Long-term sacubitril/valsartan is well tolerated in dogs with heart failure and myxomatous mitral valve disease and suggests excellent survival benefits.

Sacubitril/valsartan appears safe and may significantly improve survival in dogs with MMVD-associated heart failure.

This retrospective cohort study evaluated the safety and survival outcomes of sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor, ARNI) in 50 dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD) over a 2.8-year period. Dogs were treated at a mean dose of 18.1 ± 5.4 mg/kg PO q12h. After excluding five dogs due to surgical intervention, left atrial decompression, or adverse events requiring discontinuation, survival analysis was conducted on 45 dogs. The overall median survival time from first CHF episode was 577 days (range 431–751). Stage C dogs demonstrated markedly longer median survival of 1,149 days compared to 446.5 days for stage D dogs, consistent with expected disease progression differences. Notably, these survival times appear to exceed those reported in historical canine MMVD CHF studies using conventional therapy. The adverse event rate was low at 6% (3/50 dogs), suggesting good clinical tolerability. The most frequently reported owner-observed improvements following dose titration were increased energy level and exercise tolerance, reported in 83% of cases. This study provides preliminary evidence that sacubitril/valsartan may offer meaningful survival benefits and quality-of-life improvements in canine CHF patients with MMVD. Limitations include the retrospective design, lack of a control group, and potential selection bias. The authors highlight the importance of these findings for informing future prospective, randomized controlled trials evaluating ARNI therapy in veterinary cardiology.

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