For decompensated advanced heart failure patients, the intra-aortic balloon pump (IABP) is a commonly used mechanical circulatory support (MCS) device used to support pharmacotherapy-refractory myopaths. In the United States, the heart allocation policy was revised in 2018, placing patients who may receive a clinically indicated temporary MCS device, like an IABP, at elevated medical urgency on the transplantation waiting list. Percutaneous transaxillary IABP delivery for the decompensated advanced heart failure patient is a safe, tolerable and efficacious alternative to traditional transfemoral deployment, and allows for ambulation and meaningful physical therapy engagement in the patient who may require an extended duration of support awaiting advanced therapies. We present two cases of percutaneous transaxillary IABP delivery via the Super Arrow-Flex braided sheath (Teleflex, Morrisville, NC) in advanced heart failure patients. The Super Arrow-Flex Sheath is a braided, durable, non-kinking conduit that can negotiate tortuous vascularity while maintaining its internal integrity; transaxillary IABP delivery through this sheath offers the patient a wide latitude of ipsilateral upper extremity movement and ambulation with minimal risk of damage to the IABP catheter. The Super Arrow-Flex sheath may improve transaxillary IABP security, durability and longevity in the advanced heart failure population for whom long-term IABP is anticipated.