50 | VET GAZETTE | RVC
OPENING HEART SURGERY TO ALL DOGS
Dan Brockman , professor of small animal surgery at the Royal Veterinary College , has been performing open-heart surgery on dogs intermittently over the last twenty five years . He recently performed the world ’ s first successful operation on a dog with a stenotic tricuspid valve
started doing open-heart
I surgery in dogs about 25 years ago when I was working at the University of Pennsylvania . I returned to England and started working at the RVC in 2000 , and we completed our first open-heart surgery here in 2005 .
The RVC is the only veterinary service in the UK that performs heart bypass surgery . Japan has led the way in the field and we have strong relationships with Japanese experts in canine open-heart surgery .
When I was first performing open-heart surgery at the RVC I worked alongside human cardiac surgeons and collaborated with a team from the University of Colorado . Historically , collaborations with experts from overseas and within the medical profession have been vital . However , now we have expanded the RVC team and this allows us to do many more surgical procedures involving heart bypass than ever before .
Since last year we have quadrupled our capacity for canine mitral valve repair surgery , for instance , as a result of creating four new roles in our cardiothoracic surgery team .
Mitral valve disease is one of the most prevalent heart defects in dogs . The expansion of our service enables us to treat many more dogs and gives us confidence to intervene earlier on in the disease process . This maximises the dog ’ s chance of a good recovery and of having a long and active life . Successful heart surgery in dogs can also improve the quality of owners ’ lives as it often means less medication needs to be given as well as less often .
In contrast to human healthcare , where repair is the standard treatment for a ‘ leaky ’ mitral valve , in dogs the disease is still primarily managed with medicine rather than surgery . The RVC has a worldclass Cardiology Service with considerable experience managing dogs and cats with heart disease . That service , led by Professor
Virginia Luis Fuentes , carries out a range of advanced procedures , including pacemaker implantation and treating severe arrhythmias . We work closely on mitral valve cases and other conditions that can benefit from surgery .
LANDMARK CASE
One of the most rewarding challenges I have had in my surgical career was performing open-heart surgery on a threeyear-old Labrador called Mabel , who had congenital tricuspid dysplasia causing valve narrowing or stenosis . This means her tricuspid valve was fused in the middle with just two very small openings for blood to flow through . Tricuspid valve stenosis is much less common in dogs than mitral valve disease and there were no reports of surgery to successfully open up the valve .
Though there were no cases of this surgical technique being used on dogs , we knew that another approach to opening the valve , balloon valvuloplasty , was less likely to be successful . Nevertheless , surgery had risks and these were explained carefully to the owner . The owner had to make a decision based on the potential for giving Mabel a longer and more active life against the 20 percent risk of not making it through the operation . The operation was a success , however , and the owner reports that Mabel
Professor Dan Brockman in surgery and Dan Brockman with Mabel , who had congenital tricuspid dysplasia and was treated by surgery .
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is doing well . Mabel was a fascinating landmark case and since then we have had other fantastic open-heart surgery patients come through and be treated successfully . As there are so many more dogs with mitral valve disease than tricuspid dysplasia , the former has been a greater focus for our cardiothoracic surgery team .
STRONG TEAMS
It is important to say that the success of such a programme depends of many people . The local vets who refer cases are a critical part of the process and animals are then assessed by members of the Cardiology Service , who help identify which are most suitable for surgery . In Mabel ’ s case the surgical team included a perfusionist , two anaesthetists , an anaesthesia nurse , two surgery nurses , three surgeons and a cardiology veterinary specialist-in-training .
There is also a large team at the RVC delivering pre and post-operative care . We are fortunate to have one of the strongest veterinary Emergency and Critical Care teams in the world . This gives pets with challenging conditions who have undergone the greatest chance of making a good recovery .
www . vetgazette . biz July 2017