A 91-year-old woman who had been refused surgery for her appendicitis and had to make do with antibiotics received a more advanced and less invasive procedure that put an end to her suffering.
Physicians deemed the woman unfit for anesthesia due to aortic valve stenosis, an abnormal narrowing of the aortic valve in the heart that occurs in approximately 12 percent of people aged 75 and above. People with the condition have a mortality rate of 50 percent if they do not undergo a heart valve replacement surgery within a year.
According to Taipei Veterans General Hospital’s (TVGH) Division of Cardiology physician Chen Ying-hwa (陳嬰華), the patient, surnamed Yin (尹), suffered from acute appendicitis multiple times, but her severe aortic valve stenosis made it too risky to surgically treat her condition.
“However, given Yin’s advanced age, having her undergo a traditional valve replacement surgery — which takes up to five hours and requires a long, open-chest incision — could jeopardize her life,” Chen told a news conference in Taipei yesterday afternoon.
After careful consideration, Chen said Yin decided to receive a trans-catheter aortic valve implantation (TAVI) surgery, which involves inserting a new artificial heart valve using a balloon catheter that enters the body through the femoral artery.
Because of the relatively small incision, Yin was transferred into an ordinary ward after spending just one day in an intensive care unit and was able to walk by herself shortly afterward, Chen said.
TVGH Cardiovascular Surgery Care Unit Director Chang Shiao-hwang (張效煌) said severe aortic valve stenosis is defined by an aortic valve opening smaller than 1cm2, and has a prevalence rate of about 3.5 percent among people aged 75 and older.
“After the onset of symptoms, including a sensation of chest pain, fainting and cardiac failure, more than 50 percent of patients with the condition die within a year if they receive only medical treatment without a valve replacement procedure,” Chang said.
However, about 30 percent of patients with severe aortic valve stenosis are unable to have such procedures, due to their ages or other physical conditions, he said.
“That makes the introduction of TAVI in 2002 all the more important, as it offers a chance of survival to individuals who cannot tolerate the traditional surgery,” Chang said.
Despite its advantages, Chang said TAVI also has its disadvantages, citing the high price of an artificial heart valve that is yet to be covered by the National Health Insurance (NHI) program and costs more than NT$1 million (US$31,700).
“Also, serious complications could occur if the artificial valve is of the wrong size or is not positioned correctly, such as heart failure and even death,” Chang said.
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