Table of Contents
- Why this matters to dog owners
- From desperation to action: one owner’s journey
- What TEER is and where it fits
- Open heart mitral valve repair: the gold standard
- Why a Midwest center matters
- Left atrial decompression: buy time for surgery
- How the referral process works—and what helps
- What to expect from a surgical center
- Practical guidance for owners evaluating options
- Costs and logistics
- Building capacity: training, mentorship, and collaboration
- How we can help each other
- Key takeaways
- Frequently asked questions
- Final thoughts
Why this matters to dog owners
Mitral valve disease is the single most common heart condition we see in small and toy-breed dogs. For decades the standard approach has been medical management—pills, diuretics, ACE inhibitors, and close monitoring. That approach keeps many pets comfortable for a time, but it cannot repair the valve itself. Advances in interventional and surgical cardiology now give us real options: transapical mitral valve repair (commonly called TEER in clinical conversations) and full open heart mitral valve repair under cardiopulmonary bypass.
We are at a tipping point. More centers offering open heart repair means more dogs get a true chance at a normal life span and improved quality of life. This is why the work happening at the University of Illinois and the leadership of Dr. Saki Kadotani are so important.
From desperation to action: one owner’s journey
Jessica Braun’s story illustrates how quickly things can escalate and how critical timely access to specialized care is. In late 2023 Oliver—her dog—was in stage C heart disease and declining. Local cardiology capacity meant a six-month wait. That delay could have been fatal.
Jessica searched widely, learned about TEER, and found references to open heart repair. She joined the Mighty Hearts Project community, asked questions, read pet testimonies, and used that information to make a plan. When she reached University of Illinois for a consult they performed an echo the same day. The outcome was unexpected.
“His heart is just too small for even our smallest clip.”
That statement captures a critical truth: device-based repairs like TEER can be life-changing, but they are not suitable for every patient. Device sizes and anatomic criteria limit who is a candidate. When TEER was not an option for Oliver, the team at Illinois facilitated a referral to the Jasmine Clinic in Japan where open heart mitral valve repair is well established. Jessica’s persistence—and the support of a referral network—made a surgical cure possible for Oliver.
What TEER is and where it fits
TEER is a minimally invasive, catheter-based approach that clips or approximates the mitral valve leaflets to reduce regurgitation. It is generally less invasive than open heart surgery and can provide substantial symptomatic relief and extended survival in appropriately selected dogs.
- Pros: Less invasive, shorter immediate recovery, effective in many patients.
- Cons: Strict anatomic and size criteria, not suitable for very small hearts or certain valve morphologies.
Because TEER depends on specific device sizes and valve geometries, candidacy is determined by careful echocardiography. Even when TEER would help, it may not be the optimal long-term solution for every dog. That is where surgical repair can be superior.
Open heart mitral valve repair: the gold standard
Open heart mitral valve repair involves cardiopulmonary bypass, direct visualization of the valve, and surgical correction of the diseased leaflets and supporting structures. When performed successfully, it restores valve function in a way that device-based repairs may not fully match.
Dr. Kadotani has trained with leaders in the field, including time at the Jasmine Clinic in Japan with Dr. Uechi, observing and participating in multiple open heart cases. That hands-on experience—seeing a series of procedures and scrubbing in herself—was crucial to bringing the technique home.
She explains that surgical repair is not a niche rescue option. It must be part of a broader care pathway that includes early referral, complete diagnostics, and options to bridge dogs that are too unstable to travel or to undergo immediate bypass surgery.
Why a Midwest center matters
Access is the single largest barrier for many families. Japan and a handful of U.S. centers perform open heart mitral valve repairs, but long wait lists and travel logistics keep the procedure out of reach for many dogs. Creating a center in the Midwest expands access and reduces travel burdens for owners across large parts of the country.
Dr. Kadotani and the University of Illinois team are building that capacity. They already offer other supporting procedures such as left atrial decompression to stabilize patients who are too ill to immediately undergo full repair—and that work saves days or months of time for patients who are deteriorating.
Left atrial decompression: buy time for surgery
Left atrial decompression is a surgical or interventional procedure designed to decompress the left atrium, reduce pulmonary edema, and relieve congestive signs so that a dog can survive long enough to be transported or optimized for definitive repair.
Based on published outcomes and experience, decompression can add meaningful survival time—often measured in months—allowing dogs to reach centers that can perform definitive repairs. This bridging approach is especially relevant when:
- TEER is not an option due to anatomy or size.
- Open heart surgery is desired but immediate transfer or bypass is not feasible.
- Medical therapy alone is not maintaining adequate stability without risking kidney or other organ injury from high-dose diuretics.
Costs vary. At the University of Illinois decompression runs roughly $5,000 to $7,000. Highly experienced centers in California may charge $7,000 to $9,000. These procedures are not inexpensive, but they can be lifesaving in the right scenario.
How the referral process works—and what helps
From the patient perspective, time is often the limiting factor. Referral pathways that are efficient and transparent make a huge difference. Jessica’s experience highlights practical tips:
- Bring detailed diagnostics to the consult: complete echocardiography reports, recent bloodwork, and medication lists let specialists make faster decisions.
- Insist on email transparency: ask to be CCed on all communications with referral coordinators and clinic liaisons so nothing falls through the cracks.
- Use support networks: peer groups and community projects such as Mighty Hearts Project aggregate patient testimonies, clinic contacts, and logistical experience that other owners can leverage.
For referring cardiologists, performing comprehensive diagnostics before surgical consults prevents avoidable delays. A missing test can be the difference between moving to surgery within days or waiting weeks for additional workups.
What to expect from a surgical center
When a center offers open heart repair, a few operational realities matter to outcomes and owner experience:
- Multidisciplinary teams: cardiologists, cardiac anesthesiologists, surgeons, residents, and experienced technicians work together. Consult visits often include multiple clinicians for broad perspectives.
- Postoperative care: intensive monitoring in-hospital for complications, then a gradual transition to internal medicine follow-up and cardiology checkups.
- Opportunity to observe: depending on the center, owners and visiting clinicians may be able to see surgical theatres and learn directly from procedures. That transparency builds trust and spreads technical know-how.
Practical guidance for owners evaluating options
If your dog has mitral valve disease and you are assessing options, use the following practical checklist:
- Obtain a high-quality echocardiogram with measurements and video clips.
- Discuss TEER candidacy explicitly—ask whether your dog fits device size and anatomic criteria.
- Ask about open heart repair availability, expected wait times, and whether a bridge procedure such as left atrial decompression is an option.
- Secure complete labs and organ function tests so transfer teams can make informed decisions quickly.
- Join a community resource to learn about other owners’ experiences and clinic contacts.
Remember that “not a candidate for TEER” does not mean “no hope.” Surgical repair has restored durable function in many dogs, and growing programs reduce the geographic and logistical barriers to access.
Costs and logistics
The financial and logistical burden of advanced cardiac procedures is real. TEER and open heart repair costs vary widely by center, extent of disease, and geographic location. Left atrial decompression provides a less expensive way to stabilize some patients, but even that can run several thousand dollars.
When planning, factor in:
- Transport and travel: air or ground transport to specialized centers, lodging, and time off work.
- Preoperative testing: additional imaging, ECGs, and blood panels.
- Postoperative stay: intensive care monitoring and any needed medications and follow-up visits.
Building capacity: training, mentorship, and collaboration
Expanding open heart surgery for canine mitral valve disease requires more than one surgeon or one hospital. It requires a coordinated effort of training, mentorship, and institutional commitment. Sending clinicians to high-volume centers, encouraging hands-on experience, and creating referral systems are all part of that ecosystem.
Dr. Kadotani’s week at the Jasmine Clinic, observing multiple open heart cases and scrubbing in, is exactly the kind of apprenticeship that speeds safe program development. We expect to see more centers following that model—collaborating internationally and adapting proven techniques to local caseloads.
How we can help each other
Communities of owners, referring veterinarians, and specialists can dramatically shorten the path to repair for many dogs. Sharing diagnostic protocols, referral contact points, and successful timelines helps everyone.
If you are a referring cardiologist, consider a standing referral pathway with surgical centers and a checklist of diagnostics to avoid delays. If you are an owner, gather complete records and reach out to peer groups for firsthand experience on logistics and choices.
Key takeaways
- Open heart mitral valve repair offers the best chance for durable valve correction in many dogs and should be part of the spectrum of care available to owners.
- TEER is transformative when devices match the patient’s anatomy, but device size and valve morphology limit candidacy.
- Left atrial decompression is a valuable bridging strategy to stabilize patients and buy time for definitive repair.
- Access matters: more centers performing open heart repair will save more lives. Training, mentorship, and efficient referral systems accelerate that expansion.
- Community resources like peer groups and coordinated projects can be the difference between getting timely surgery and missing the window of opportunity.
Frequently asked questions
What is the difference between TEER and open heart mitral valve repair?
TEER is a catheter-based, less invasive procedure that clips mitral valve leaflets to reduce regurgitation. Open heart repair is a surgical approach performed under cardiopulmonary bypass that allows direct repair of the valve and supporting structures. TEER is appropriate for many dogs but is constrained by device size and valve anatomy. Open heart repair can treat a wider range of deformities and often has superior long-term results when feasible.
How do we know if a dog is a candidate for TEER?
Candidacy is determined by detailed echocardiography assessing valve anatomy, leaflet motion, and chamber size. Some dogs are excluded because the heart is too small for the available clips or because valve morphology prevents successful clipping. If TEER is not possible, surgical repair or bridging strategies may be considered.
What is left atrial decompression and when is it used?
Left atrial decompression reduces pressure in the left atrium to relieve pulmonary edema and congestive signs. It is used as a bridge in dogs that are too unstable for immediate open heart repair or travel. It can buy weeks to months of time—often 200 days or more in reported series—allowing dogs to be optimized for definitive surgery.
How much does decompression cost?
Costs vary by center. At the University of Illinois the range discussed was roughly $5,000 to $7,000. Highly experienced centers in California may charge $7,000 to $9,000. These are general ranges and individual estimates should come directly from the treating center.
What should owners bring to a surgical consultation?
Bring all recent diagnostics: complete echocardiogram reports with video loops, recent bloodwork, current medication lists, and any imaging or specialist notes. Be proactive about being CCed on referral emails and gather a clear timeline of events. Peer support groups can share practical forms and checklists that simplify this process.
Where can owners find more information and peer support?
Community projects and peer-led groups collecting patient stories, clinic contacts, and procedural experiences are invaluable. They provide real-world practical advice about logistics, costs, and outcomes. Reaching out to these groups early in the process helps build momentum and avoids avoidable delays.
Final thoughts
We are hopeful. The push to create additional open heart mitral valve repair centers in the United States is driven by clinicians who have trained internationally, by owners who refuse to accept “no options,” and by communities that share knowledge openly. Establishing a Midwest center at the University of Illinois under Dr. Kadotani’s leadership is a concrete step toward giving more dogs the chance to live longer, healthier lives.
If you are navigating mitral valve disease with your pet, gather robust diagnostics, lean on community resources, and ask your cardiologist about both interventional and surgical options. Timely action and transparent referral systems can make the difference between temporary comfort and a surgical cure.
