What is the goal of surgery?
The goal of surgery is to keep the dog stable at Stage B1 for the rest of the dog’s life. This means mild regurgitation without enlargement of the heart and no symptoms. Eighty Five percent of dogs will no longer require medication after recovery.
Where is surgery available?
Dr. Masami Uechi performs mitral valve repair at, The JASMINE Clinic in Yokohama, Japan.
Dr. Johnn-Hugues Bozon perforns mitral valve repair at his clinic, Clinique Veterinaire Hopia in Versailles, France with his wife Dr. Sabine Bozon.
Dr. Dan Brockman performs mitral valve repair at, Royal Veterinary College (RVC) in Brookmans Park, United Kingdom.
What is the cost of surgery?
This varies depending on the location of the surgery, and prices are subject to change at any time. As of July 2018, surgery at the Bozon Clinic is $20-22k USD (depending on exchange rate and if stem cells are requested). Surgery at the JASMINE clinic is $17k USD (depeding on exchange rate). The RVC is charging £12,000 GBP (~$17,000 USD). The surgery is currently subsidized by the RVC. The cost is expected to slightly increase in the future as it slowly approaches its break-even target. Please keep in mind that the cost of surgery itself is only one portion of the total cost. Deposit to hold surgery date, Travel to France, UK or Japan, along with pre-op and post-op check-ups (blood work, X-Rays, Echocardiograms) also needs to be factored in.
What is the latest age recommended for surgery?
Is it best for me to make contact by email or telephone?
Email is best. The doctors prefer to communicate with your cardiologist directly to ensure all necessary files are transferred to them for review at once, for candidacy. Have your doctors CC you on all communications. Contact information is provided below:
What is Dr. Uechi’s current success rate?
The most recently published success rates are available as an excerpt of a paper Dr. Uechi published in October 2016 downloadable here. In short the paper states that more than 600 dogs have been operated on with a perioperative survival rate of 98% and discharge rate of 92%.
Additional metrics about the surgery can be found in this blog article.
At what stage is surgery recommended and most beneficial?
The most ideal time for surgery is when a dog is at Stage B2, when the heart muscle is still at its strongest and the dog is not weakened by symptoms of congestive heart failure. Dogs can be operated on at any point beyond Stage B2; however, the likelihood for complications grows as the dog advances to Stage C and Stage D. Advancement beyond Stage B2 causes the survival rates to reduce slightly.
What are surgical complications your dog can face once home from surgery?
Dogs can have minor side effects related to Plavix, the blood thinners prescribed to prevent blood clotting after the surgery. The dosage may need to be re-evaluated once you are back at home. The incision site should be monitored to ensure no irritation is occurring from the clothing or harness worn by the dog. There have been past reported cases of minor infection due to this irritation. Beyond that, any concern should be addressed with your veterinarian and/or cardiologist at home and if consultation is needed, Drs. Bozon are available to weigh-in. It’s always better to be on the safe side.
What are needed tests for pre-screening and qualification for surgery?
A sample listing of the tests are enclosed below:
- Brief past medical history and known current diseases
- Physical Examination
- Blood Pressure (NIBP)
- Blood Tests – CBC, Biochemistry test, Electrolytes, CRP
- Cardiac Biomarkers (NT-proBNP)
- Chest x-rays (3 views)
- Abdominal ultrasound
- Urinalysis and further kidney tests if indicated
- Full coagulation profile
- Blood Type
What is sildenafil and why do dogs need to take it pre-operative?
Sildenafil is a selective vasodilator that helps with pulmonary hypertension (high blood pressure) in pets. Pulmonary pressure is something the doctors try to decrease before surgery. Dogs with borderline pulmonary pressure (around 50) who have been taking Pimobendan for a while may only need to take Sildenafil a few weeks before surgery. The ultimate determination on whether your dog will take Sildenafil will be based on the current condition of your dog, duration of the disease, the treatment already prescribed, and your dog’s breed. All decisions are made on a case by case basis, and will be unique to each dog. The only commonality in the use of Sildenafil is on the day of surgery. Doctors will give 2 mg/kg of Sildenafil one hour before anesthesia.
Can more than one surgery be performed in a day?
Sometimes, when dogs appear to be a “textbook” case, the doctors will feel comfortable fitting in an emergency case in the afternoon and double book the day. This does not happen frequently, but the doctors will make the best use of their time and will not put any dogs at risk by booking more than they can handle.