UNLABELLED: Advanced heart failure (HF) often requires support with vasoactive drugs and mechanical assist devices, such as the intra-aortic balloon pump (IABP), particularly in cases of cardiogenic shock. Heart transplantation is the definitive therapy but is limited by the scarcity of available donors. Traditionally, the IABP is inserted via the femoral artery, which restricts patient mobility and prevents participation in rehabilitation programs. Axillary access may allow ambulation and physical activity during hospitalization, potentially contributing to improved physical condition before transplantation. AIM: To describe clinical and laboratory changes, as well as complications associated with the use of axillary IABP in hospitalized patients with advanced HF awaiting heart transplantation. METHODS: A retrospective case series was conducted based on anonymized medical records of patients hospitalized between January 2020 and December 2024 at a Chilean hospital, in whom axillary IABP was used as a bridge to transplantation. Clinical, hemodynamic, and laboratory parameters before and after device implantation were analyzed, along with associated complications. RESULTS: Eight male patients were included, with a mean age of 46.6±12,8 years. A reduction in mean pulmonary artery pressure was observed (48.6±4,6 to 44.75±12,5 mmHg), as well as an increase in cardiac output (3.65±0,72 to 4.15±0,55 L/min) and a decrease in pulmonary vascular resistance (from 4.61±2,05 to 3.9±0,57 Wood units). There was evidence of stabilization of renal function, a decrease in B-type natriuretic peptide (BNP), and mild, transient hepatic dysfunction. The most frequent complications were displacement (38%) and balloon rupture (38%), with no associated mortality. DISCUSSION: Patients undergoing axillary BCPIA as a bridge to heart transplantation show hemodynamic and functional improvement and preservation of mobility in patients with advanced HF, with a clinically manageable complication rate.