Local Anesthesia and Analgosedation for Surgical Micro-Axial Flow Pump Implantation

Temporary mechanical circulatory support is recommended for cardiogenic shock management. Although surgical device implantation usually requires general anesthesia and orotracheal intubation with inherent hemodynamic risk, local anesthesia with analgosedation in spontaneously breathing patients offers a promising alternative. This retrospective, single-center study analyzed 374 patients receiving surgical implantation of a micro-axial flow pump (mAFP) between January 2023 and December 2024. Fifty (13.4%) of them were performed under local anesthesia. Of the 49 investigated patients, 79.6% were male, with a median age of 62 years (53-67). Cardiogenic shock was caused by dilated (51.0%) and ischemic (26.5%) cardiomyopathy. Preoperatively, 91.8% of patients required catecholamines, with a median vasoactive inotropic score of 11 (3.8-24.0) and a median lactate level of 1.9 (1.4-3.4) mmol/L. According to the SCAI Shock classification (SCAI), 49.0% of patients were classified as stage C and 38.8% as stage D. Ten patients (20.4%) received combined mAFP and venoarterial extracorporeal life support. Sedation was most commonly achieved with remifentanil, and lidocaine 2% was used for local anesthesia at the implantation site. Four patients required conversion to general anesthesia due to respiratory or cardiac complications. Procedure-related complications were infrequent (n = 6). Implantation of mAFP under analgosedation and local anesthesia appears to be feasible.