This is a portion of the transcript from Session III of the VetVine Mitral Valve Disease Masterclass Q&A segment:
Dr. Sheri Berger l VetVine: Dr. Matsuura talked about being able to potentially stop Pimobendin after open-heart mitral valve repair surgery. Is the same true with the V-clamp procedure?
Dr. Michael Aherne: I think it's certainly true. Again, it's dependent on the individual patient. But, again, if we consider that the best candidates for this procedure are those that have smaller hearts to begin with, they usually have pretty well-preserved function. And if we can limit the degree of mitral regurgitation with the procedure, then there really shouldn't be any need for Pimobendan in those patients long-term.
I do think it all comes down to the degree of repair that we can achieve with the device. If there's still a significant amount of regurgitation after the procedure, then there's certainly a possibility that some patients might either need to go back on Pimobendon after the procedure or stay on it long-term. It really depends on the amount of residual regurgitation afterwards. But I do think there's a good possibility that, in those more mildly affected patients, it could be discontinued.
Dr. Sheri Berger l VetVine: What about postoperatively for these animals in terms of lifestyle, other procedures, and other meds. Is there anything we would need to be concerned about?
Dr. Michael Aherne: So, with the transcatheter techniques, just like open-heart repair, we're placing implants into the heart. And so, particularly in the earlier stages, we worry about thrombosis and clot development on the devices - be they the neochords with the harpoon or with the V-clamp. And so patients, postoperatively, will go on antithrombotic drugs or blood thinners - to use the colloquial term - to try and reduce the risk of clotting afterwards. And so that's usually the biggest component in these patients.
Again, it depends a little bit on the stage of the disease. So, some of these patients are in heart failure at the time of the procedure. So, depending on the success of the procedure and the degree of residual regurgitation, they may or may not need to stay on their Pimobendan long term (the case in most scenarios), and the diuretic can hopefully be discontinued.
In many cases the medical management is going to be for a relatively short period of time after the procedure. The antithrombotics should be able to be stopped after several months - 3 months maximum - because we should get endothelialization, in which the lining of the heart essentially kind of grows over the device. And once that occurs, then it's going to be resistant to clot formation.
But again, at this time, we don't necessarily have the longer term outcome data to suggest that there is there is anything else that we need to include as part of the medical therapy in these patients over the long term after such procedures.
