Surgical insertion of a catheter-based left ventricular microaxial flow pump for cardiogenic shock

Catheter-based left ventricular microaxial flow pumps are temporary mechanical circulatory support devices. Surgical insertion is usually done under general anaesthetic. The microaxial flow pump catheter is inserted using a surgically implanted end-to-side graft onto the axillary artery through an infraclavicular incision. The catheter is advanced into the ascending aorta, across the aortic valve and into the left ventricle, guided by fluoroscopic or echocardiographic imaging. Alternatively, the pump can be surgically inserted directly into the aorta, through a sternotomy or thoracotomy. Once it is in position, the pump delivers blood from the inlet area, which sits inside the left ventricle, through a cannula to the outlet opening in the ascending aorta. A wired console controls the pump speed, and monitors its function and position. The procedure is intended to be used for a period of days to a few weeks.

The aim is to reduce ventricular work and provide the circulatory support needed to allow the heart time to recover from an acute injury. It can also be used as a bridge to longer-term treatments, such as a heart transplant or implantation of a durable left ventricular assist device.

Smaller pumps can be inserted percutaneously. This is covered by NICE's HealthTech guidance on percutaneous insertion of a catheter-based microaxial flow pump for cardiogenic shock.