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Reviews in Cardiovascular Medicine  2021, Vol. 22 Issue (3): 939-946     DOI: 10.31083/j.rcm2203102
Special Issue: The treatment of mitral regurgitation in the 21st Century
Original Research Previous articles | Next articles
The antegrade reperfusion test avoids the risk of mitral regurgitation recurrence optimizing valve repair
Amir Youssari1, †, Jean-Paul Couetil2, †, Mariantonietta Piscitelli2, Céline Zerbib3, Ophélie Brault-Meslin3, Sanjeet Singh Avtaar Singh4, Francesco Nappi5, *(), Antonio Fiore2
1Department of Cardiovascular Surgery, Jacques Cartier Hospital, 91300 Massy, France
2Departement of Cardiac Surgery, Henri Mondor University Hospital, University of Paris-Est Creteil, 94000 Creteil, France
3Departement of Cardiology, Henri Mondor University Hospital, University of Paris-Est Creteil, 94000 Creteil, France
4Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, G81 4DY Clydebank, Glasgow, UK
5Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, 93200 Paris, France
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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.
Key words:  Mitral valve repair      Saline test      Intraoperative evaluation      Beating heart test      Antegrade reperfusion     
Submitted:  28 May 2021      Revised:  01 July 2021      Accepted:  09 July 2021      Published:  24 September 2021     
*Corresponding Author(s):  Francesco Nappi     E-mail:
About author:  These authors contributed equally.

Cite this article: 

Amir Youssari, Jean-Paul Couetil, Mariantonietta Piscitelli, Céline Zerbib, Ophélie Brault-Meslin, Sanjeet Singh Avtaar Singh, Francesco Nappi, Antonio Fiore. The antegrade reperfusion test avoids the risk of mitral regurgitation recurrence optimizing valve repair. Reviews in Cardiovascular Medicine, 2021, 22(3): 939-946.

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