經導管主動脈瓣膜植入術治療嚴重主動脈瓣膜狹窄

Transcatheter Aortic Valve Implantation in Severe Aortic Stenosis

主動脈瓣膜狹窄為老年人常見的退化性心血管疾病，其造成原因大多由於主動脈瓣膜隨著年齡增長而逐漸鈣化、硬化進而狹窄。有症狀嚴重主動脈瓣膜狹窄病人若評估狀況許可，應考慮介入性治療。經導管主動脈瓣膜植入術（transcatheter aortic valve implantation, TAVI）是一種先進的醫療技術，手術過程中 不須切開心臟，手術時間較傳統開心手術短，病患術後傷口較小，復原時間也較短。過去的國際大型研究已經顯示，對無法手術或是手術高度風險的病人而言，TAVI是一個有效的治療；對於外科手術中度風險的病人，TAVI的臨床效果與開刀手術在效果上是一致的。本文將針對TAVI就其優缺點、種類特性、病患選擇、臨床證據以及健保規範作一詳細介紹。 Aortic stenosis (AS) is prevalent among individuals older than 75 years of age. The pathogenesis of aortic stenosis is stiffness and thickening of the aortic valve leading to difficulty on opening and closing. That most of this group patients are elderly, makes the decision on appropriate treatment choice be challenging. Intervention is recommended in patients with severe symptomatic AS. Transcatheter aortic valve implantation (TAVI) is a novel valve-replacement technique. Compared with traditional open heart surgery (surgical aortic valve replacement, SAVR), TAVI is associated with smaller post procedure wound and shorter recovery time. TAVI is now recommended in patients with severe symptomatic AS who are considered unsuitable or at high risk for conventional surgery. In patients at intermediate risk, the results of TAVI appear to be non-inferior to traditional SAVR. In this article, we describe the current advantages and disadvantages of TAVI with regards to valve type, indications, clinical outcome reports, and national health insurance regulations.