CSU cardiology team takes open heart surgery to the UK

FORT COLLINS, COLO.—A Colorado State University (CSU) cardiology team is headed to the University of London to perform open-heart surgery on a dog and help set up an open-heart surgery program at the Royal Veterinary College.

Between eight to 10 people will be needed to an perform open-heart surgery, including a human-trained clinical perfusionist to operate the heart-lung machine. A cardiology team from Colorado State University will travel to the Royal Veterinary College in London to perform an operation and assist in creating a new program.

Dr. E. Christopher Orton, DVM, PhD, diplomate American College of Veterinary Surgeons, and professor of clinical sciences at CSU, says while the client is financing the trip, it will serve two important purposes: hopefully save a dog and build a new program.

The client financing the surgery requested anonymity. It provides a unique opportunity for the team and CSU.

The January surgery is slated for a Rhodesian Ridgeback, estimated between 1 to 2 years of age, for a tricuspid valve replacement. Orton will use a tissue valve made from bovine pericardium, which is considered state-of-the-art for humans. Estimated in the United States as costing $8,000-$10,000, it is the most frequent open-heart surgery performed at CSU's veterinary college, Orton explains.

Tricuspid dysplasia is a congenital heart defect, which is causing insufficiencies for this dog.

"When this condition is severe, it leads to heart failure and a shortened life," Orton adds.

To perform the surgery, Orton has recruited Dr. Khursheed Mama, anesthesiologist; Dave Peterson, a certified clinical perfusionist (to operate the heart/lung machine); Dr. Tim Hackett, a critical-care specialist and Michele Pullaro, a scrub nurse (certified veterinary technician). Ideally, the surgery takes between eight to 10 people to perform, so Orton says the team will work with other members of The Royal Veterinary College.

"The dog we are operating on is already in heart failure, which is not ideal. He is in arrhythmia, atrial fibrillation that is also not ideal. We would predict that this dog without surgery would have progressive heart failure within the next months. He might survive another eight to 12 months, but not beyond that."

The key to the surgery will be the aftercare.

"The challenge here is aftercare because he is in heart failure. Getting him through the surgery and getting his heart able to withstand the insult of open-heart surgery will be the challenging part here," he explains.

Orton says that the first 12 hours are the most critical for patients undergoing open-heart surgery.

"The majority of dogs who survive until the next morning will do okay. This case might have some lingering issues for the first few days, while he decides whether his heart is going to pump or not."

Long-term the surgery has the potential to be curative. Orton adds, "We have had good response from dogs with similar conditions. If we don't do something, we know what the outcome will be."

Overall, the success of open-heart surgery is around 80 percent, although mitral-valve repair is less successful due to the complexities of the surgery.

The team must travel to the United Kingdom because of rabies restrictions in the country. Because the UK has declared itself rabies free, transported dogs must be quarantined for eight months, which was not a solution due to the required level of aftercare.

Collaborative effort

Ultimately, this surgery will lead to an entirely new collaboration with the Royal Veterinary College.

The idea stemmed from conversations with Orton and University of London's Dr. Dan Brockman, who has interest in creating an open-heart surgery program within the college.

Orton adds that CSU is currently doing the most open-heart surgeries in dogs in the country. They perform about 12 to 15 cases a year, including mitral-valve repair.

"It is the number one heart disease in dogs by far. Degenerative mitral valve disease is an aging change and leads to mitral regurgitation. And this is an extraordinarily common cause of heart failure in dogs and the number two cause of death after cancer," Orton adds.