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.

Taipei Veterans General Hospital TAVI Team Overview

Taipei Veterans General Hospital (VGH) was the first hospital in Taiwan to perform TAVI, with the first procedure completed in 2010. A multidisciplinary team was formed, consisting of specialists from cardiology, cardiac surgery, anesthesiology, radiology, and neurology. To date, the team has completed 150 TAVI procedures.

In 2013, the team pioneered the use of non-intubated procedures under local anesthesia and percutaneous vascular closure devices to reduce surgical complications. The team adheres to the "3M principles": Multidisciplinary collaboration, Multimodality, and a Minimalist approach, setting a benchmark for interdepartmental cooperation in healthcare.

VGH is also among the few institutions in Taiwan approved by the Ministry of Health and Welfare's IRB to perform TAVI. Although the average surgical risk of patients (as assessed by EuroSCORE) reaches up to 20%, the team has achieved complication and mortality rates significantly lower than international averages, making them a globally recognized center of excellence.

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)

Academic Recognition and Media Coverage

• The team's research has been published in the European Heart Journal (SCI Impact Factor: 15.064) and other international journals.

• In 2014, they performed a live demonstration at the Annual Scientific Meeting of the Taiwan Society of Cardiology.

• In 2017, they were invited to demonstrate at the Taiwan Society of Cardiovascular Interventions' live course.

Future Outlook

Currently led by Dr. Ying-Hua Chen and Dr. Xiao-Huang Zhang, the TAVI team includes 16 board-certified cardiologists and cardiac surgeons approved by the National Health Insurance Bureau of Taiwan.

Both Dr. Chen and Dr. Zhang are certified proctors for Medtronic TAVI devices, with Dr. Zhang being the only cardiovascular surgery proctor for Medtronic in Asia. They are also certified proctors for Edwards Lifesciences devices.

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。

台北榮總 TAVI 團隊簡介

台北榮總是台灣最早進行 TAVI 手術的醫院，第一例手術於 2010 年完成。由心臟內科、心臟外科、麻醉科、放射科及神經科等專業人員共同組成跨科整合團隊，至今已完成 150 例手術。

在 2013 年，團隊率先採用局部麻醉下不插管技術及經皮血管閉合裝置，以減少手術併發症。手術採用「3M 原則」：跨科整合（Multidisciplinary）、多模式（Multimodality）、極簡手術（Minimalist approach），成為醫療合作典範。

台北榮總也是少數獲得衛福部 IRB 核准執行 TAVI 的醫療團隊之一。雖然團隊所收治病患的平均手術風險（EuroSCORE）高達 20%，但實際的併發症與死亡率卻遠低於多數國家，成為國際矚目的標竿團隊。

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%）

學術與媒體肯定

• 團隊研究成果刊登於《European Heart Journal》（SCI影響因子：15.064）等國際期刊。

• 2014 年於台灣心臟學會年會進行現場手術演示。

• 2017 年受邀於台灣心血管介入醫學會進行現場課程演示。

展望未來

目前由陳嬰華醫師與張孝煌醫師領導的 TAVI 團隊，擁有16位通過中央健保局審核的心臟科與心臟外科醫師。

陳醫師與張醫師皆為美敦力（Medtronic）裝置合格指導醫師（Proctor），其中張醫師更是亞洲唯一的美敦力心臟外科指導醫師，兩人同時也具備 Edward 公司裝置的指導資格。