Evaluation of Intraoperative Saline Injection Leak Test Without Transesophageal Echocardiography as a Reliable Method During Heart Valve Repair

Background: Valvular heart diseases (VHD) pose a significant global health challenge, leading to numerous cardiac surgeries. The quality of valve repair is typically assessed using transesophageal echocardiography (TEE) and saline injection tests intraoperatively. However, TEE is not universally available, particularly in resource-limited settings. Objectives: This study aimed to evaluate the effectiveness of saline injection tests as the sole method for assessing cardiac valve repair quality. Methods: This retrospective cohort study included patients who underwent cardiac valve surgery without intraoperative TEE assessment. Preoperative transthoracic echocardiography (TTE) was performed on all patients. A consistent team performed all valve repairs, and the quality of these repairs was assessed intraoperatively using the saline injection test. Postoperative TTE was also conducted to evaluate valve function and compare it with preoperative measurements. Results: The study comprised 16 patients (mean age: 63.8 ± 10.6), predominantly male. Mitral valve (MV) repair was performed on 11 patients, with nine showing improved function (P-value: 0.006). Seven patients underwent tricuspid valve repair (TVr), all of whom exhibited improved function (P-value: 0.01). Four patients received aortic valve repair, with three showing improved function (P-value: 0.10). Additionally, significant improvements were observed in left ventricular end-diastolic diameter (LVEDd), left ventricular end-diastolic volume (LVEDV), inter-ventricular septal diameter, posterior wall thickness (PWT), tricuspid annular plane systolic excursion (TAPSE), right ventricular peak systolic myocardial velocity (RVSm), pulmonary artery pressure, tricuspid regurgitation (TR) gradient, and right atrium area. Conclusions: The saline injection test can be a valuable tool for assessing the quality of mitral and tricuspid valve repairs, particularly when TEE is unavailable. However, its reliability for aortic valve repair remains uncertain.