Extracorporeal life support (ECLS) is an expanding technology for patients in cardiogenic shock. Most patients requiring ECLS can be managed with percutaneous veno-arterial (VA) femoral cannulation. Despite sufficient extracorporeal circulatory support, an unclear number of patients develop left ventricular distension which can result in increased wall tension and stress as well as worsening pulmonary edema. Indications to vent the left ventricle can be controversial. When venting is indicated a number of additional procedures may be considered including inotropic support, intra-aortic balloon pump, Impella, balloon atrial septostomy, or placement of a transseptal cannula. We present a unique case of a femoral VA Extracorporeal membrane oxygenation (ECMO) as bridge to transplant (BTT) with left-sided venting using a Bio-medicus NextGen cannula (Medtronic) with a transseptal approach.