Seoul St. Mary’s Hospital’s Cardio-cerebrovascular Center said Tuesday it has provided a minimally invasive Transcatheter Aortic Valve Implantation (TAVI) for a patient with aortic stenosis successfully.
The minimally invasive TAVI procedure, an upgraded version of TAVI, helps patients with heart disease to be discharged early with minimal complications. Korea introduced the old version in 2012.
Korea Biomedical Review has met Chang Ki-yuk, a professor at the Cardiology Department at Seoul St. Mary’s Hospital, to learn the implication of the successful procedure of the minimally invasive TAV.
|Chang Ki-yuk (right), a professor at the Cardiology Department at Seoul St. Mary’s Hospital, performs the Transcatheter Aortic Valve Implantation (TAVI) procedure for a patient with aortic stenosis.|
Question: Which do Korean patients prefer, TAVI procedure or surgical aortic valve replacement (SAVR)?
Answer: We don’t have data related to surgeries on local patients with aortic valve stenosis. But, in my experience, no one over 70 years old wants surgery. This is because of the fear of opening the chest. Not all patients can be treated with TAVI. Among the elderly patients, those aged over 80 or 75 years old can consider the procedure. If you're under 70, you need to consider a few more things.
Q: Why don’t you recommend TAVI for patients under 70?
A: We have insufficient TAVI data for patients under 70. The valve used for the TAVI procedure and surgery is different. The operation has been in progress since the 1980s, and data has been accumulated for over 15 years. On the other hand, the valve used in the TAVI procedure has no data for more than 10 years, so the prognosis is uncertain. Besides, patients under the age of 70 are more active, so valve damage is more likely to occur earlier. There is a gray area between the ages of 70 and 75. In this case, physicians make decisions considering various factors such as patients’ physical weakness and underlying disease.
Q: What made you try minimally invasive TAVI?
A: In Europe and the U.S., where many more cases of TAVI procedures are reported, patients have been requesting hospital discharge the next day after the procedure. There are even papers for this. However, in Korea, TAVI is still considered as a strict procedure. So, Korean hospitals observe patients for four or five days or up to a week after the process and finally allow discharge.
But in the past two years, some domestic patients who underwent TAVI requested early discharge. I tried to find a way to help them leave the hospital early without any complications. Then, I could use one femoral artery, which would be similar to putting in a stent in the coronary artery. The key in the minimally invasive TAVI procedure is to lower the possibility of vascular complications by reducing blood vessel punctures to one femoral artery and one right wrist artery, compared to the conventional TAVI procedure requiring puncture of both femoral arteries and one femoral vein.
Q: In Korea, the TAVI procedure is reimbursable partially, which means that a patient pays 80 percent of the treatment cost. Don’t you think patients will suffer financial burdens?
A: In the U.S. and Europe, the TAVI procedure is more common because it gets insurance benefits. In Korea, however, it is still costly to receive the procedure. We recommend TAVI for patients aged over 80, but some of them refuse the expensive treatment. I heard that the government was discussing this with the medical societies. If they agree, there will be good results.