Surgical Repair of the Mitral Valve


Surgical repair of the mitral valve is the most definitive way to address advanced degenerative mitral valve disease. This procedure requires cardiopulmonary bypass and a highly skilled surgeon. The Open Heart Surgery Program at the University of Florida Small Animal Hospital is led by Dr. Katsuhiro Matsuura, who has extensive experience in surgical repair of the mitral valve in dogs with high success rate.

Please check out some frequently asked questions below if you are interested in exploring this surgical option for your dog.

cute dogs

The purpose of the Open Heart Surgery Program at the University of Florida is to make lives better for pets with heart disease through access to open heart surgery. Through this program, we envision a world where no pet needs to die from surgically treatable heart disease.

Frequently Asked Questions

Which dogs are eligible for mitral valve surgery?

Dogs with advanced degenerative mitral valve disease (ACVIM Stages C and D as well as advanced Stage B2) will be considered for open heart mitral valve surgery on a case-by-case basis after preoperative testing is evaluated by our team.

Screening can be performed by your local cardiologist. They can carry out the necessary examinations and arrange for the required testing. Please ask your veterinarian to complete the RDVM mitral valve surgery consult form for review by the cardiology team at UF.

What tests do I need to have done before making an appointment for surgery?

Several tests are needed to determine eligibility for mitral valve surgery. These tests can be performed at the University of Florida or at a specialty hospital nearer to you. If they are not performed at the University of Florida, the test results will need to be reviewed for eligibility.

If it has been more than 6 months between pre-operative testing and the planned surgery date, some or all of the tests will need to be repeated. The team at UF will discuss this with you.

The preoperative testing will need to be done prior to the surgery to allow the open heart team time to assess all the test results. This testing might require several appointments to be completed. Selected tests will be rechecked the day before surgery.

The following tests are required to be submitted four weeks before the anticipated surgery date. The procedure may need to be rescheduled if the results are not received by then.

  • Echocardiography performed by a boarded cardiologist or cardiology resident under supervision of boarded cardiologist
  • A veterinarian’s assessment of the dog’s skin is required within 2 weeks of surgery to be sure there is no evidence of skin infection
  • Blood Pressure
  • 6-lead Electrocardiogram
  • Complete blood count
  • Chemistry panel
  • Urinalysis
  • C-reactive protein
  • Coagulation profile (PT/PTT)
  • 3-view thoracic (chest) radiographs
  • Abdominal radiographs
  • Abdominal ultrasound performed by a boarded radiologist or radiology resident under the supervision of a boarded radiologist
  • Blood typing

Most dogs can safely fly in the cabin after being evaluated by their cardiologist to be sure they are stable and do not have active evidence of congestive heart failure. Your cardiologist can prescribe a safe sedative if necessary.

How much does the surgery cost?

The cost for mitral valve repair is estimated to be $45,000-50,000. This estimate includes surgery and in-hospital post-operative care, barring complications. As with any medical procedure, the cost is an estimate and can be affected by a variety of factors including duration of the hospital stay and complications. The estimate will be fully discussed with you, especially if it changes during the hospital stay.

How long does my dog stay in the hospital and what happens after surgery?

Most dogs stay in the hospital for seven days, but post-operative recovery can be variable. Rechecks will be scheduled for one week after surgery, 1, 3, 6, and 12 months after surgery and then annually thereafter. The cost of recheck evaluations is not part of the initial estimate. Follow-up evaluations can be performed at UF or with your local cardiologist.

For dogs taking medications, the dose and number of medications can be decreased or stopped after mitral valve surgery.

Specific instructions for a return to activity will be discussed with you at the time of discharge. For most dogs, this will be a gradual return to full activity by three months after surgery.

As with any surgical procedure, complications can occur. Complications of mitral valve repair surgery include, but are not limited to bleeding, infection, clot formation, arrhythmias (irregular rhythm), low blood pressure and death. Our group of experts at the UF Veterinary Hospitals will monitor closely for the development of any of these complications and tailor the treatment plan as appropriate.

Is mitral valve surgery ever done on an emergency basis?

No. Dogs should be medically stabilized before open-heart surgery. Owners of dogs who have been hospitalized for the treatment of active congestive heart failure should work with their primary cardiologist to ensure that their dog’s heart failure is controlled before surgery.

How is open heart surgery to repair the mitral valve different from transcatheter edge-to-edge repair (TEER) of the mitral valve using the V-Clamp?

Surgical repair of the mitral valve is performed by opening the heart after placing the dog on cardiopulmonary bypass. The mitral valve is repaired by tightening the annulus and replacing chordae tendineae, the chords that attach the mitral valve to the heart, to improve the function of the mitral valve. The TEER procedure is a minimally invasive procedure performed by introducing a clamp device called a V-Clamp into the beating heart and across the mitral valve after surgically opening the chest. The V-Clamp brings the middle of the mitral valve leaflets together to reduce the amount of valve leak or regurgitation.

Open heart mitral valve surgery to repair the valve and chordae tendineae is more definitive than the V-Clamp procedure, which just brings the mitral valve leaflets together in the middle. Surgical repair requires cardiopulmonary bypass and specialized teams to perform the surgery and perfusion during bypass.

What is the difference between pursuing open heart mitral valve surgery as compared to medical management of mitral valve disease?

Medical management of mitral valve disease is palliative, meaning that medications do not necessarily prevent the progression of the valve thickening and dysfunction, but rather delay the onset and recurrence of congestive heart failure. Surgical repair of the mitral valve corrects the valve abnormality that leads to the valve leak (mitral regurgitation) and therefore is a definitive treatment by addressing the cause of the problem.

What is the process for the waiting list? My dog was on the waiting list for mitral valve surgery several years ago. Is the previous list still active?

The previous waiting list is no longer active. Please either make an appointment with the cardiology service at the University of Florida Small Animal Hospital or with your local cardiologist to have the required pre-operative testing done. If these tests are not done at UF, please have your cardiologist submit the test results for review by one of our cardiologists.

Your dog can be placed on the current waiting list after our team’s review of the pre-operative test results. Because this can take some time for the team to discuss, please allow three to four weeks for review. A UF cardiology team member will reach out to you after reviewing this information to let you know if your dog is eligible and discuss placement on the waiting list as well as tentative timing for surgery.

Mandy’s Mission

Mandy’s Mission to Mend Hearts, established by a generous donation, is in honor of Mandy, a wonderful Cavalier King Charles Spaniel who lost her battle with Mitral Valve Disease. Mandy’s Mission supports the development of an open heart surgery program at the University of Florida Small Animal Hospital. Donations to this fund will help provide necessary funding to support the program, and the training of our cardiac surgeons to perform mitral valve repair surgery under cardiopulmonary bypass. The high quality care and expertise of the faculty and staff, is vital to ensure a successful outcome. Your support will help with the development and sustainability of this program at UF.

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