Key result
OMVR achieves more complete regurgitation reduction than V-Clamp TEER in dogs with advanced mitral disease.
Why the study?
Myxomatous mitral valve disease in dogs progresses to CHF and death despite medical management, and guidance is needed to select between open mitral valve repair and transcatheter edge-to-edge repair.
This review proposes a structured patient selection framework to guide clinical decision-making between open mitral valve repair, V-Clamp TEER, and medical management for dogs with myxomatous mitral valve disease.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This manuscript represents the analysis of team performance in a complex sociotechnical environment. The results highlight the importance of team-working habits that include reflective and deliberate practice both by individuals and by the whole team delivering such a complex therapy. In addition, it emphasises the critical importance of ongoing 'skills maintenance' once a skill set has been acquired. In practical terms, this means that once the team has learned what needs to be done, they have to keep doing it a lot to maintain a high level of performance.”
Patient selection for OMVR versus V-Clamp in advanced canine MMVD warrants individualized assessment by stage and anatomy; leaves open need for prospective comparative trials.
Myxomatous mitral valve disease (MMVD) is the most common acquired cardiac disease in dogs, and progression to congestive heart failure (CHF) and cardiac death remains common despite optimal medical management. Two surgical interventions are now clinically available for dogs with advanced MMVD: open mitral valve repair (OMVR) under cardiopulmonary bypass and transcatheter edge-to-edge repair (TEER) using the canine V-Clamp device. This narrative review synthesizes the contemporary literature on both techniques and proposes a framework to guide patient selection. OMVR has more than a decade of clinical experience and a published outcome base of more than 1,000 dogs, with surgical survival rates exceeding 99% across all clinical stages and long-term mortality risk modulated by age, body weight, breed, and pulmonary vascular status. V-Clamp TEER has emerged since 2020 with multiple published clinical cohorts demonstrating high acute procedural feasibility (96–97% in the largest series) and, most recently, sustained one-year hemodynamic and remodeling improvements with two-year all-cause survival of 67% at the leading reporting center; outcomes vary across centers, reflecting the interacting influence of patient selection, anatomic eligibility, and operator learning curve. Because the two techniques differ in evidence maturity and in the outcome metrics reported, direct numerical comparison between them requires caution. OMVR achieves more complete mitral regurgitation (MR) reduction, while V-Clamp produces a less invasive double-orifice repair with intermediate hemodynamic effect that may partially regress in the presence of significant residual MR. A proposed selection framework integrates ACVIM stage, mitral valve anatomy, body size, comorbidity burden, and center experience to guide decisions among OMVR, V-Clamp, and continued medical management. Honest owner counseling that includes center-specific experience and the limits of each option remains a clinical priority as the field evolves.
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Kongchatree et al. (2026) conducted a review in Myxomatous mitral valve disease (MMVD). Open mitral valve repair (OMVR) and V-Clamp transcatheter edge-to-edge repair (TEER) vs. Medical management was evaluated. Open mitral valve repair and V-Clamp transcatheter edge-to-edge repair are viable surgical options for dogs with advanced myxomatous mitral valve disease, with OMVR achieving more complete regurgitation reduction.
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