Based on promising early clinical results, the Cardiology service at the Colorado State University Veterinary Health System offers a minimally invasive beating-heart mitral valve repair for dogs with severe mitral regurgitation (MR).
About the procedure
Mitral transcatheter edge-to-edge repair (TEER) is a minimally invasive beating-heart intervention for treatment of severe MR secondary to degenerative mitral valve disease. In humans, the mitral TEER procedure has been performed in more than 200,000 patients and is now considered an alternative to surgical mitral valve repair.
The TEER procedure in dogs is performed under general anesthesia through a small (1.5”) incision in the chest wall and transapical cardiac approach in the beating heart under fluoroscopic and transesophageal echocardiography guidance with a device called a V-Clamp (Hongyu Medical). Early clinical results of the TEER procedure in more than 120 dogs over the last four years have been associated with relatively low risk, meaningful decreases in MR severity, and rapid recovery. Patients typically walk outside the day after the procedure and are released from the hospital within two days. The current expectation for a decrease in MR severity is on average 50% and depends on severity of MR and anatomic complexity. Dogs with the most favorable anatomy can be expected to have the best outcomes in terms of reduction in MR severity and extension of life expectancy with the lowest procedural risk. Dogs with less favorable functional anatomy may derive benefit from TEER with some associated increase in procedural risk. Dogs with unfavorable functional anatomy carry a high procedural risk compared to potential benefit and are considered poor candidates for the TEER procedure. Current overall risk of a serious complication including detachment of the clamp resulting in worsened MR or death is 6%. The risk for leaflet detachment is highest within the first 72 hours after the procedure and diminishes after several weeks due to healing around the clamp.
Eligibility
Dogs must be under the care of a veterinary cardiologist. Inclusion criteria are:
- body weight generally four to 14 kg depending on the size of the heart
- severe degenerative MR (stage late B2/early C)
- appropriate anatomy for edge-to-edge repair (primary A2 segment prolapse/flail)
- absence of significant non-cardiac disease
Eligibility is determined by the Cardiology service’s heart team after evaluation of the referring cardiologist’s report and echocardiographic DICOM images. A link for transmitting images is available on request.
Costs
Medical costs of the procedure (pre-op evaluation, procedure, aftercare) are estimated to be $16,000-18,000 including the cost of the clamp. Some dogs may need two devices to achieve the best results. If so, the second device is no charge.
Follow-up care
Dogs will be returned to the care of the referring cardiologist after the procedure. Regular follow-up evaluations by the referring cardiologist are expected and recommended at one month, three months, and six months post-operatively, and approximately every six months thereafter.
Case review and scheduling
We are receiving referrals from cardiologists only. See the echocardiographic views necessary for case review.
For case review, please have your cardiologist complete the appointment and procedure inquiry form. Case reviews can only be performed on a complete set of DICOM images. We accommodate requests for case review in as timely a manner as possible. However due to high demand, cases reviews may take up to three to four weeks after images are received. Procedures are typically scheduled two to three months after completion of a case review.
For further questions, please contact [email protected].