IMR Press / RCM / Volume 22 / Issue 3 / DOI: 10.31083/j.rcm2203102
Open Access Original Research
The antegrade reperfusion test avoids the risk of mitral regurgitation recurrence optimizing valve repair
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1 Department of Cardiovascular Surgery, Jacques Cartier Hospital, 91300 Massy, France
2 Departement of Cardiac Surgery, Henri Mondor University Hospital, University of Paris-Est Creteil, 94000 Creteil, France
3 Departement of Cardiology, Henri Mondor University Hospital, University of Paris-Est Creteil, 94000 Creteil, France
4 Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, G81 4DY Clydebank, Glasgow, UK
5 Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, 93200 Paris, France
These authors contributed equally.
Rev. Cardiovasc. Med. 2021, 22(3), 939–946;
Submitted: 28 May 2021 | Revised: 1 July 2021 | Accepted: 9 July 2021 | Published: 24 September 2021
(This article belongs to the Special Issue The treatment of mitral regurgitation in the 21st Century)

Saline injection into the left ventricle trough mitral valve (saline test) is the most commonly used intraoperative assessment method in mitral valve repair. However, potential discrepancies between the saline test findings and intraoperative transesophageal echocardiography results after the weaning of cardiopulmonary by-pass, remain significant. Here, we describe a new antegrade reperfusion test, reproducing intraoperatively, the physiologic conditions of loaded and beating heart for direct transatrial evaluation of valve tightness. The proposed test is performed by perfusing warm oxygenated blood into the aortic root under cross-clamping. From February 2016 to December 2018, 91 patients (mean age: 63 ± 11 years) underwent mitral valve repair for mitral regurgitation. In all of them, the classic saline test was completed with the newly proposed antegrade test. We report our results with this combined approach. Data were obtained from the medical records and our mitral valve repair database. In 32 (35.1%) patients, evident or undetectable minor regurgitation at the saline test were respectively unconfirmed or detected by the antegrade reperfusion test leading to their complete correction. In only three patients (3.2%) major discrepancies was present between the intraoperative evaluation and the post-pump transesophageal echocardiography. Two of them (2.1%) required a second cardiopulmonary bypass run to fix the residual regurgitation. The antegrade reperfusion test is a simple dynamic intraoperative approach mimicking the physiological conditions of ventricular systole for mitral valve repair evaluation. Combined with the classic saline test, it seems to be a valuable additional intraoperative tool, enabling a more predictable repair result.

Mitral valve repair
Saline test
Intraoperative evaluation
Beating heart test
Antegrade reperfusion
Fig. 1.
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