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.

Providing Medical Institution

Kishiwada Tokushukai Hospital

〒596-0042
4-27-1 Kamoricho, Kishiwada City

https://kishiwada.tokushukai.or.jp/en/

Specialty

**Cardiovascular Surgery:**
1. Coronary Artery Disease
2. Heart Valve Disease
3. Aortic Aneurysm
4. Aortic Dissection
5. Arteriosclerosis Obliterans
6. Arterial Thrombosis
7. Complications of Myocardial Infarction
- Ischemic Cardiomyopathy
- Left Ventricular Rupture
- Left Ventricular Aneurysm
- Ventricular Septal Rupture
- Papillary Muscle Dysfunction (Mitral Regurgitation)
8. Infective Endocarditis
9. Intracardiac Tumors

**Cardiology:**
1. Ischemic Heart Disease (e.g., Angina, Myocardial Infarction)
2. Lower Limb Arteriosclerosis Obliterans
3. Arrhythmia
4. Heart Valve Disease
5. Aortic Stenosis
6. Mitral Regurgitation

**Lower Gastrointestinal Surgery**
*Da Vinci Si - Robot-Assisted Surgery*
1. Malignant Diseases
2. Surgical Treatment of Small and Large Intestine Diseases
3. Primarily Surgical and Medical Treatments for Colon and Rectal Cancer
4. Robot-Assisted Surgery
5. Laparoscopic Surgery
6. Multimodal Therapy Combining Surgery, Chemotherapy, and Radiation Therapy
7. Systemic Chemotherapy for Unresectable Colorectal Cancer

**Breast Surgery:**
1. Breast-Conserving Surgery
2. Mastectomy
3. Sentinel Lymph Node Biopsy
4. Lymph Node Dissection
5. Breast Reconstruction Using Autologous Tissue

**Neurosurgery:**
1. Stroke
2. Cerebral Hemorrhage
3. Subarachnoid Hemorrhage
4. Cerebral Infarction
5. Head Trauma
6. Traumatic Intracranial Hematoma
7. Skull Fracture
8. Chronic Subdural Hematoma
9. Brain and Spinal Cord Tumors
10. Acoustic Neuroma
11. Pituitary Tumor
12. Meningioma
13. Metastatic Brain Tumors
14. Functional Neurological Disorders
15. Facial Spasm
16. Trigeminal Neuralgia
17. Epilepsy
18. Normal Pressure Hydrocephalus

**Urology**
*Da Vinci Si - Robot-Assisted Surgery*
1. Robot-Assisted Laparoscopic Radical Prostatectomy
2. Prostate Cancer
3. Renal Cancer
4. Upper Urinary Tract Cancer
5. Urolithiasis (Urinary Stones)

**Radiology:**
1. Comprehensive Imaging Diagnosis (X-ray, Ultrasound, CT, MRI, Angiography, PET)
2. Liver Tumors
3. Gastrointestinal Hemorrhage
4. Arterial Embolization for Hemoptysis and Traumatic Hemorrhage
5. Transcatheter Venous Embolization for Gastric Varices
6. Intra-Arterial Chemotherapy for Cancer
7. Reservoir Placement
8. CT-Guided Biopsy (Interventional Radiology - IVR)
9. TomoTherapy - Radixact

**Dialysis**
*Travel Hemodialysis* (Available for Individual Travelers Only, Not for Groups)

**Other**
*Second Opinion* (In-person Only, Online Not Available)

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.