The V-Clamp is the veterinary version of the human Mitra-Clip. This is a small device (approximately 8 mm in length) that is implanted to clamp together the two mitral valve leaflets of patients with myxomatous mitral valve disease to reduce blood leaking backwards through the valve. It is this leak in the valve that results in heart failure in veterinary and human patients.

This procedure is relatively new in dogs, but not experimental. The Mitra-Clip has been used for 18 years in people and the equivalent device (ie. the V-Clamp) has been used for 3 years in dogs. The technique in dogs has been refined during this time primarily through the input of the thoracic surgery team at Colorado State University (CSU) and the device developer.

Unfortunately, all cardiac surgeries may result in adverse outcomes, including death. The only large, published study describes a successful result in 38/40 patients (CSU), with no patient deaths (Potter et al. ACVIM abstract 2023). Patient deaths may be reported in the future in larger studies. Avoidance of an open-heart approach and avoidance of cardiopulmonary bypass makes the V-Clamp procedure lower risk than other methods of mitral valve repair.

It is too early to have long term data to definitively answer these important questions. However In humans, the Mitra-Clip is proven to be superior to medical treatment alone. In dogs, the significant improvement in valve function following V-Clamp placement is very encouraging in terms of potential for enhancement of both length and quality of life.

Typically the number and/or amount of medications will decrease. However over time, dogs may progress towards heart failure, requiring re-commencing medications or increasing dose rates of existing medications.

Patients are typically able to go home within 2 days of the procedure, with minimal signs of discomfort. Some patients may require low grade pain-relief during the first few days at home.

The V-Clamp procedure is performed via a small (5-6 cm) incision low on the chest, between the ribs. The device is delivered via a catheter placed into the beating heart, avoiding the need for open heart surgery under cardiac bypass. The procedure is guided by 3-D transoesophageal ultrasound and fluoroscopy.

While pet insurance (if available) will cover a variable proportion of the fees, the procedure is expensive. The costs are associated with the attendance of a large team of specialists during the surgery (2-3 cardiologists and an anesthetist) and the device cost. The procedure is currently less than half the cost of open-heart mitral valve repair surgery, with significantly reduced risks to the patient. Given the variability between patients, accurate pricing is provided on a case-by-case basis following consultation with your VCA cardiologist.

Identifying dogs with the best chance of a good result is our highest priority. Small breed dogs (over 4 kg) with advanced valve disease (ACVIM Stage B2 or Stage C)* may be eligible for the procedure. To assess an individual’s suitability, the mitral valve anatomy and function is meticulously examined via ultrasound by a VCA cardiologist.

*ACVIM Stage B2 myxomatous mitral valve disease patients have enlarged hearts, however they are not in heart failure. ACVIM Stage C patients have experienced heart failure (fluid on the lungs) and are currently prescribed diuretics as part of their medical management.

No. Patients which are hospitalized for treatment of acute heart failure (fluid in the lungs) require urgent medical stabilization. Only once a patient is stabilized on medication is it appropriate for your cardiologist to discuss surgical options.

The images in this download are not the typical views obtained during an echo assessment and will require a veterinary cardiologist or a highly trained sonographer/radiologist to obtain suitable images. Please refer your cardiologist or sonographer to this page for more information on mitral valve surgery and pre-operative ultrasound imaging of the heart.

Dogs which have undergone surgery by Dr Uechi in Japan over the last several years have lived longer than those dogs which are treated by medication alone. For dogs that have developed congestive heart failure (fluid in the lungs) and are taking diuretics, life-expectancy with medication alone is typically 6-12 months. But for those dogs that have had surgery with Dr Uechi, most (>70%) are still doing well 3 years after surgery. Dogs with very advanced which are taking multiple diuretics at the time of surgery also do better with 57% still alive 3 years post-operatively.

For 7-10 days after open-heart surgery, patients are cared for in our Pet Intensive Care Unit (PICU). During this time, your pet will be under the constant care of highly specialised critical care veterinarians and nurses. Owners are able to able to visit during this time and the nursing staff will send pictures and updates when visits aren’t possible.

Following discharge from hospital, exercise must be restricted for a variable period for which you will be advised.

Unfortunately, all cardiac surgeries may result in adverse outcomes, including death. Cardiopulmonary bypass also carries some risks, even during the first week post-operatively which is why patients are monitored around the clock by highly specialised critical care personnel in the Pet Intensive Care Unit (PICU) following surgery.

For most patients receiving diuretics at time of surgery, diuretics will no longer be necessary. Other medications may or may not be necessary after the surgery depending on the reason for their use.

While pet insurance (if available) may or may not cover a variable proportion of the cost, the surgery is expensive at roughly 3-4 times the cost of TEER of the mitral valve with V-Clamp. The costs are associated with the large team of specialists involved in the surgery and cardiopulmonary bypass who travel from Japan to perform the surgery and in the pre- and post-operative period while a patient is in intensive care (VCA cardiologists, PICU critical care team). Given the variability between patients, accurate pricing is provided on a case-by-case basis following consultation with your VCA cardiologist.

Dogs  with advanced valve disease (ACVIM Stage B2 or Stage C)* are likely to be eligible for surgery. Dogs that do not have a valve anatomy suitable for TEER of the mitral valve with V-Clamp are likely to be suitable for open-heart surgery. Some dogs with concurrent disease or complications associated with advanced mitral valve disease will not be eligible.  An individual’s suitability will be determined based on of review a patient’s history and diagnostic imaging results by a VCA cardiologist and Dr Uechi.

*ACVIM Stage B2 myxomatous mitral valve disease patients have enlarged hearts, however they are not in heart failure. ACVIM Stage C patients have experienced heart failure (fluid on the lungs) and are currently prescribed diuretics as part of their medical management.

No. Patients which are hospitalised for treatment of acute heart failure (fluid in the lungs) require urgent medical stabilisation. Only once a patient is stabilised on medication is it appropriate for your cardiologist to discuss surgical options.