Experience of using intra-aortic balloon counterpulsation during coronary bypass surgery and coronary stenting in patients with reduced left ventricular ejection fraction and mitral regurgitation of ischemic genesis

AIM: To analyze the changes in the degree of mitral regurgitation (MR) of ischemic origin and of clinical outcomes in patients with reduced left ventricular ejection fraction (LVEF) and multi-vascular coronary artery disease during use of intra-aortic balloon counterpulsation (IABC).

MATERIALS AND METHODS: The results of the treatment of 186 patients with ischemic mitral insufficiency who underwent intra-aortic balloon counterpulsation as a preoperative preparation in connection with a low LVEF were outlined in this manuscript. The patients were divided into 2 groups. Group 1 included 132 patients who underwent coronary bypass surgery while Group 2 included 54 patients who underwent coronary artery stenting. The dynamics of MR and LVEF before and after left ventricular revascularization were studied on the basis of echocardiographic data.

RESULTS: In group 1, there was a decrease in the degree of mitral regurgitation by 58% using IABC (p < 0.05) in the early postoperative period (based on the measurement of vena contracta, v.c., the width of the regurgitation jet on the valve), and by 54% (p < 0.05) in more than 6 months following surgical treatment. In group 2, there was a significant decrease in the degree of MR (based on v.c.) by 42% (p < 0.05) in the early postoperative period and by 41% (p < 0.05) in more than 6 months following surgical treatment.

CONCLUSION: The use of intra-aortic balloon counterpulsation in patients with low LVEF, moderate and severe MI, and with significant coronary artery pathology, led to the reduction in the duration of surgical treatment and the time of using artificial blood circulation through by excluding the need for the correction of MI, both directly during surgical revascularization and in the long-term period (more than 6 months).