Mitral valve surgery
Myxomatous mitral valve disease is a very common cause for heart murmurs in older dogs. It is a condition whereby the aging collagen in the mitral valve creates a laxity in the valve leaflets which prevents them from sealing normally allowing blood to leak backwards through the valve. With time, the leak gets progressively larger as the valve continues to age. For most dogs, the disease will progress slowly and it will not result in an adverse outcome within their lifetimes. However for dogs with advanced disease, congestive heart failure (fluid in the lungs) will develop. While medication is necessary for patients that develop congestive failure, life-expectancy is typically reduced to several months if the valve is not surgically corrected.
There are two types of mitral valve surgery, transcatheter edge-to-edge repair (TEER) using a V-Clamp device and open-heart surgical repair under cardiopulmonary bypass.
Transcatheter Edge-to-Edge Repair (TEER) of the Mitral Valve using a V-Clamp device
In 2023, veterinary cardiologists Dr Brad Gavaghan, Dr Fiona Meyers and Dr Chris Lam brought to Australia a new mitral valve surgery option for patients diagnosed with mitral valve disease. Transcatheter edge-to-edge repair (TEER) of the mitral valve using the V-Clamp is an evolution of the same surgery in human patients using the Mitraclip, a device which has been successfully implanted in over 150,000 people worldwide who have benefited by extension of life-expectancy. The long-term value of the surgery in dogs appears similarly superior to medical treatment with 80% of dogs alive 1-year post-operatively and 78% of dogs alive 2 years following surgery.
Veterinary Cardiologists Australia is the only specialist cardiology group performing this procedure in Australia and since commencement of their TEER program in 2023, patients which have had mitral valve repair using the V-Clamp have demonstrated exceptional outcomes.
About The Surgery
The V-Clamp is a small device (approximately 8mm in length) that is implanted into the heart to clamp together the diseased mitral valve leaflets, reduce their laxity and minimising the leak in the valve. A small surgical incision between the ribs is necessary to expose the surface of the heart and a catheter is then inserted through the exposed wall of the heart through which the device is deployed.
Meet Our Patient, Sunshine
Sunshine, the 14-year-old Shibu Inu, began her journey with a grim prognosis. Diagnosed with the most common heart disease in dogs, Sunshine faced congestive heart failure and a reduced life expectancy of just 6-12 months. Sunshine had responded to standard medical therapy in Sydney, however this only offered a temporary improvement before repeat episodes of fluid on the lungs would have been expected to occur. However, hope arrived with the V-Clamp procedure – a technique adapted from human medicine, promising improved survival and quality of life.
Our dedicated team, led by Drs Brad Gavaghan, Fiona Meyers, and Chris Lam, embarked on this complex surgery. Remarkably, Sunshine showed rapid post-operative recovery, becoming ambulatory and bright within three hours. The procedure not only resolved Sunshine’s grade V/VI heart murmur but also allowed for the discontinuation of diuretic therapy.
This case is a testament to the cutting-edge advancements in veterinary cardiology. It underscores our commitment at VCA to provide innovative care, transforming the lives of pets like Sunshine. Through collaborative efforts and specialised training, we’re proud to pioneer such life-saving techniques, offering hope to countless pets and their families. Sunshine is now 16 years old and continues to love her life with her family on the Gold Coast where her owner says she “runs like a puppy on the beach!”.
Transcatheter Edge-to-Edge Repair (TEER)
What is Transcatheter edge-to-edge repair (TEER) of the mitral valve?
Transcatheter edge-to-edge repair (TEER) of the mitral valve is performed using a V-Clamp. 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. For patients with myxomatous mitral valve disease this reduces blood leaking backwards through the valve. It is this leak in the valve that results in heart failure in veterinary and human patients.
Will this procedure improve my dog’s quality and length of life?
For patients with myxomatous mitral valve disease sufficiently advanced to cause fluid in the lungs (ACVIM Stage C), medical management alone typically limits life-expectancy to 6-12 months. Most patients with similarly advanced disease that undergo TEER of the mitral valve are still alive and well 1 year (80%) and 2 years (78%) after the surgery.*
*Potter, Orton et al, CSU, 2025.
Is my dog a candidate for this procedure?
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 rigorously examined by a VCA cardiologist via an ultrasound of the heart. Transoesophageal ultrasound is an ultrasound of the heart performed using a long probe that is inserted down the oesophagus under a brief general anaesthetic. It allows the most detailed assessment of valve anatomy and is essential to confirming eligibility of an individual.
*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.
Will I still need to give my dog medications?
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.
Does recovery take long?
Patients are typically able to go home within 2 days of the procedure with minimal/ no signs of discomfort and without need for ongoing pain medication.
What are the risks?
Transcatheter edge-to-edge repair of the mitral valve is a low risk surgery. Because the heart continues to beat throughout the surgery and circulation is uninterrupted while the device is implanted, it carries minimal risks compared to open heart surgery. Device dislodgement has been reported and so every precaution is taken to minimize this risk by careful assessment each individual’s valve anatomy. The team at VCA has been performing TEER since 2023 and with excellent procedural outcomes and no procedural deaths.
Is Transcatheter Edge-to-Edge Repair of the mitral valve expensive?
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 anaesthetist) and the device cost. The procedure is currently less than half the cost of open-heart mitral valve repair surgery. An accurate estimate of costs can be provided on a case-by-case basis following consultation with your VCA cardiologist.
Can Transcatheter Edge-to-Edge Repair (TEER) be performed as an emergency procedure?
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.
If you are considering mitral valve surgery for your pet with VCA, which ultrasound images are required to be sent to VCA for assessment?
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.
Open-heart surgical repair of the mitral valve
Since early 2025, Dr Masami Uechi and the Jasmine Group cardiac bypass team from Japan have regularly travelled to Brisbane to perform open-heart surgical repair of the mitral valve under cardiopulmonary bypass.
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 Veterinary Specialist Services, provides a world class standard of peri-operative care to support cardiac patients and their families throughout their surgical repair journey.
About The Surgery
Open-heart surgery for reconstruction of the mitral valve is performed by a highly skilled surgeon who is trained specifically for this surgery. It requires that the chest be opened, the beating heart be temporarily stopped, and blood diverted away from the heart and lungs so that the heart can be opened for the surgeon to operate on the valve. A cardiopulmonary bypass (CBP) machine is functions in the place of the heart and lungs by drawing blood from the body for oxygenation prior to return to the body, so vital organs continue to receive oxygen and nutrients. Once the surgery is finished, the heart is restarted, and the CPB machine gradually takes a step back as the heart and lungs begin to take over their normal functions again.
Open Heart Surgical Repair
Will this procedure improve my dog’s quality and length of life?
For patients with myxomatous mitral valve disease sufficiently advanced to cause fluid in the lungs (ACVIM Stage C), medical management alone typically limits life-expectancy to 6-12 months. Most patients with similarly advanced disease that undergo open-heart repair of the mitral valve are still alive and well 1 year (%) and 3 years (72-79%) after the surgery.
Is my dog a candidate for this surgery?
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 are likely to be suitable for open-heart surgery. Some dogs with concurrent disease or complications associated with 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.
Does the procedure carry significant risk?
Cardiopulmonary bypass for open-heart repair of the mitral valve carries some risks both during the surgery and in the post-operative period. During the first week after surgery patients are monitored around the clock by highly specialised critical care personnel in the Pet Intensive Care Unit (PICU). The surgery is associated with a low risk death (2%) and non-fatal complications (7%).
Is open-heart surgical repair of the mitral valve expensive?
There are significant costs involved for families opting for open-heart repair of the mitral valve. These costs are associated with the Jasmine surgery and cardiopulmonary bypass team travelling to VCA, surgery and equipment costs and a patient’s intensive care post-operatively. Every aspect of our mitral valve repair program, including the specialist personnel, equipment and facilities have been purposefully and carefully chosen to optimize our patient outcomes.
Does recovery take long?
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.
Can mitral valve surgery be performed as an emergency procedure?
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.
Advanced ICU Care – 24/7 Monitoring for Peace of Mind
When your pet is recovering from heart surgery, every detail matters. Through our partnership with the Pet Intensive Care Unit (PICU), specialist critical care veterinarians lead a team of highly trained veterinary nurses, providing round-the-clock monitoring and treatment.
We use advanced monitoring and oxygen delivery systems designed for maximum safety and comfort. These regulate oxygen and carbon dioxide levels, maintain the perfect temperature and humidity, and deliver oxygen rapidly in emergencies. Built-in floor heating helps keep patients warm, while continuous ECG, oxygen saturation, and blood pressure monitoring allows us to respond to even the smallest change in their condition.
Your pet is never alone. Our dedicated team of specialised nurses are with your pet throughout every minute of their hospitalisation, to provide the highest level of care with compassion and competence.
What are the next steps?
For those patients and their families interested in open-heart surgical repair of the mitral valve, the next step is to make an appointment for your pet with a specialist veterinary cardiologist.
For patients in south east Queensland and northern New South Wales, an appointment should be made with one of our VCA cardiologists in Brisbane. For interstate patients, we can direct you to the nearest cardiologist (or highly-specialised sonographer/ radiologist). The cardiologist will perform an echocardiogram (ultrasound of the heart) and any other tests that may be indicated (bloodwork, radiographs) to optimise medical management of your pet. Eligibility for the surgery can then be assessed by VCA and Dr Uechi on review of diagnostic imaging and other information provided by the attending cardiologist