“Transcatheter Edge-to-Edge Mitral Valve Repair” (TEER) is a new innovative technique for mitral valve disease in dogs. 

Many dogs with mitral valve disease develop Congestive Heart Failure (CHF) which significantly shortens their lifespan.

TEER is a minimally invasive procedure which avoids the need for open-heart surgery and cardiopulmonary bypass to treat the heart disease. Instead, an implant, a.k.a. V-Clamp, is introduced through a catheter into the beating heart, guided by transesophageal echocardiography (TEE) and fluoroscopy. 

Results from a surgery programme in 40 dogs at Colorado State University suggest that patients have a low complication rate (95% success rate) and can benefit greatly from the operation (Potter et al. ACVIM abstract 2023).

The benefits include a reduction in the severity of mitral valve disease, a lower required medicine use, and improved exercise capability. 

The risks of the minimally invasive technique are much lower than conventional open-heart surgery.

This is because dogs undergoing the TEER procedure do not need cardiopulmonary bypass. This also minimizes hospitalization time from weeks to only a few days. Most dogs can eat and walk within hours of the procedure and are ready for discharge on the second or third day after the surgery

The procedure is suitable for Mitral Valve Disease Stage B2, C and D.

All potential candidates will need to be fully assessed and screened for suitability. 

Our multidisciplinary international TEER team includes:

• Board-certified Cardiologist
• Dedicated veterinary anaesthesiologist
• Minimally invasive surgeon with the highest TEER caseload in Asia

For more information and to inquire about a possible TEER case referral, please ask your vet to contact us by email at hello@atlasvet.com.sg.

FAQ

How does TEER work?

Congestive heart failure due to mitral valve disease can be a life-threatening condition. In most studies, 50% of dogs that develop heart failure die within nine to ten months. About 80% die before 18 months, and only a few manage to survive more than two years. 

TEER uses a V-Clamp to reduce mitral valve regurgitation and thus slows down congestive heart failure. It has been performed in more than 100 dogs over the past 3-4 years. So far, it is highly successful, low risk with a rapid recovery time:

• 50 to 90% reduction in the severity of the mitral valve leak
• The procedural survival rate of the procedure is 95%.
• Patients will be up and walking as soon as they recover from the anaesthetic.
• Hospitalisation time is expected to be 1-3 days.
• Sometimes the heart murmur totally resolves.
• The heart enlargement from mitral regurgitation is also expected to reverse.
• After the surgery, the patient can usually discontinue furosemide and benazepril.

For dogs in congestive heart failure, this procedure can be life-saving.

Are there other surgery options for mitral valve disease?

Open-heart bypass surgery to perform mitral valve repair has been performed by a team from Japan.

• Such a surgery costs between $60,000 to 75,000.
• In a research study, 45 of 48 dogs survived the surgery and 25% of them were still alive 3 years later (Uechi, M et al., JAVMA 2012).
• This is a major surgery with significant risks due to the need for cardiopulmonary bypass.

Alternatively, TEER is a minimally invasive option to repair mitral valve disease.

What is a V-Clamp?

The V-Clamp is the veterinary counterpart to the human MitraClip. This small device, approximately 8 mm in length, is implanted to clamp together the two mitral valve leaflets in patients with myxomatous mitral valve disease, thereby reducing the backward flow of blood through the valve. While the veterinary V-Clamp has only been available for the last 3 years, the human MitraClip has been successfully implanted in over 150,000 humans worldwide and demonstrated superior results over medical treatment.

What stages of Mitral Valve Disease can TEER be used for?

TEER is suitable for dogs Mitral Valve Disease Stage B2, C and D.

Is my dog a candidate for V-Clamp surgery?

All potential candidates will need to be fully assessed and screened for suitability. A special form of echocardiogram would be required. Please contact us for more information at hello@atlasvet.com.sg

The patient needs to be at least 3kg to proceed with the TEER procedure.

What is the recommended age for the surgery?

There is no age limit. 

Are there any significant risks for TEER procedure?

Unfortunately, all forms of surgeries, including cardiac, may have complications such as death. Clinical evaluation of the TEER procedure over the past years has shown low procedural risk and significant reductions in the severity of mitral disease.

Research indicates freedom from all-cause and cardiac-related mortality at 9 months to be 87.4% and 91.1%, respectively.

The most serious complication is detachment of the clamp (~ 7% risk) which can be potentially fatal if it happens. The risk of clamp detachment is highest within 3 days of the procedure.

By avoiding an open-heart approach and the need of cardiopulmonary bypass, the TEER has much lower risks and complications compared to other forms of mitral valve surgery.

What are the general anaesthesia risks?

Unfortunately, all anaesthesia has risks. We will review any other comorbidities during the case selection process with the anaesthesia specialist. Thankfully, the anaesthesia protocol is specifically tailored for patients with heart conditions.

Will my dog still need to be on heart medications?

The number and/or dosage of medications will decrease.

• The tapering of medications would be tailored to the individual.
• For most cases, the patient only needs pimobendan after the surgery. 

However, regular monitoring would still be required to ensure the heart condition does not relapse.

What would be the cost of the procedure?

As of Jan 2026, the cost of the implant and procedure including hospitalisation is $20,000 to 24,000.  

• Includes ICU hospitalisation of 2 to 4 days
• Depending on the cost of flight tickets during peak periods, there may be an extra $1000-2000 surcharge.

While this is a significant sum, it remains cost effective for a procedure of such caliber. The cost covers the logistics of flying in the overseas team to support the surgery.

Is the TEER done in other parts of the world?

The TEER procedure is championed by Dr Christopher Orton’s team at Colorado State University. He is a world-renowned veterinary cardiologist.

The procedure has since been done at the following locations (but not limited to):

• University of Illinois, USA
• University of Bristol, UK
• Veterinary Specialist Services Brisbane, Australia
• University of Minnesota, USA
• Texas A&M University, USA
• Veterinary Specialists of Sydney, Australia
• Chulalongkorn University, Thailand
• Azabu University, Japan
• Korea Animal Medical Center, South Korea