Ultrasound-Guided Axillary Block in an Anticoagulated Patient after Heartmate II Implantation


Objective: This case exemplifies the understanding of the physiological changes associate with 1) Left Ventricular Assist Devices, 2) monitoring challenges associated with Left Ventricular Assist Devices and 3) the usefulness of peripheral nerve blocks in this subset of patients. Case report: A 73-year-old man was scheduled for left wrist arthroscopy and debridement to treat a very painful septic joint. He had undergone Heartmate II Left Ventricular Assist Device implantation uneventfully for Destination Therapy 4 months prior. The patient required maintenance of therapeutic anticoagulation. We elected for an ultrasound-guided axillary block, which limits the risks of vascular injury in presence of high INR. The axillary nerve block enabled us to overcome potential anesthetic problems in a patient with a continuous flow LVAD. Conclusion: The physiologic principles of Left Ventricular Assist Device function should be understood before the initiation of anesthesia. Regional Anesthesiologists can offer a very significant contribution to the safe care of patients with heart failure requiring a continuous flow Left Ventricular Assist Device.

Share and Cite:

Trunfio, G. , Yaguda, B. , Saunders, P. and Feierman, D. (2014) Ultrasound-Guided Axillary Block in an Anticoagulated Patient after Heartmate II Implantation. Open Journal of Anesthesiology, 4, 159-162. doi: 10.4236/ojanes.2014.47022.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Rose, E.A., Gelijns, A.C., Moskowitz, A.J., Heitjan, D.F., Stevenson, L.W., Dembitsky, W., Long, J.W., Ascheim, D.D., Tierney, A.R., Levitan, R.G., Watson, J.T., Meier, P., Ronan, N.S., Shapiro, P.A., Lazar, R.M., Miller, L.W., Gupta, L., Frazier, O.H., Desvigne-Nickens, P., Oz, M.C., Poirier, V.L. and Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure Study G (2001) Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure. The New England Journal of Medicine, 345, 1435-1443.
[2] Kirklin, J.K., Naftel, D.C., Kormos, R.L., Stevenson, L.W., Pagani, F.D., Miller, M.A., Timothy Baldwin, J. and Young, J.B. (2013) Fifth INTERMACS Annual Report: Risk Factor Analysis from More than 6,000 Mechanical Circulatory Support Patients. The Journal of Heart and Lung Transplantation, 32, 141-156.
[3] Rogers, J.G., Aaronson, K.D., Boyle, A.J., Russell, S.D., Milano, C.A., Pagani, F.D., Edwards, B.S., Park, S., John, R., Conte, J.V., Farrar, D.J., Slaughter, M.S. and HeartMate II Investigators (2010) Continuous Flow Left Ventricular Assist Device Improves Functional Capacity and Quality of Life of Advanced Heart Failure Patients. Journal of the American College of Cardiology, 55, 1826-1834.
[4] Slininger, K.A., Haddadin, A.S. and Mangi, A.A. (2013) Perioperative Management of Patients with Left Ventricular Assist Devices Undergoing Noncardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 27, 752-759.
[5] Lanier, G.M., Orlanes, K., Hayashi, Y., Murphy, J., Flannery, M., Te-Frey, R., Uriel, N., Yuzefpolskaya, M., Mancini, D.M., Naka, Y., Takayama, H., Jorde, U.P., Demmer, R.T. and Colombo, P.C. (2013) Validity and Reliability of a Novel Slow Cuff-Deflation System for Noninvasive Blood Pressure Monitoring in Patients with Continuous-Flow Left Ventricular Assist Device. Circulation: Heart Failure, 6, 1005-1012.
[6] Sheikh, F.H. and Russell, S.D. (2011) HeartMate® II Continuous-Flow Left Ventricular Assist System. Expert Review of Medical Devices, 8, 11-21.
[7] Argiriadou, H., Anastasiadis, K., Antonitsis, P., Karapanagiotidis, G., Foroulis, C.N., Piggott, D., Papakonstantinou, C. and Westaby, S. (2010) Use of Cerebral Oximetry for Monitoring Cardiac Output during Off-Pump Implantation of Jarvik 2000 Left Ventricular Assist Device. Artificial Organs, 34, 267-271.
[8] Oleyar, M., Stone, M. and Neustein, S.M. (2010) Perioperative Management of a Patient with a Nonpulsatile Left Ventricular-Assist Device Presenting for Noncardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 24, 820-823.
[9] Ficke, D.J., Lee, J., Chaney, M.A., Bas, H., Vidal-Melo, M.F. and Stone, M.E. (2010) Case 6-2010: Noncardiac Surgery in Patients with a Left Ventricular Assist Device. Journal of Cardiothoracic and Vascular Anesthesia, 24, 1002-1009.
[10] Barbara, D.W., Wetzel, D.R., Pulido, J.N., Pershing, B.S., Park, S.J., Stulak, J.M., Zietlow, S.P., Morris, D.S., Boilson, B.A. and Mauermann, W.J. (2013) The Perioperative Management of Patients with Left Ventricular Assist Devices Undergoing Noncardiac Surgery. Mayo Clinic Proceedings, 88, 674-682.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.