Percutaneous 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. Percutaneous insertion is typically done through the femoral artery, under general anaesthetic or sedation with local anaesthesia. The microaxial flow pump catheter is advanced into the ascending aorta, across the aortic valve and into the left ventricle, guided by fluoroscopic or echocardiographic imaging. Once it is in position, the catheter-based 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. Different blood flow rates can be achieved, depending on the power of the pump that has been implanted.

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.

Some pumps can be surgically inserted using a graft cut-down technique through the axillary or subclavian artery, or through a direct aortic approach using a sternotomy or thoracotomy. This is covered by NICE's HealthTech guidance on surgical insertion of a catheter-based microaxial flow pump for cardiogenic shock.

The procedure can also be used as support during high-risk percutaneous coronary intervention. This is covered by NICE's HealthTech guidance on percutaneous insertion of a temporary heart pump for left ventricular haemodynamic support in high-risk percutaneous coronary interventions.