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TAVI / TAVR 主動脈瓣膜狹窄手術

Introduction to Aortic Stenosis and TAVI Procedure

With the global aging population, the number of aortic stenosis cases has been increasing. Among individuals aged 75 and older, approximately 3.4% suffer from severe aortic stenosis. When symptoms such as chest pain, syncope, and heart failure appear, the standard treatment is surgical aortic valve replacement. However, over 30% of patients are unable to undergo open-heart surgery due to advanced age or comorbidities. Once symptoms of severe aortic stenosis develop, patients who only receive medication without surgery face a one-year mortality rate as high as 50%, Five-year survival rate is close to zero—making the condition as life-threatening as cancer.

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive alternative for patients who are unsuitable for conventional surgery or face high surgical risks.

Medical Achievements

Six Transcatheter Access Routes
The team can perform valve implantation via six different access routes: the femoral artery, subclavian artery, ascending aorta, apex, abdominal aorta, and carotid artery. This provides treatment options for patients with peripheral vascular disease and significantly reduces the risk of major vascular rupture and bleeding.

  • Major Vascular Complication Rate: 3.4%, lower than the 4.1%–10.9% reported in the U.S. and Europe.

  • Stroke Rate: 1.3%, well below the international average of 1.5%–4.0%. If a stroke occurs during the procedure, the 30-day mortality rate increases by 3.5 times.

  • Moderate or Severe Paravalvular Leak: 2.0%, significantly lower than the 5.1%–16.2% observed internationally. All patients undergo comprehensive preoperative imaging (e.g., transthoracic and transesophageal echocardiography, cardiac catheterization, and 3D CT reconstruction), followed by thorough planning discussions in pre-procedure meetings.

  • Permanent Pacemaker Implantation Rate: 4.1%, much lower than the global rate of 10%–26.3%. This reduction minimizes hospital stay, complications, and readmissions due to bradycardia.

  • Postoperative Mortality:

    • 30-day mortality rate: 5.4% (lower than the international range of 4.5%–8.4%)

    • One-year mortality rate: 14.0% (significantly lower than the 18.4%–24.3% reported in the U.S. and Europe)

主動脈瓣狹窄與TAVI手術簡介

隨著全球人口老化,主動脈瓣狹窄的病例數也不斷上升。在75歲以上的人口中,約有3.4%患有嚴重主動脈瓣狹窄。若病患出現症狀(如胸痛、昏厥、心衰竭),標準治療方式為手術更換主動脈瓣。然而,超過30%的病患因高齡或合併其他疾病而無法接受傳統開心手術。一旦出現嚴重主動脈瓣狹窄的症狀,若僅接受藥物治療且未進行手術,其一年內的死亡率高達50%,五年存活率幾乎為零,死亡風險不亞於癌症。

經導管主動脈瓣植入術(TAVI)是一種創傷小的新選擇,適合無法接受傳統手術或手術風險高的病人。

醫療成果亮點

  • 六種導管路徑選擇
    能夠從股動脈、鎖骨下動脈、升主動脈、心尖部、腹主動脈與頸動脈等多種路徑進行瓣膜植入,有效降低大血管破裂與出血風險,讓外周血管狹窄的病患也有治療選擇。

  • 重大血管併發症率: 3.4%,低於美國與歐洲的 4.1%~10.9%

  • 中風風險: 1.3%,明顯低於國際間的 1.5%~4.0%。若手術中風,病人 30 天內的死亡率將提高 3.5 倍。

  • 瓣周逆流率: 2.0%,遠低於美國與歐洲的 5.1%~16.2%。術前皆進行完整影像檢查(心臟超音波、導管攝影、電腦斷層3D重建等),並於術前會議詳細討論植入計畫。

  • 術後需裝設永久性心律調節器比率: 4.1%,顯著低於國際數據 10%~26.3%,大幅減少因心率過慢所需再住院與併發症風險。

  • 術後死亡率:

    • 30天內死亡率為 5.4%(低於國際 4.5%~8.4%)

    • 一年死亡率為 14.0%(明顯低於美國與歐洲的 18.4%~24.3%)