Click here for a information brochure (flyer) of the Teer surgery
TRANSCATHETER EDGE-TO-EDGE REPAIR (TEER)
A new minimally invasive procedure for mitral valve repair in dogs
Download a PDF for veterinary cardiologists: which views to acquire for V-Clamp referrals
What is myxomaoutous mitral valve degeneration (MMVD)
Mitral valve endocardiosis, also calle chronic mitral valve disease, or myxomaouts mitral valve degeneration (MMVD) is a degenerative disease of the mitral valve (and sometimes the tricuspid valve) characterized by progressive changes in the valve tissue.
MMVD is the most common cardiac disease in small dog breeds, sich as Cavalier King Charles Spaniels, Dachshounds, Yorkies etc.
These changes lead to thickening, shortening, and loss of elasticity of the valve, preventing it from closing completely.
Consequences of MMVD
• Blood regurgitation (mitral valve insufficiency): Due to incomplete valve closure, blood flows backward from the left ventricle into the left atrium during systole (heart contraction).
• Volume overload: This causes volume overload in the left atrium and ventricle, leading to their enlargement (dilation) over time.
• Left-sided heart failure: As the disease progresses, it can result in a backup of blood into the lungs (pulmonary edema) and heart failure.
What is the TEER Procedure?
The transcatheter edge-to-edge repair (TEER) procedure is a minimally invasive intervention on the beating heart used to treat mitral regurgitation caused by degenerative mitral valve disease.
The V-Clamp procedure is the veterinary version of the MitraClip, which is used in human medicine.
V-clamp surgery
The procedure is performed under general anesthesia. A small incision is made in the chest, and the V-Clamp device is guided into the beating heart using advanced imaging techniques (3D transesophageal echocardiography). This method reduces valve leakage and improves heart function without the risks of a full surgical procedure.
Advantages of the TEER Procedure
• Minimally invasive: The procedure is performed through a small incision without the need for a heart-lung machine.
• Catheter-based technique
• Quick recovery: Discharge within a few days
• Short procedure time: 40–60 minutes
• Tailored treatment
due to different divice sizesFrequently asked questions:
Is my dog suitable for the procedure?
Whether your dog is a candidate for the V-Clamp operation depends on several factors and requires a thorough examination.
Why a comprehensive assessment is essential:
• Individual evaluation: Every dog is unique. A detailed examination is crucial to understand your dog’s specific condition.
• Risk assessment: Surgery carries risks. A careful evaluation is needed to ensure the benefits outweigh the risks.
• Alternative treatment options: Depending on your dog’s condition, other therapeutic approaches may also be considered.
Eligibility Criteria:
The following criteria apply:
• ACVIM Stage: Late B2 or early C stage
• Weight: Between 4 and 15 kg
• Anatomy: Suitable valve structure for repair (e.g., A2 segment prolapse)
• General health: No significant non-cardiac health issues.
Initial Eligibility Assessment
An initial assessment of eligibility is conducted by the TEER team at LMU Veterinary Cardiology after an echocardiographic examination. If your local cardiologist has performed an echocardiogram with specialized views, we can review the DICOM images (video loops) before your visit to Munich.
The final decision on eligibility is made under anesthesia using transesophageal echocardiography immediately before the procedure.
Please send DICOM images or a download link to:
Is the procedure associated with significant risks?
While complications, including fatalities, can occur with any heart surgery, a recent large study reported successful outcomes in 48 out of 50 patients with no fatalities (Potter et al., 2024). However, future studies with larger sample sizes might report fatalities. Since the V-Clamp procedure avoids open-heart surgery and a heart-lung machine, the risks are lower compared to other mitral valve repair methods.
Benefits of the TEER Procedure
The number and/or dosage of medications typically decrease post-procedure. Over time, however, dogs may show signs of heart failure again, requiring resumption or adjustment of medications.
Is recovery time lengthy?
Most patients can go home 2 to 4 days after the procedure and exhibit minimal discomfort. Mild painkillers may be needed for the first few days at home.
Costs
The procedure costs approximately €12,000. If a second V-Clamp is needed during the initial operation, no additional costs are incurred.
The LMU TEER Team
Our multidisciplinary TEER Team at the LMU Small Animal Clinic, under the leadership of Prof. Dr. Gerhard Wess, Head of the Veterinary Cardiology Service, includes 2 surgeons, 2 cardiologists, a TEE ultrasound specialist, and specialized support from anesthesia and emergency/critical care. This collaborative approach ensures comprehensive care for our patients.
Follow-Up Care
Regular check-ups for at least one year after the procedure are essential to monitor recovery and heart health. These check-ups can be conducted either at our clinic or by your regular cardiologist. Long-term cardiological care may still be required.
Contact
For appointments or to submit DICOM images/download links, contact us at: