Ms. Lu, aged 73 years, was diagnosed with severe aortic valve stenosis 4 years ago but delayed her treatment because of her fear of pain and open surgery. Recently, she was suddenly out of breath, and she passed out and lost her breath and heartbeat on the ride to the doctor. After she was successfully rescued, the Taipei Veterans General Hospital medical team decided to replace the high-risk conventional thoracotomy with transcatheter aortic valve implantation (TAVI), after which the patient’s heart function successfully recovered and she was discharged after one week of hospitalization.

According to cardiologist Ying-Hwa Chen, the opening of the aortic valve is normally 3–4 cm2 in size, but it narrows over age, affecting the process by which the heart pumps blood throughout the body. This has occurred in approximately 12% of people aged older than 75 years, and particularly severe conditions have occurred in 4% of such people, with the valve opening less than 1 cm2 in size. Severity of the symptoms varies from chest tightness to dizziness and heart failure, which lead to an average time of survival of 5, 3, and 2 years, respectively. When the stenosis is not treated in time, it leads to a 50% mortality rate in 1 year, and nobody survives it in 5 years, by which point it becomes a terminal illness. Medication is limited in its effectiveness in treating the stenosis. Immediate surgery is advised for people who may have heart failure, such as those who pant when walking and even without moving.

Conventional thoracotomy involves sawing the sternum for valve replacement, which requires 4–5 hours to complete and requires general anesthesia, endotracheal intubation, and stopping the heartbeat. Convalescence lasting 2 to 3 months is required. However, this thoracotomy is inapplicable to 30%–40% of patients with severe aortic valve stenosis, who are either too old or diagnosed with comorbidities. These patients may opt for TAVI, which involves accessing the narrowed aortic valve with a catheter from the groin. After the catheter is positioned, the protective cover is retracted, and the valve stent expands by itself. Thus, the prosthetic valve replaces the narrowed valve. TAVI requires only 45–90 minutes to complete, requires only local anesthesia, and does not require endotracheal intubation or stopping the heartbeat. Only 7 days of convalescence is required.

The Taipei Veterans General Hospital TAVI team has contributed to a 99% postoperative mortality rate at 30 days in the recent 5 years, which is higher than the global average of 97.5%. According to Chen, severe aortic valve stenosis is deadly. Older family members should seek medical attention as soon as they experience chest tightness, faint, or become short of breath. Patients who cannot accept conventional thoracotomy may opt for TAVI, which requires only opening a small wound and is low in invasiveness and complication rate. Delaying treatment will endanger patients’ lives.