Visual Summary.

Timeline of the Case

Timeline	Event
Day 1	A 64-year-old man presented with ventricular tachycardia requiring advanced life support. Echocardiography showed severely reduced left ventricular ejection fraction with low-flow, low-grade aortic valve stenosis. Coronarography revealed triple-vessel disease with critical left main stenosis. Patient underwent combined CABG (4 bypasses) and AVR and required maintained support by venoarterial ECMO.
Day 2	In the coronary care unit with progressive pulmonary edema. Echocardiography showed sign of left ventricular overload with scarce opening of the aortic prosthesis due to ECMO flow. Decision for mechanical support escalation to ECMO with Impella devices (ECPELLA, Abiomed).
Day 20	ECMO removal
Day 22	Tracheostoma
Day 26	Subarachnoid hemorrhage
Day 30	Impella 5.5 was removed.
Day 40	Patient was discharged to rehabilitation facility

AVR = aortic valve replacement; CABG = coronary artery bypass graft; ECMO = extracorporeal membrane oxygenation.