Left atrial decompression in dogs with heart failure secondary to myxomatous mitral valve disease: a long-term outcome study.

LAD provided median survival of 379 days in refractory MMVD dogs, though right-sided CHF developed frequently.

This retrospective cohort study evaluated long-term outcomes in 111 client-owned dogs with stage B2, C, or D myxomatous mitral valve disease (MMVD) that underwent left atrial decompression (LAD) between October 2018 and September 2021. LAD creates an iatrogenic atrial septal defect (iASD) to relieve left atrial hypertension in dogs refractory to standard medical management. The primary outcome was time to cardiac-related death or euthanasia; secondary outcomes included right-sided CHF development, iASD closure, and CHF-related rehospitalization. Median survival time after LAD was 379 days (range 1–1282 days), suggesting clinically meaningful benefit in this advanced population. Right-sided CHF developed in 42.3% of dogs, with onset ranging widely from 1 to 873 days post-procedure, indicating that right heart monitoring should be a routine component of follow-up care. Spontaneous iASD closure occurred in 20.2% of dogs and was most frequently associated with septal puncture caudal to the fossa ovalis, suggesting procedural technique may reduce this complication. Only 22.5% of dogs required cardiac-related hospitalization after LAD, indicating relatively low left CHF recurrence. Study limitations include its retrospective design and lack of a medically managed control group, precluding definitive conclusions about benefit over standard therapy alone. The authors recommend prospective controlled studies to better characterize LAD outcomes. Overall, LAD appears to offer a reasonable survival benefit for dogs with advanced, medically refractory MMVD.

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