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Mitral Valve Surgery

Minimally Invasive

TEER (Mitral Transcatheter Edge-to-Edge Repair) is a state-of-the-art, minimally invasive heart surgery designed to help dogs suffering from severe mitral valve disease. The goal of TEER is to restore the dog’s heart function to near-normal levels, improving quality of life and life expectancy. Dogs treated with TEER are expected to have improved heart function, reduced heart size, and in some cases, the ability to reduce or discontinue heart medications. TEER offers an excellent alternative to traditional open-heart surgery.

Why TEER Sugery?

1

Lower Risk

2

Less Invasive Technique

3

Faster Recovery Time

An exciting option for pet owners who want to improve their dog’s heart function without the significant risks and downtime of more invasive surgeries. It significantly reduces symptoms of heart disease, helps extend your pet’s life expectancy.

How Does TEER Work?

TEER uses a small device called V-Clamp to connect the two flaps of your dog’s mitral valve (the anterior and posterior leaflets). This helps the valve close more effectively, preventing the backward flow of blood, which is the hallmark of mitral regurgitation. The procedure is performed through a small incision in the chest (about 2 inches), while the heart is still beating. This eliminates the need for open-heart surgery, reducing recovery time and the risk of complications.

Why Choose TEER?

Minimally invasive: unlike traditional open-heart surgery, TEER requires only a small incision and doesn’t involve stopping the heart. This leads to a faster recovery and less postoperative pain for your pet.

Proven success: TEER has been performed in over 100,000 human patients worldwide and has recently been adapted for veterinary use, with promising results in dogs. Quicker recovery: most dogs are able to walk the day after surgery and are discharged within two days, making it a less stressful experience for both the pet and the owner.

Eligibility for TEER

  • Dogs in stages B2, B2 Borderline Stage C, or early heart failure.
  • Age less than 15 years and weight between 9 to 33lbs.
  • Severe degenerative mitral regurgitation (MR) with appropriate valve anatomy for edge-to-edge repair.
  • Eligibility is confirmed through a TEER Candidacy Exam, which involves detailed imaging and assessments by our veterinary cardiology team. A final determination is made by the device manufacturer and the surgical team just before the procedure.

Pre/Post- Surgery Care & Cost

  • Pre-surgery: patients will undergo several tests to determine candidacy, including echocardiograms and other evaluations as needed.
  • Post-surgery: dogs typically recover quickly. Most patients are walking within 24 hours and can return home after 1 day of observation. Follow-up care includes regular checkups every 3 months for 1 year, with medication adjustments as needed.
  • $18,000 – includes procedure, specialized device, & 24-hour post-operative care. Steps

Steps Leading to TEER Surgery

Non-Heart Failure Patients:

  • TEER Candidacy Exam: after the surgery is recommended, patients undergo a detailed evaluation, including a transesophageal echocardiogram (TEE), to ensure that it is safe to proceed with anesthesia and surgery.
  • Pre-surgical tests: once candidacy is confirmed, patients undergo further testing to ensure they are ready for surgery.

Heart Failure Patients:

  • The first step is stabilizing the heart failure condition through medication and monitoring. Once stabilized, the dog will follow the same steps as non-heart failure patients.
  • Final evaluation: a final TEE will be performed on the day of surgery to confirm candidacy.

The Procedure

TEER is performed via a transapical cardiac approach through a small incision. A specialized device called the V-Clamp is used to grasp and clip the valve leaflets together under the guidance of fluoroscopy and echocardiography.

If you believe your dog might benefit from TEER surgery, please contact our office to schedule a consultation. We will guide you through the process and provide detailed information about your pet’s eligibility.

Maki

…the earlier the better

Maki’s heart journey started when a basic heart murmur was found during her physical exam with her primary care veterinarian. Maki showed no symptoms of cardiac disease. Maki’s veterinarian performed an echocardiogram and determined that Maki’s heart chambers were moderately enlarged, and initiated treatment with medications.

Maki’s parents learned there was a doctor in Florida who performed surgery for this condition with much better results than medications alone, to avoid the development of congestive heart failure, a life-threatening condition. Maki and her family lived in Texas, but they were willing to travel across the US to get the care she needed to survive. Maki came to CFVC and had a cardiac workup by Dr. Bolfer.

Maki was diagnosed with Degenerative Mitral Valve Disease. She was a candidate for the TEER surgery at CFVC, where Dr. Bolfer is one of the few doctors in the world trained in this procedure.

Prior to entering the surgery room, she had a transesophageal echocardiogram (TEE) performed. This final test is conducted to affirm the patient is a good candidate for the surgery. During the TEE exam we learned Maki’s heart condition had progressed further, making the procedure higher risk. Despite the increased risks, her family made the courageous decision to proceed, hoping for a better future for Maki as they knew they did not have much time left with the current diagnosis.

Maki’s surgery proceeded, and Dr. Bolfer was able to stabilize her and successfully repair the defective heart valve. The goal of TEER is to reduce the backflow through the mitral valve to near-normal levels, improving quality of life and life expectancy. Dogs treated with TEER are expected to have improved heart function, reduced heart size, and in some cases, the ability to reduce or discontinue heart medications.

Maki’s heart is a testimony to how the TEER procedure saves lives.

Without it, she wouldn’t have the chance at life that she now has. We are so grateful. Dr. Bolfer and his team are doing incredible things. It is not easy work, and it makes me emotional thinking about the sacrifices they make to save these animals’ lives. Every healthcare professional should have to take a course from him on how to care for patients and run a practice! Central Florida Veterinary Cardiology is the standard by which all other medical care—animal or human—should be measured. They are phenomenal.

Bandit

…late is not too late

Bandit, a 12-year-old male Dachshund mix from Ocoee, FL, presented to the clinic with a history of syncope episodes. After a thorough evaluation by Dr. Bolfer, Bandit was diagnosed with Degenerative Mitral Valve Disease ACVIM Stage C. Given the severity of his condition, surgical intervention was recommended to address the mitral valve insufficiency and improve his quality of life. Bandit was another candidate for TEER surgery.

Prior to entering the surgery room, Bandit had a transesophageal echocardiogram (TEE) performed, which discovered Bandit’s surgery carried a higher risk than initially expected, as his heart had worsened progressively since his previous check-up. His parents decided to proceed with the surgery, fully aware of the heightened risks, but understanding that without it, he might only have a few months left. Surgery was performed, and Dr. Bolfer was able to successfully insert the device into the heart. Bandit defied the bleakest of expectations, emerging from heart surgery not only alive, but with a renewed chance at a better life.

Bandit’s echocardiogram showing the position of the Mitral Valve V-Clamp decreasing the amount of mitral valve insufficiency.

We cannot express in words how grateful and thankful we are for Dr. Bolfer and his team at CFVC. We were originally given a prognosis of 6-18 months with Bandit, and now we are looking at getting to spend years with him. I know Bandit’s surgery was not easy, so it truly goes to show the amount of care, talent, and skill everyone has at CFVC. The CFVC team truly cares for their patients and prioritizes effective communication. We have felt heard and validated throughout this whole process, and are so glad that we found your practice in time for Bandit to stay with us for many more years! Thank you CFVC team!!

A New Era… Mitral Valve Repair

Locations

Clermont

1600 S. Grand HWY2300

Ocoee

1555 Boren Drive

Daytona

2300 S. Ridgewood Ave.

About the doctor

Luiz Bolfer, MV, DVM, Ph.D., DBCVECC, Res. ACVECC & ACVIM-CA, V-Clamp Surgery Specialist by Hongyu Medical

DBCVECC (Emergency & Critical Care); American Veterinary Medical Association, Certification (ECFVG); Diplomate, Brazilian College of Veterinary Emergency & Critical Care (BCVECC); Residency, American College of Veterinary Emergency & Critical Care (ACVECC); Residency, American College of Veterinary Internal Medicine, Cardiology (ACVIM); Certificate of Achievement in Veterinary Hemodialysis, UC-Davis; PhD Veterinary Clinical Sciences – Cardiology – University of Florida; Pediatric Heart Transplant Researcher – eGenesis Inc. – Madison, WI