How much does mitral valve 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.
Please Note: This cost does not include the follow-up care, which is necessary to reduce serious complications following surgery. Typically, this consists of 6 recheck visits with your local cardiologist for the following year for echocardiograms, blood work, and other diagnostics.
How is mitral valve disease (MVD) treated?
Medical management: Treatment of MVD depends on the severity. Mild disease without heart enlargement (Stage B1) is typically monitored regularly without treatment. Dogs with heart enlargement but without symptoms (Stage B2) benefit from treatment with pimobendan to slow disease progression. Dogs that experience Congestive Heart Failure (CHF) (Stages C and D) require diuretics, ACE-inhibitors, and spironolactone in addition to pimobendan to control signs of congestion. Some dogs with CHF need to be hospitalized for initial heart failure treatment.
Interventional management: The V-Clamp is a device that brings the center of the mitral valve leaflets together to reduce the amount of mitral regurgitation (also called trans-catheter edge-to-edge repair). It is placed during open-chest surgery, which allows a catheter to be introduced into the beating heart (without cardiopulmonary bypass), through which the device is delivered. The V-Clamp is in the early phases of clinical use at several institutions in the United States.
Surgical management: Because medications only control the signs of CHF and do not treat the primary valve problem, there is great interest in surgical methods to repair the valve abnormalities associated with MVD. Surgical repair of the mitral valve is done through open-heart surgery facilitated by cardiopulmonary 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.
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 happens during surgery?
Patients undergoing this procedure will be under anesthesia and placed on cardiopulmonary bypass to ensure a stable environment for the surgery. The total procedure typically lasts around 7 hours, with the heart being stopped for 1-2 hours. The patient is maintained by the anesthesia, bypass heart, and lung machines.
The surgical team will make three external incisions: one in the left neck, one on the left-hand side of the chest between the ribs, and one in the right groin area. The procedure involves creating new, additional chords from the mitral valve leaflets to the inner heart muscles (neo-chord implantation) and reforming the valve opening (annuloplasty).
Once the repairs are completed, the heart will be restarted, and the patient will be weaned off cardiopulmonary bypass. After awakening from anesthesia, the patient will be taken to the ICU for close monitoring and care.
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.
Can I fly with my dog?
Most dogs can fly in the cabin after being evaluated by their veterinarian to be sure they are stable and can travel safely. Your veterinarian can prescribe a sedative for your pet, if necessary.
Please ensure that your pet is up-to-date on all required vaccinations (including rabies vaccination) for interstate travel to prevent being denied by any transportation or lodging arrangement.
Should my dog be on a heartworm preventative prior to surgery?
It is recommended that all dogs visiting Florida be on a heartworm preventative. In the southern United States, especially the Gulf Coast and Florida, where mosquitoes are present year-round, the threat of heartworm disease is constant.
How is mitral valve disease monitored by my veterinarian and my cardiologist?
Signs of MVD in dogs can range from no signs, to difficulty breathing, coughing, collapse, and abdominal enlargement. Dogs that are not symptomatic for their heart disease are often monitored with chest x-rays at regular intervals to monitor for disease progression after the initial diagnosis. Dogs that have experienced CHF are monitored more closely with chest x-rays, blood pressure and bloodwork, typically every 3-6 months or after medication changes. Monitoring of home breathing rates at rest or sleep is a sensitive way to detect onset or recurrence of CHF. Most normal dogs and most dogs with controlled CHF breathe less than 30 times per minute. Therefore, an increase in resting or sleeping breathing rates above 30 is a reason to call a veterinarian and might prompt a recheck visit.
What is the prognosis with mitral valve disease?
Many dogs have MVD but do not experience CHF or other symptoms. However, for dogs who progress to develop CHF, the average survival time with medical therapy is approximately one year. This time can vary depending on patient factors and other concurrent diseases. Close monitoring and communication with both the primary care veterinarian and the cardiologist provide the best chance possible for dogs to feel good during this time. Surgical mitral valve repair offers a more definitive treatment for this disease with significantly longer survival times than medical therapy.
