台灣開始進入高齡化社會，而心臟疾病更是銀髮族長照計畫中必須面對的難題，三軍總醫院心臟血管外科醫師柯宏彥表示，這些難題當中，瓣膜性心臟病尤為棘手，因其無法單純以藥物治療，需要輔以開心手術，目前的微創的經導管主動脈瓣置換手術，有助於避免傳統開胸手術的大傷口、體外循環心臟暫停、及長時間的全身麻醉等風險。
柯宏彥指出，之前曾經有一位82歲的陳伯伯，本身有長年高血壓、糖尿病病史，並曾中風但恢復良好，目前皆規則藥物控制。但在今年初開始行動力變差，走路爬樓梯會胸悶且喘，並合併有雙腳水腫的症狀，在近期開始有幾近昏厥的症狀，甚至因此導致數次跌倒，經心臟超音波檢查後證實為嚴重主動脈瓣膜狹窄導致心臟衰竭及腦部循環不足等症狀。
三總團隊與病患及家屬討論，考量傳統開心手術的風險較高，最後決定接受微創的經導管主動脈瓣置換手術治療。手術順利成功，僅有鼠蹊部不到一公分的傷口，病患恢復良好並於術後一周出院，現術前不適症狀都已改善。
柯宏彥說明，主動脈瓣膜一旦因為退化或風濕等原因造成瓣膜出口狹窄，除導致心臟無法輸出足夠的血液供應全身器官之循環，亦會造成心臟費力做工而導致心臟本身衰竭，後期更會進展到心臟衰竭而有喘及水腫的情形，若不加以介入處理則平均存活時間不超過兩年。
而最有效的治療方式為瓣膜置換手術，傳統開胸主動脈瓣置換手術已行之有年，是相當成熟且有效的手術，但對於年紀大又併發有許多慢性病的銀髮族長者，手術及麻醉的風險相對提高，而近年發展出經由周邊導管方式植入壓縮的組織瓣膜進行主動脈瓣膜置換，這有助於避免傳統開胸手術的大傷口、體外循環心臟暫停、及長時間的全身麻醉，因此病患術後可恢復較快，重返正常生活。
Taiwan has begun to enter an aging society, and heart disease is a problem that must be faced in the silver-haired long-term plan. Ke Hongyan, a cardiovascular surgeon at the General Hospital of the Three Armies, said that among these problems, valvular heart disease is particularly difficult because it cannot be Drug therapy, coupled with open surgery, the current minimally invasive transcatheter aortic valve replacement surgery, to help avoid the risk of traditional thoracotomy, large wounds, cardiopulmonary bypass, and long-term general anesthesia.
Ke Hongyan pointed out that there was an 82-year-old Chen Bobo who had a history of hypertension and diabetes for a long time and had a stroke but recovered well. Currently, he is regularly controlled by drugs. However, at the beginning of this year, the mobility became worse. Walking up the stairs will cause chest tightness and wheezing, and combined with the symptoms of edema of the feet. In the near future, there are symptoms of near fainting, and even several falls, after the ultrasound examination of the heart. It was confirmed that severe aortic valve stenosis caused symptoms such as heart failure and insufficient brain circulation.
The three general team discussed with patients and their families, considering the risk of traditional open surgery, and finally decided to undergo minimally invasive transcatheter aortic valve replacement surgery. The operation was successful and successful. Only the wound of the squid was less than one centimeter. The patient recovered well and was discharged one week after the operation. The symptoms of preoperative discomfort have improved.
Ke Hongyan explained that once the aortic valve is narrowed due to degeneration or rheumatism, the heart can not output enough blood to supply the circulation of the whole body. It will also cause the heart to work hard and cause the heart to fail. Later, it will progress to the heart. In the case of exhaustion and asthma and edema, the average survival time is no more than two years without intervention.
The most effective treatment is valve replacement surgery. Traditional open thoracic aortic valve replacement surgery has been carried out for many years. It is a very mature and effective operation, but for the elderly who are older and have many chronic diseases, surgery and anesthesia The risk is relatively increased, and in recent years, aortic valve replacement has been developed by implanting a compressed tissue valve through a peripheral catheter, which helps to avoid large wounds in traditional thoracotomy, cardiopulmonary bypass, and prolonged general anesthesia. Therefore, the patient can recover faster and return to normal life after surgery.
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