Aortic valve stenosis is the most common degenerative disease that occurs in the elders Its typical symptoms include angina, syncope, and heart failure. When patients present with angina, syncope and heart failure, 50% survive was 5 years, 3 years and 2 years respectively. Once the patient present with heart failure combined multiple organ diseases, the average one-year survival rate is only 50%.
Since Dr. Cribier of France reported the first success case of "transcatheter aortic valve implantation" (TAVI) in patients with aortic valve stenosis on 2002, this surgery has been well accepted. Surgeons only need to insert the catheter through patient’s femoral artery, put the stent valve on the desired place then deploy the stent valve to replace the original valve. Patients do not have to receive open heart surgery any longer, avoided a 20-centimeter wound on the anterior chest wall, and the risk and disadvantage of cardiopulmonary bypass. The duration of hospitalization and the recovery periodare much shorter than patients who received traditional aortic valve replacement surgery which is especially important for elders. With the time goes by, the stent- valve system improves. The new generation of valve can be repositioned, so we can implant the valve more precisely to reduce the risk of paravalvular leak. Besides its diameter is smaller than before, so patients with small femoral artery which have to received transapical or transsubclavical TAVI before can be treat by transfemoral TAVI now. Furthermore, with the improvement of percutaneous vascular closure device, we can reduce the wound size to 0.6 cm.
This surgerybecome the mainstay surgery for severe aortic valve stenosis in elders now. The Ministry of Health and Welfare of Taiwan approved this treatment in January 2013. After that, our hospital (Kaohsiung Medical University Hospital) devoted to preparing for the surgery. We set up a team for TAVI which composed of cardiac surgeon, cardiologist, radiologist, radiologic technician, anesthesiologist, cardiopulmonary bypass technician and nurses. In December 2013, our team completed the first case of TAVI succesfully. In May 2015, we received the certification that we are a matured team can perform TAVI without supervisor. In April 2017, we began to use the new generation of stent-valve.
We have performed TAVI for more than five years and completed more than 40 surgeries. Till now we are still the most experienced hospital in Southern Taiwan. Our30-day mortality rate of TAVI is still 0. Our patients’ discomforts and quality of life can be enormously improved.
Every time before surgery, the patient has to received thorough examination. All our team members would gather to discuss the surgical and care plan. After surgery, we would provide health education and long-term care. All of these is because we want to provide our patients a good experience and better future.
Surgeons only need to insert the catheter through patient’s femoral artery, put the stent valve on the desired place then deploy the stent valve to replace the original valve.