Program details
Minimally Invasive Treatment for Heart Valve Disease【Kishiwada Tokushukai Hospital】
Internal medicine
Kishiwada Tokushukai Hospital（Kinki/Osaka）
Elderly-Friendly
Heart Valve Disease Treatment with Reduced Burden
At our hospital, we offer Transcatheter Aortic Valve Replacement (TAVI) and MitraClip procedures, providing heart valve disease treatments with minimal burden for elderly patients. We are committed to safe and effective care.
- Genres
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- Department
- Disease
- Examination Items/Treatments/Surgical method
- Region/Organ
- Program Summary
- Heart valve disease occurs when the heart's "valves" malfunction and can no longer perform their intended functions. A condition where the valve does not open properly, restricting blood flow, is called "stenosis," while a condition where the valve does not close properly, causing blood to flow backward, is referred to as "regurgitation."
Treatment for heart valve disease varies depending on severity. In mild cases, medical management is sufficient, but in severe cases, surgical intervention becomes necessary.
Among the four valves in the heart, the aortic valve, located between the left ventricle and the aorta, is responsible for pumping blood from the left ventricle to the entire body. Aortic valve stenosis is a condition where the valve becomes narrowed, often due to calcification and hardening caused by aging. As aortic valve stenosis progresses, symptoms such as shortness of breath, palpitations, and chest pain appear during physical activity, and in severe cases, it can lead to fainting or sudden death. Medical treatment alone is insufficient, and valve replacement surgery is required.
Since this condition typically affects older individuals, many patients hesitate to undergo surgery as they age, despite the progression of symptoms.
A newer treatment for this condition is **Transcatheter Aortic Valve Implantation (TAVI)**. In this procedure, an artificial valve, folded to approximately the width of a pencil, is placed over a balloon catheter. The catheter is advanced to the narrowed, hardened aortic valve, and the balloon is inflated to deploy and implant the artificial valve. Once deployed, the implanted artificial valve immediately begins functioning as a new valve.
TAVI has a relatively short history, with about 10 years of use, and long-term safety data is still under investigation. For this reason, younger patients or those with low surgical risk are typically advised to undergo traditional open-heart surgery. TAVI is recommended for patients over 80 years old or those with a history of previous heart surgery, making conventional surgery high-risk.
At our hospital, TAVI was introduced in August 2015, and in 2018, we performed 84 procedures annually.
**Percutaneous Mitral Valve Repair (MitraClip)** is a treatment for elderly patients with mitral regurgitation who are unsuitable for open-heart surgery. This new procedure uses a catheter to clip the mitral valve leaflets at the sites of severe regurgitation, thereby reducing the backflow.
In Japan, this treatment was approved for insurance coverage in April 2018 at 12 institutions, including ours. Over nine months, we performed 14 safe procedures. MitraClip offers hope for improving symptoms and prognosis in elderly patients with mitral regurgitation that is difficult to manage with medications for heart failure.
- Medical Institutions
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Kishiwada Tokushukai Hospital
〒596-0042
4-27-1 Kamoricho, Kishiwada City
- Examination Items
- Setup Date
- Excluded days
- Required Days/Hours
- Start/end time
- Eligibility Criteria/Exclusions for Treatment
- [Acceptance Criteria]
1. Medical Information:
- Diagnosis (e.g., aortic valve stenosis, mitral regurgitation)
- Details of symptoms (presence of shortness of breath, palpitations, chest pain, fainting, etc.)
- Test results from other facilities (e.g., echocardiogram, CT, catheter examination, cardiac catheterization)
- Comorbidities (e.g., diabetes, hypertension, heart failure)
2. History of Treatment:
- History of cardiac surgery or catheter-based treatment
- Current medications (e.g., anticoagulants, antiplatelet drugs)
- History of allergies or adverse drug reactions
3. Age and Physical Condition:
- Confirm if the patient is elderly and at high risk for open-heart surgery, or falls within the age group suitable for catheter-based treatment.
- Evaluate physical strength and surgical tolerance (e.g., overall condition and cardiac function to determine if surgery is feasible).
4. Treatment Duration, Days, and Time:
- Estimated treatment schedule (e.g., hospitalization period for catheter-based treatments or TAVI).
- Determine feasibility of outpatient follow-up and postoperative care planning.
5. Urgency:
- Assess the progression and severity of heart valve disease (e.g., whether it is an urgent case).
- Confirm the ability to handle emergency surgeries or treatments if required.
6. Other Conditions:
- Confirm eligibility for TAVI or MitraClip based on criteria (e.g., age over 80 or history of cardiac surgery).
- Adapt the treatment plan to the patient’s lifestyle and preferences.
Based on the above information, we will determine acceptance and develop an appropriate treatment plan.
- Precautions / Contraindications
- [Precautions and Contraindications]
1. Cases Unsuitable for Surgery or Treatment:
- Severe comorbidities (e.g., advanced renal failure, untreated infections, advanced cancer) may limit eligibility for treatments such as TAVI or MitraClip.
- Anatomical issues with blood vessels or structural abnormalities in the heart may make catheter-based treatments challenging.
- Patients unable to discontinue anticoagulants (e.g., those with a high risk of thrombosis) may face increased bleeding risks, requiring careful evaluation.
2. Contraindications for Specific Treatments:
- Exposure to strong electromagnetic fields (e.g., MRI) may affect devices; patients should avoid such environments after surgery.
- Patients with a history of allergies or hypersensitivity to medications require special caution regarding catheter treatments and related drugs.
3. Considerations for Long-Term Use:
- As catheter-based treatments like TAVI have a relatively short history and uncertain long-term safety, traditional open-heart surgery is often recommended for younger or low-risk patients.
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[Important Pre-Treatment Information]
1. Preoperative Preparation:
- Patients must follow the physician’s instructions regarding the discontinuation period for anticoagulants.
- Essential tests (e.g., echocardiogram, CT, blood tests) required before TAVI or MitraClip must be completed for accurate diagnosis and treatment planning.
2. Postoperative Complication Risks:
- There is a risk of complications such as bleeding, infections, and thrombosis. Patients must contact a medical facility promptly if any abnormalities occur.
- Regular follow-ups are essential as adjustments to artificial valves or clips may be necessary.
3. Postoperative Lifestyle Precautions:
- If pacemakers or defibrillators are implanted, patients should avoid devices that generate strong electromagnetic fields (e.g., MRI or industrial machinery).
- Patients may need to follow exercise restrictions and lifestyle modifications as recommended by their doctor to ensure a safe recovery.
4. Hospitalization and Follow-Up:
- Confirm the duration of hospitalization, rehabilitation, and the frequency of follow-up visits before surgery. A structured follow-up plan is essential after discharge.
- Follow instructions regarding activity restrictions and lifestyle guidance after discharge to prevent complications.
5. Emergency Response:
- If symptoms such as shortness of breath, chest pain, palpitations, or fainting occur after discharge, patients should contact a medical facility immediately.
- Patients should be familiar with medical facilities and emergency contacts in advance to act swiftly in case of abnormalities.
