Thu, Dec 14, 2023 page2

• NTUH performs new open-heart surgery alternative

  LESS INVASIVE: The procedure takes just two hours, while traditional open-heart surgery takes up to six hours and requires weeks of recovery, doctors said

  • By Lee I-chia / Staff reporter
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  A team at National Taiwan University Hospital (NTUH) has implanted the nation’s first TricValve transcatheter bicaval valve, on an 82-year-old man with a severe form of heart valve disease, the hospital said yesterday.

  Chou (周) had chronic atrial fibrillation — which is when abnormal electrical impulses fire in the atria — that led to severe tricuspid regurgitation, a disorder in which a valve between heart chambers does not close tightly, and right-side heart failure, NTUH said.

  Although he took medication for four years, it did not relieve his symptoms and his condition worsened this year, developing shortness of breath when walking and swelling in his legs and feet, it said.

  

  An 82-year-old man surnamed Chou, third left, poses with surgeons at National Taiwan University Hospital yesterday after he had TricValve transcatheter bicaval valve implantation.

  Photo: CNA

  One day the heart pain was so severe, he thought he might die, Chou said.

  As he was unwilling to undergo open-heart surgery, a medical team at NTUH’s Cardiovascular Center suggested the new valve procedure, the hospital said.

  The tricuspid valve controls the flow of blood from the heart’s right atrium (top chamber) to the right ventricle (bottom chamber), acting like a door to the heart, NTUH cardiology associate professor Lin Mao-hsin (林茂欣) said.

  Tricuspid regurgitation can be caused by congenital heart defects, inflammation of the inner lining of the heart, trauma, chronic atrial fibrillation, pulmonary arterial hypertension or cardiac device implantation, he said.

  People with mild tricuspid regurgitation usually do not experience symptoms, but severe cases might have shortness of breath, reduced exercise capacity and swelling of the legs, and it could progress to heart failure, ascites (fluid in the abdomen), jaundice and liver failure, Lin said.

  The tricuspid valve repair procedure, an open-heart surgery, is a standard treatment, but some elderly patients with comorbidities might not want to take the risk, he said.

  NTUH attending cardiology physician Chiang Jiun-Yang (江君揚) said the prevalence of tricuspid regurgitation in Taiwan is as high as about 60 percent, but most cases are mild and do not require treatment.

  However, the prevalence of severe tricuspid regurgitation in people 65 or older is about 3 percent, and up to 5 or 6 percent are people in their 70s or 80s, Chiang said.

  Before pursuing the TricValve transcatheter bicaval valve implantation, the team sent a proposal to the hospital ethics committee for review, and applied to the Food and Drug Administration (FDA) for special approval to import the device, Lin said.

  The procedure involves implanting two bioprosthetic valves in the circulatory system — one in the superior vena cava and the other in the inferior vena cava — to reduce the backflow of blood and pressure, increase cardiac output, and improve a patient’s functional capacity and quality of life, he said.

  It is a two-hour minimally invasive procedure done through a small incision in the groin, which does not require an extracorporeal membrane oxygenation life support system, and has a 94 percent success rate, he said.

  The procedure is suitable for patients with severe tricuspid regurgitation, but who are at high risk or unsuitable for open heart surgery, he said.

  It has been performed on more than 200 people around the world, but Chou is the first to receive it in Taiwan, he said.

  However, as the TricValve transcatheter bicaval valve has not obtained an FDA medical device license, Chou had to pay about NT$1.3 million (US$41,236) out of pocket, he added.

  Lu Hsi-yu (虞希禹), NTUH’s director of cardiovascular surgery, said an open-heart tricuspid valve repair procedure takes about three to six hours, and requires a couple days in the intensive care unit, followed by one to two weeks of recovery in a hospital.

  Chou said he was able to leave the bed the next day and was even able to play table tennis with his friends one month after the surgery.
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