What is the goal of surgery?

The goal of the surgery is to prevent heart failure and prolong their survival time. The goal is also to attain mild regurgitation without heart enlargement, keeping them asymptomatic. The hope is to reduce the medications the dog is currently taking, depending on the actual disease progression.

Where is surgery available?

Dr. Masami Uechi performs mitral valve repair at, The JASMINE Clinic in Yokohama, Japan.

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, surgical cost at the JASMINE clinic are $17K USD (depeding on the current exchange rates). Plus travel, hospital, pre and post op care, consultation fees and any additional extended aftercare cost.

The RVC is currently charging a total of £17,500 GBP for surgery which includes the deposit, surgical and aftercare cost. Please keep in mind travel cost are additional separate costs for each location. Each clinic will send you your contract with detailed payment terms and conditions.

Mitral Valve Repair Possible Surgical Complications

Perioperative surgical complications

We understand how scary these risks sound, we encourage you to speak to the clinics directly regarding these possibilities and your concerns before considering surgery. When you arrive at each center the doctors again go over the risks with you and have you sign acknowledging, so they know you are completely well informed of the risks.

Patients with CHF associated with severe lung problems have a higher risk of mortality during surgery from surgical complications or anesthesia-related issues. Some patients may require prolonged respiratory support by mechanical ventilation.

Postoperative Congestive Heart Failure

The heart may lose contractility following open-heart surgery. This may occur from surgical manipulations induding temporarily stopping the heart, incision and placing suture materials. Following the mitral valve repair surgery, tricuspid regurgitation may temporarily become prominent. The Tricuspid valve is located on the right side of the heart and severe tricuspid regurgitation may lead to retention of fluid in the abdomen.

Postoperative Pulmonary Dysfunction

Respiratory complications are caused from: hemorrhage in the chest pain, reduced contractility of the heart, reduced lung function (collapsed lung lobes, pulmonary embolism), diaphragmatic paralysis, and airway obstruction. Early detection of the problem is necessary for prompt treatment

lntracardiac Hematoma

lntracardiac hematoma may develop during or after the surgery. It may contribute to the mortality or it may reduce in size with or without surgical intervention to drain the hematoma. The cause of the hematoma is still unknown.

Hemorrhage

If anticoagulation effect is insufficient, postoperative prolonged hemorrhage from the surgical site may occur.

Anemia and Low Platelet Count

Mitral valve repair surgery is performed with cardiopulmonary bypass. Anemia is a common postopertaive clinical finding from dilution effect of blood during the surgery. Low platelet count may also occur after the operation and its common symptoms include bruising of the skin. Anemia and low platelet count usually improve few days after the surgery, but some patients may require blood transfusion.

Blood Transfusion Reaction

Blood typing and cross-matching are always performed prior to the operation, However, blood transfusion reaction can occur in some animals.

Thromboembolism

Postoperatively clots may form in the heart chambers or blood vessels and can lodge anywhere in the body. Symptoms of blood clots depend upon their location and size. Thromboembolism is a significant cause of morbidity and mortality.

► Neurological signs (coma, seizure, paralysis) ► Congestive heart failure from acute myocardial infarction ► Respiratory failure from pulmonary embolism ► Peripheral arterial embolism (motor dysfunction and necrosis) ► Pancreatitis (poor appetite, vomiting, diarrhea)

Possible Adverse Effects on Organ Function

The heart is temporarily stopped during the cardiopulmonary bypass, organs such as the liver, kidneys and pancreas may not receive adequate blood flow and may cause adverse effects on organ function postoperatively. Pancreatitis is one of the common complications from thrombosis or poor perfusion. Symptoms include poor appetite, vomiting or dianhea and severe cases of pancreatitis can be fatal.

Arrhythmia

Arrhythmia (irregular heart beat) may occur during and after the surgery. Usually arrhythmia disappears after 1 to 2 days, however in rare cases the patient requires antiarrhythmic medications or pacemaker.

Diaphragmatic Paralysis

Paralysis of diaphragm occurs following incision into the left chest cavity. Rapid, shallow breathing, and shortness of breath can occur temporarily and spontaneous resolution is common.

Infection Postoperative infections may occur from a weakened immune system.

13 years, Although it’s at each clinics discretion to take on older patients.

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:

You may also email us at any time at mightyheartsproject@gmail.com or connect with us on our Facebook Community page to get answers to any preliminary questions you have before engaging the clinics.

What is Dr. Uechi’s and Dr. Brockman’s current success rates?

(Dr. Masami Uechi)

Dr. Masami Uechi has done sugery on roughly a 1,000 dogs with a discharge rate of 92% which Masami considers his success rate. The eight percent unfortunately are complications following surgery.

Additional metrics about the surgery can be found in this blog article. [9]: /s/062_SmallAnimal_01_04_Uechi.pdf

(Dr. Dan Brockman)

Dr. Dan Brockman has told us his current success rates are 90%. He has performed surgeries on about 75 dogs as of May 2019.

The most ideal time for surgery is when a dog is at advanced 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 incision site should be monitored to ensure no irritation is occurring from 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.

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)

  • ECG

  • Blood Tests – CBC, Biochemistry test, Electrolytes, C-Reactive Protein

  • Chest x-rays (3 views)

  • Echocardiography

  • Abdominal ultrasound

  • SDMA

  • Urinalysis and further kidney tests if indicated

  • Full coagulation profile: (PT,APTT, Fibrinogen, ATIII,FDP,ACT)

  • Blood Type

Contact the clinc for further details.

See Requirements to become a surgical candidate for Japan