal life support. The stabilization of hemodynamics and improvement of end-organ perfusion could be achieved after
extracorporeal life support initiation. After 48 and 40 days, respectively, on
extracorporeal life support with active
physical therapy and no major adverse events, both patients received a cardiac retransplantation and were eventually discharged home. The presented cases are the first reported where a successful cardiac retransplant was performed following prolonged upper-body
extracorporeal life support.