Mitral Valve Surgery

A New Mitral Valve Surgery Option: V-Clamp Device Placement

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.

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.

Vets doing an ultrasound

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