林羽德的Blog

台灣社會老年化，銀髮族一旦面臨瓣膜性心臟病往往陷入左右為難困境，一方面無法單純以藥物治療，但如果要開心手術，又得面對手術及麻醉的高風險。所幸拜科技進步，近年已可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，避免傳統開心手術的大傷口，術後恢復較快，約1周能出院返家。

三軍總醫院去年就建構完成新一代混成手術室（Hybrid OR），裝設亞洲第一台最新一代的高解析度多軸式機械手臂攝影系統，並引進國外最新一代的經導管植入式瓣膜。

82歲的陳伯伯就受惠新手術，原來有高血壓、糖尿病的他，曾經中風，今年初行動力開始變差，走路、爬樓梯會胸悶且喘，雙腳還出現水腫，起初只以為是年紀大體力變差，直到數次幾近昏厥，檢查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。

三軍總醫院心臟血管外科醫師柯宏彥表示，正因為考量傳統開心手術的風險較高，陳伯伯最後決定接受微創的經導管主動脈瓣置換手術治療，僅有鼠蹊部不到1公分的傷口，手術後恢復良好，1周出院，所有不適症狀都已改善。

柯宏彥指出，主動脈瓣膜是心臟幫浦的門戶，一旦因為退化或風濕等原因造成瓣膜出口狹窄，不但心臟無法輸出足夠血液供應全身器官，還會造成心臟太過費力而衰竭，初期可能有心絞痛、頭暈、暈厥等症狀；後期心臟衰竭更會出現喘及水腫的情形。

值得注意的是，柯宏彥強調，這時若不加以介入、治療，平均存活時間不超過2年，而最有效的治療方式就是瓣膜置換手術。

柯宏彥提醒，傳統開胸主動脈瓣置換手術行之有年，是相當成熟有效的手術，不過對年紀大又併發眾多慢性病的銀髮族而言，手術及麻醉風險相對高，而微創技術可避免傳統開胸手術的大傷口、體外循環心臟暫停以及長時間的全身麻醉，所以術後可恢復較快，重返正常生活，成為治療另一項選擇。

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When the Taiwanese society is aging, once the squamous heart disease is faced, the silver-haired people often fall into a dilemma. On the one hand, they cannot be treated with drugs alone, but if they want to have fun, they have to face the high risk of surgery and anesthesia. Thanks to advances in science and technology, in recent years, aortic valve replacement has been performed by implanting a compressed tissue valve through a peripheral catheter, avoiding the large wounds of traditional open surgery, and recovering quickly after surgery, and can be discharged home after about 1 week.

Last year, the General Hospital of the Three Armies built a new hybrid operating room (Hybrid OR), installed the first generation of high-resolution multi-axis robotic arm photography system in Asia, and introduced the latest generation of transcatheter implanted valves in foreign countries. .

The 82-year-old Chen Bobo benefited from the new operation. He had hypertension and diabetes. He had a stroke. At the beginning of this year, his mobility began to deteriorate. Walking and climbing stairs will cause chest tightness and wheezing. He also has edema on his feet. At first he thought it was Older physical strength deteriorated until several times of fainting, and the examination confirmed that severe aortic valve stenosis caused heart failure and insufficient brain circulation.

Ke Hongyan, a cardiovascular vascular surgeon at the General Hospital of the Three Armies, said that because of the high risk of considering traditional open surgery, Chen Bobo finally decided to undergo minimally invasive transcatheter aortic valve replacement surgery, with only a 1 cm wound in the sac of the squirrel. After a good recovery, discharged in 1 week, all symptoms of discomfort have improved.

Ke Hongyan pointed out that the aortic valve is the portal of the heart pump. Once the valve outlet is narrowed due to degeneration or rheumatism, the heart can not output enough blood to supply the whole body organs, and the heart will be too laborious and exhausted. There may be angina in the early stage. Dizziness, syncope and other symptoms; late heart failure will have asthma and edema.

It is worth noting that Ke Hongyan emphasized that the average survival time is no more than 2 years without intervention and treatment, and the most effective treatment is valve replacement surgery.

Ke Hongyan reminded that traditional open thoracic aortic valve replacement surgery has been a very mature and effective operation for many years. However, for the elderly who are chronically complicated with many chronic diseases, the risk of surgery and anesthesia is relatively high, and minimally invasive techniques can be avoided. Large wounds in traditional thoracotomy, cardiac arrest during cardiopulmonary bypass, and long-term general anesthesia, so that postoperative recovery can be faster and return to normal life, becoming another option for treatment.