MITRAL VALVE REPAIR EXPERTS
Doctors Sabine and Jean-Hugues Bozon, who are the only 2 vets diplomate of cardiopulmonary bypass sciences, belong to the worldly known team to achieve open-heart surgery. Thanks to their many years practising in this field, they now set up their own team of professionals (surgeon, instrumentalists, cardiologist, perfusionists, anaesthetists, highly trained nurses…), 10 to 15 people coming from the veterinary world or renowned human hospitals in Paris like « Necker Hospital », « La Pitié Salpétrière Hospital » or the « Centre Cardiologique du Nord ».
In 2018, 100% of our hearts restarted after the mitral valve repair !
Drs Sabine and JH Bozon are focusing more and more on open-heart surgeries and interventional cardiology by having purchased (November 2018) a brand new digital C-Arm for fluoroscopy, angiography and minimally invasive cardiac procedures (OEC ELITE CFD 21 CARDIAC from GE HealthCare).
WHICH DOGS ARE AT RISK OF DEVELOPING DMVD?
DEGENERATIVE MITRAL VALVE DISEASE (DMVD)?
WHAT ARE THE CLINICAL SIGNS OF DMVD?
Pulmonary oedema is a major cause of dyspnoea (difficulty to breathe) because the lungs are filled with fluid instead of air. The clinical signs associated with CHF are: lethargy, exercise intolerance, cough, increase in respiratory rate and amplitude in respiratory motions. If one of those clinical signs is identified, a veterinarian must be contacted urgently.
THE ACVIM CLASSIFICATION
ACVIM STAGE B
This class comprises dogs with a heart murmur without any other clinical signs. This stage is further subdivided into Stage B1 and B2.
Open heart surgery planning is a slow process – here are the 10-key steps in chronological order
Eligibility evaluation on a heart basis
Please send us, through the contact formulary, your dog’s latest heart-scan and chest radiographs, his medical history and his ongoing treatment plan.
Detailed recent physical examination
Latest heart-scan (cardiac ultrasonography evaluation with colour Doppler), with the detailed report, images and videos
Latest chest radiographs (2 ventrodorsal and 1 lateral view)
Arterial blood pressure measures
- NT-ProBNP dosage if possible
Ask your general practitioner to perform the following tests (please send the complete digital version of these tests) 2 months prior to the presumed date of surgery
NT-ProBNP and Cardiac Troponin I dosage
Complete abdominal ultrasound scan (must be particularly closely examined : the adrenal glands for signs of Cushing’s disease, pancreas for signs of pancreatitis, an occult tumour must also be searched for)
Blood work : haematology, complete biochemistry panel, electrolytes, C-Reactive Protein, SDMA, cPLi, T4, TSH, 4DX
Urinalysis including UPCR and bacterial culture (sampling by cystocentesis)
Faecal analysis (culture, search for occult blood loss and parasites)
Complete coagulation profile including antithrombin III dosage (compulsory to confirm the feasibility of extracorporeal circulation)
Blood typing (DEA 1.1). A cross-match with the donor’s blood will also be performed at HOPIA on the day prior to surgery.
Interpretation of the results, validation that your dog fits the criteria for open heart surgery
Date setting for your dog’s surgery
Reception of the signed contract and payment of your deposit at this stage will secure your dog’s place in our hospital for his surgical intervention and hospitalisation.
Possible refinement of the therapeutic plan in order to optimise preoperative conditions
Email exchanges between yourself, your cardiologistand Dr Sabine Bozon.
Payment of the balance one week prior to surgery
Plan to arrive at least 3 days prior to surgery at hopia
Heart scan, chest radiographs, blood testing and cross-matching
These tests are performed 1 to 3 days prior to surgery at HOPIA and are included in the surgical intervention fees.
The surgical procedure takes between 6 to 12 hours.
MACHINES AND CONSUMABLES
Apart from the extracorporeal circulation machine, key pieces to the procedure, the necessary equipment is as follows:
Heart-lung bypass machine – centerpiece of the intervention
The technical and human platform are important, the team must have a perfect cohesion but the most crucial point is the heart-lung bypass machinery which represents quite a challenge in small individuals.
THE DIFFERENT STEPS OF THE PROCEDURE
The next steps are the following:
The post-operative care is a real challenge!
It is a very critical phase during which the dog may die because many organs have suffered from the extracorporeal circulation, even the blood, to start with, because it has flown outside of its usual body. A complete blood panel, urinalysis, radiographic and ultrasonographic scans are performed daily during the week following surgery.
Apart from thrombosis (clot formation), the possible complications are: