Types of Mitral Valve Surgery
Veterinary Cardiologists Australia (VCA) is excited to offer two advanced options for pets diagnosed with mitral valve disease:
- Transcatheter Edge-to-Edge Repair (TEER) of the mitral valve with the V-Clamp: This minimally invasive procedure, adapted from human cardiology, offers a promising new avenue for treating mitral valve disease in pets.
- Open-heart surgical repair of the mitral valve: In collaboration with Dr. Masami Uechi and the Jasmine Group, this gold-standard approach provides a highly effective solution for advanced cases of mitral valve disease.
Scroll to TEER information
Scroll to Open-heart surgical information
Transcatheter Edge-to-Edge Repair (TEER) of the mitral valve with the V-Clamp
Veterinarians Dr Brad Gavaghan, Dr Fiona Meyers and Dr Chris Lam are excited to bring to Australia a new mitral valve surgery option for patients diagnosed with mitral valve disease. The V-Clamp, an evolution of the Mitraclip used in human cardiology, has been successfully implanted in over 150,000 people worldwide. The V-Clamp is a small device (approximately 8mm in length) that is implanted to clamp together the affected leaflets of the anterior and posterior mitral valves.
For veterinarians wishing to discuss potential candidate patients for this procedure, please contact us and we will assist with patient evaluation. There will be limited numbers accepted each month for V-Clamp procedures, commencing in February 2024.
About The Surgery
The procedure is known as a transcatheter-edge-to-edge mitral valve repair, or TEER procedure. The surgery involves placing a device via a transcatheter approach through the left ventricular apex, following a mini-thoracotomy. The device is placed via 2-D and 3-D transoesophageal echocardiography and fluoroscopic guidance.
V-Clamp surgery is not considered experimental or high risk, with the recent publication of 40 V-Clamp surgeries by Dr Chris Orton’s group at Colorado State University documenting a 95% procedural feasibility with no procedural deaths. This represents an acute procedural success rate of 95%. There is currently no long-term follow-up available in the veterinary field given this procedure has only been available for the last 3 years. However in the human field, the Mitraclip has demonstrated superiority over medical therapy.
We are passionate about providing you with all the information you need to help your clients make decisions about surgical options. To download a client information sheet, click the link below. You can also request for us to send you physical copies to an address of your choice, at no cost to you.
Which echocardiography images are required to be sent to VCA for assessment of patient suitability for the V Clamp procedure?
The images in this PDF download are not the typical views obtained during an echo assessment. The images will require ECG-gating (ie an ECG attached during the echo) and will require a veterinary cardiologist or a highly trained sonographer/radiologist to obtain suitable images. The left apical parasternal 5-chamber view is the most important for device-sizing and suitability assessment. Please send in DICOM format.
Australian First: VCA Successfully Performs Canine V-Clamp Cardiac Procedure
On Wednesday November 29, 2023, Drs Meyers, Gavaghan and Lam successfully performed the first V-Clamp (Hongyu Medical) procedure for repair of canine myxomatous mitral valve disease in Australia, marking a new era in pet healthcare and a significant breakthrough in Australian veterinary cardiology.
The patient, a 14-year-old, 5.5kg Shibu Inu dog named Sunshine, underwent this revolutionary procedure to repair advanced (ACVIM Stage C) myxomatous mitral valve disease that had resulted in congestive heart failure – the most common heart disease in dogs, affecting 10% of the canine population.
Sunshine was initially treated in Sydney and had progressed to develop pulmonary oedema, facing a life expectancy of 6-12 months. Fortunately the V-Clamp procedure, a technique well-established in human medicine but new in veterinary cardiology offered Sunshine the potential for improved survival and quality of life.
The complex yet efficient surgery, lasting approximately 2 hours, saw Sunshine recovering remarkably fast – with the patient ambulatory and bright within 3 hours post-operatively. Most patients, like Sunshine, can return home the following day. Impressively, Sunshine’s grade V/VI heart murmur resolved following the surgery, with trivial to mild mitral regurgitation present and reduced left heart chamber dimensions. Diuretic therapy was discontinued.
Sunshine’s successful operation involved the international collaboration of 6 specialists and consultants and 3 specialist cardiologists from VCA, highlighting the collaborative effort between the device engineers, anaesthetist and VCA team.
3D Ultrasound Images and Video Footage
Veterinary Cardiologists Australia have released 3D ultrasound images and video footage demonstrating Sunshine’s heart condition before and after the TEER procedure. These visuals demonstrate the effectiveness of the V Clamp to markedly reduced mitral regurgitant flow.
Thoracic radiographs post-surgery showing the V-Clamp device implanted into the patient’s heart
Color 3D transesophageal echocardiogram showing VClamp device successfully placed across A2/P2 segments of the mitral valve leaflets
2D transesophgeal echocardiogram in xPlane view showing V-Clamp device across mitral valve leaflets just before closure
2D echocardiogram pre-surgery showing severe regurgitation across the mitral valve
2D echocardiogram post V-Clamp placement showing marked reduction of regurgitation across mitral valve
3D transesophageal echocardiogram just before VClamp placement viewing from the left atrium showing severe mitral regurgitation
3D transesophageal echocardiogram viewing from the left atrium showing V-Clamp device placed across the mitral valve A2/P2 segments and marked reduction of mitral regurgitation
Open-heart surgical repair of the mitral valve
Veterinary Cardiologists Australia (VCA) are excited to announce their collaboration with Dr Masami Uechi and the Jasmine Group cardiac bypass team from Japan. Dr Uechi has chosen to operate exclusively from VCA @ Veterinary Specialist Services in Brisbane, with regularly scheduled visits from October, 2024.
Dr Uechi is recognised as the pioneer and world-leader in this field, with over 2000 highly successful open-heart mitral valve repairs performed in dogs. His collaboration with Veterinary Cardiologists Australia (VCA), Australia’s largest and most experienced cardiology group, together with the 24hr Pet Intensive Care (PICU) team at VSS, provides a world class standard of peri-operative care to support cardiac patients and their families throughout their surgical repair journey.
For veterinarians wishing to discuss potential candidate patients for this surgery, please contact us and we will assist with patient evaluation.
About The Surgery
Open heart surgery is the gold standard approach for repair of the mitral valve in human patients which confers a survival benefit beyond medical management of advanced mitral valve disease alone. It requires a very high level of surgical expertise to reconstruct the valve which Dr Uechi has achieved over the last three decades in specialist open-heart surgical practice.
Open-heart surgical repair of the mitral valve necessitates cardiopulmonary bypass and cardioplegia to provide the surgeon with a still heart and a bloodless surgical field. The challenges of cardiopulmonary bypass cannulation and external circulation in dogs with blood volumes much lower than human patients has been developed and refined by Dr Uechi and the Jasmine cardiopulmonary bypass team to minimize intra-and post-operative risks and to optimize patient outcomes.
Dogs with advanced ACVIM Stage B2, C and D myxomatous mitral valve disease are eligible for open-heart mitral valve surgery. Surgical repair by Dr Uechi and the Jasmine group confers an extension in survival time when compared with medical management alone. The 3-year survival rates for dogs undergoing surgical repair reported by the Jasmine group are 79% (stage B2), 73% (stage C) and 57% (stage D) compared to median survival times of 6-12 months for medically-managed stage C and D dogs.
The Next Steps Towards Surgery For A Patient
For your clients interested in open-heart surgical repair for their pet, the next step is examination by a specialist veterinary cardiologist. For clients in south east Queensland and northern New South Wales, please organise referral to VCA Brisbane. For clients that are interstate, we can provide details of the nearest cardiologist (or highly-specialised sonographer/ radiologist). A cardiology referral will include an ECG-gated echocardiographic examination and other tests that may be indicated (bloodwork, radiographs) to optimise medical management prior to surgery. Eligibility for the surgery is then assessed by VCA and Dr Uechi on review of diagnostic imaging and information provided by the attending cardiologist.