Surgical Implantation of Micro-Axial Flow Pumps Using Analgosedation with Local Anesthesia

Background: Surgical implantation of microaxial flow pumps (mAFP) is typically performed under general anesthesia with orotracheal intubation. However, for patients not on invasive ventilation prior to surgery, using analgosedation combined with local anesthesia may offer a less invasive alternative. This study evaluates patient outcomes following this technique.

Methods: This retrospective, single-center study reviewed patients treated with mAFP from January 1, 2023 to June 30, 2024. During this period, of the 188 mAFP implantations, 34 patients underwent mAFP implantation under local anesthesia, but one patient refused data sharing, so 33 were included in the final analysis.

Results: Most patients were male (76%), with a median age of 62 years (37–72 years). The commonest causes of cardiogenic shock were dilated cardiomyopathy (56%), followed by ischemic cardiomyopathy (24%) and other causes (20%). Patients were classified into SCAI SHOCK stages, with the following distribution: 1 patient (3%) in stage A, 2 patients (6%) in stage B, 23 patients (70%) in stage C, and 7 patients (21%) in stage D. Most patients (56%) underwent mAFP implantation alone, while 8 patients (24%) required an additional venoarterial extracorporeal membrane oxygenation. The primary implantation site for the mAFP was the right axillary artery (97%). Prior to surgery, the average lactate level was 18.5 mg/dL (4–90), and except for three patients, all received inotropes and vasopressors (VIS: 11.75 [0–100]). Sedation was achieved using remifentanil (82%), dexmedetomidine (12%), and midazolam (6%), often in combination. Local anesthesia was administered with 2% lidocaine at the implantation site. Two patients required conversion to general anesthesia due to respiratory issues. By the first postoperative day, two patients (6.1%) were able to stand, and 16 patients (48.5%) could be mobilized to the edge of the bed. Complications during the hospital stay included one patient requiring surgical revision for hematoma, two patients needing thrombolytic therapy for suspected mAFP thrombus, and one patient experiencing distal arm ischemia, necessitating contralateral implantation. Hospital mortality rate was 27%, with 56% mortality following a palliative approach.

Conclusion: mAFP implantation using analgosedation and local anesthesia presents a feasible and effective option. This approach may support early mobilization and oral nutrition. However, further randomized studies are required to comprehensively assess its safety.

Publication History

Article published online:
11 February 2025