Paws, Pump, Repeat: Keeping Hearts Beating
In veterinary medicine, and in healthcare in general, there’s much to be said about the team behind the team; those who keep the wheels turning, the teammates who fuel momentum and pass the baton from the very moment a patient steps into the hospital until the time they’re discharged.
Veterinary surgeons and specialists oftentimes get the shine, but a patient success story isn’t possible without the backbone crew – client service representatives, veterinary technicians, house officers, veterinary assistants, cardiology, social workers, radiology, anesthesia, perfusion, the intensive care and operating room teams – all the behind-the-scenes champions who ensure continuity of care, multifaceted treatment strategies and problem-solving skills throughout a hospital stay.
Almost two years ago, the UF College of Veterinary Medicine unveiled its open heart surgery program for dogs, propelling UF CVM’s Small Animal Hospital to the forefront of complex care for canines facing mitral valve disease in the United States.
Under the leadership of Darcy Adin, D.V.M., associate dean for clinical services at UF’s Veterinary Hospitals, the college hiredworld-renowned veterinary cardiac surgeon Katsuhiro Matsuura, D.V.M., Ph.D., a mitral valve repair expert from Japan, to blaze the trail.
Adding Matsuura and building out a care team, including partnering with Vivacity Perfusion, has been essential for the success and growth of UF’s veterinary open-heart surgery program, which will celebrate its second anniversary this fall.
A perfusionist is an essential member of any cardiovascular surgery team. Perfusionists operate a cardiopulmonary bypass machine during open heart surgery and do so within a tightly-controlled system which allows blood to be routed to the bypass machine, where it’s oxygenated and circulated to the rest of the organs in the body while the heart is stopped for surgery.
An organization for veterinary perfusion does not exist in the U.S.
“There are only a handful of perfusionists who work with dogs in the world, so we reached out to Tyler Posten’s team at Vivacity Perfusion and asked if they’d be willing to partner with us for the launch of our open heart surgery program,” Adin said. “They are top-notch human perfusionists and they were instrumental in ensuring we had everything we needed to get started.”
Vivacity Perfusion is a specialized company featuring a team of certified, technologically advanced cardiovascular perfusionists, with a primary focus on human pediatric perfusion. In addition to Posten, founder of Vivacity Perfusion, pediatric perfusionists Darren Atalig, chief of pediatric perfusion at UF Health, and Chris Sansing brought a combined 35 years of perfusion experience into the canine perfusion journey.
From there, a novel, groundbreaking partnership was formed; one rooted in innovation that introduced a new era of veterinary medicine featuring the first open heart surgery program dedicated to mitral valve repair for dogs in the U.S., and a blueprint for parallel open heart surgery and perfusion training programs at the UF College of Veterinary Medicine.
“They are trailblazers,” Adin remarked. “They’re the first perfusion team to partner with a veterinary academic institution for programmatic development of open heart surgery in dogs and they’ve been part of every surgery, not just by performing bypass, but in the preparation and post-operative debriefing each time a dog has had surgery. Vivacity has played a transformative role in something so much bigger than all of us.”
Posten said learning specific techniques and homing in on key elements of canine perfusion from Matsuura’s team, incorporating their own adaptations and supplies, and their relationships with pediatric anesthesiologists and surgeons helped him, Atalig and Sansing bring the perfusion and cardiac surgery community together to combine brainpower and compress information and research.
It was a really unique and fun new venture to be a part of,” Posten said. “In ways, there was a certain pressure – we really had to dial in with a lot of research and tremendous attention to detail. With Darcy’s leadership we had everything we needed to be successful; a lot of stars aligned with a very talented surgical team, which is ultimately reflected in the results and success of the team and program.”
Perfusion requires a tremendous amount of coordination and technical expertise, and is characterized by fine-tuning pressures, electrolytes and blood flow in the body.
“You simply can’t perform intracardiac mitral valve repair surgery without a perfusionist and it’s such an uncommon procedure in veterinary medicine,” Adin said. “It’s paramount to have no blood in the heart so surgeons can visualize the extremely fine work during canine cardiac surgery, which is challenging considering that the heart size of most dogs with mitral valve disease is quite small. And, of course, the most crucial part is making sure the heart restarts after surgery when blood is returned to it. Tyler, Chris and Darren are expert perfusionists. While there are nuances associated with perfusing dogs, an exceptionally high level of expertise is required, and Vivacity has embraced developing this niche area with the rest of the team at UF.”
With two perfusionists on each case, Posten said it took just a few months for canine perfusion to become second-nature.
“There’s not a lot of literature or a hotline for help,” Posten said, “but there are a lot of years of experience between us, and it was a tremendous learning process to get the secret sauce. That’s been the most exciting part about this – to play this role in a full-functioning canine open heart surgery program at the UF Small Animal Hospital.”
From humans to dogs, Posten, Atalig and Sansing have been a key cog in establishing UF’s canine open heart surgery program. They’ve provided perfusion stability at the highest level through nearly two years of once-weekly surgeries, enabling UF’s cardiology team to concentrate on perfecting every aspect of the program.
“Pets are family members,” Posten said. “Just like in human surgery, it’s someone’s life in your hands.”
Posten’s team will continue to support the program as needed but will step back as UF transitions from contracted perfusion work to its next development phase of establishing in-house perfusion with a training program this fall.
“We are so grateful for their investment in the program,” Adin said. “Not only are they now renowned specialists in canine perfusion, but they’ve been reliable partners who helped lay the foundation for an innovative future that provides an avenue to disperse and expand the surgical offerings for canines at UF and throughout the United States. The program would not have been possible without them.”
“On top of that, they’ve helped so many dogs and there are many grateful owners.”
Source: https://www.vetmed.ufl.edu/
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