Preliminary Outcome of a Novel Edge-to-Edge Closure Device to Manage Mitral Regurgitation in Dogs

Abstract

Background: Veterinary management of mitral valve regurgitation due to mxyomatous valve disease in dogs is limited to medical treatments, which only postpones the onset of congestive heart failure or alleviates clinical symptoms. Most surgical procedures to manage this condition in humans require cardiopulmonary bypass and have a high risk of complications.Animals: Eight dogs with naturally occurring mitral valve regurgitation.Methods: Prospective observational study. All dogs were treated with a novel edge-to-edge transcatheter device named ValveClamp. The total surgical procedural time and total catheterization time were recorded. Echocardiographic variables measured pre- and post-procedure were compared using Wilcoxin-signed rank test with a P < 0.05 considered significant. Data were expressed as median and interquartile range and absolute numbers and percentages.Results: The procedural success rate was 100% and all the dogs survived without complications. The median (interquartile range) total surgical procedural time was 86.5 (76–96.2) minutes and catheterization time was 23.5 (22–33.8) minutes. Echocardiography revealed a significant reduction in mitral regurgitation severity in all dogs following the procedure based on both a reduced mitral regurgitant maximum jet area (P = 0.012) and a reduced mitral regurgitant maximum jet area to left atrial area (P = 0.018).Conclusion: The ValveClamp device is effective at reducing the severity of mitral regurgitation in dogs with naturally occurring myxomatous valve disease.

Evaluation of Changes in the Cardiac Function before and after Transcatheter Edge-to-Edge Mitral Valve Repair in Healthy Dogs: Conventional and Novel Echocardiography

“…In the current report, the TEER, an example of a minimally invasive device, was successfully implanted in two healthy dogs. The operation time was approximately one hour to one and a half hours, which is much shorter than the time required for valvuloplasty under extracorporeal circulation conditions [ 15 , 23 , 24 ]. Additionally, the postoperative recovery was rapid, and less postoperative management was required.…”

“…Similarly to the MitraClip, the TEER clamps the anterior and posterior mitral leaflets to reduce the regurgitation [ 15 ]. The clamping arms of the TEER close toward the central line, resulting in tighter clamping compared to the MitraClip.…”

“…These two dogs were healthy, based on physical examinations, hematobiochemical profile, conventional echocardiography, and urinalysis. The detailed procedure of the surgical approach has been previously described [ 15 ]. Briefly, the dogs were maintained on general anesthesia using 2–3% isoflurane (Pfizer, Tokyo, Japan) after induction with propofol (Fresenius Kabi, Tokyo, Japan).…”

“…Briefly, the dogs were maintained on general anesthesia using 2–3% isoflurane (Pfizer, Tokyo, Japan) after induction with propofol (Fresenius Kabi, Tokyo, Japan). The TEER was guided by a transesophageal echocardiography (TEE) probe in the median longitudinal and transverse views [ 15 ]. Heparinized normal saline (100 IU/kg) was administered intravenously after exposing the heart at the left sixth intercostal space via thoracotomy.…”

“…Transcatheter Edge-to-Edge Repair (TEER) is an easy-to-operate, transcatheter MV repair system for use in humans and dogs using a hybrid approach [ 14 ]. This device appears to be effective; however, no detailed information has been published except for a simple prognostic evaluation in a single canine and porcine study [ 14 , 15 ]. To evaluate the prognostic effect of the treatment on the heart, echocardiographic changes should be evaluated.…”