Impact of novel intraoperative evaluation for mitral valve regurgitation: the retrograde cardio-protective beating...

The saline injection test is commonly employed during mitral valvuloplasty. However, discrepancies in regurgitation between the naked eye findings during the saline injection test and the postoperative echocardiographic findings have been noted. Here, we describe the new retrograde cardio-protective beating test (RC-beating test) which allows direct transatrial evaluation of the valve in the fully loaded, beating heart under cross-clamping by means of the retrograde perfusion of warm oxygenated blood into the coronary sinus.

From January 2006 to June 2012, 63 patients (mean age, 59 ± 15 years) with degenerative mitral valve regurgitation underwent mitral valve repair with application of this novel evaluation.

In 20 of the 63 patients (31.8%), minor residual leaks that were not remarkable in the saline injection test were detected during the RC-beating test and were completely corrected. Almost all patients (n = 61, 96.8%) revealed no mitral regurgitation on intraoperative transesophageal echocardiography. The results of the RC-beating test were satisfactory, and discrepancies were not recognized at all between this evaluation and the postoperative echocardiographic findings. The ultrastructure of the mitochondria showed significant myocardial preservation.

The RC-beating test is a simpler and more accurate evaluation for mitral valve repair than the saline injection test. This novel evaluation enables a safe and more complete mitral valve repair.