專題討論12:經皮主動脈瓣置換術何時應用在主動脈瓣閉鎖不全之病人
      When should we Consider TAVR in Patients with Pure Aortic
      Regurgitation ?

程 序 表

S12-1
Epidemiology and current status of treatment for AR in Taiwan
林致源
三軍總醫院心臟血管外科

  主動脈瓣膜逆流(或稱主動脈瓣閉鎖不全)起因為主動脈瓣膜葉的不適當閉合。其造成原因包括瓣膜葉的功能異常或/和主動脈根部及瓣膜環的擴張。此類疾病在男性的發生率高於女性。在美國麻州進行的Framinghan心臟研究發現主動脈瓣膜逆流的盛行率為百分之四點九,在這中有百分之零點五的人其有中等嚴重度以上的主動脈瓣膜逆流。
  在台灣,由於經濟的發展及公共衛生的進步,瓣膜性疾病的病因已逐漸由風濕性原因轉變成為先天性或退化性疾病。從2017年的台灣的健保資料庫統計資料來看,台灣的主動脈瓣、二尖瓣及合併主動脈瓣和二尖瓣疾病的盛行率分別為百分之零點五、百分之三點一和百分之零點六。本研究將依據台灣的健保資料庫及台灣胸腔及心臟血管外科學會的手術資料庫來進一步報告目前台灣主動脈瓣膜逆流病患的流行病學及醫療處置現況。
  Aortic regurgitation (AR; also known as aortic insufficiency) is caused by inadequate closure of the aortic valve leaflets. AR maybe caused by malfunction of the valve leaflets themselves, by dilatation of the aortic root and annulus, or may be due to a combination of both factors. It is more common in men than women. The prevalence of AR in Framinghan study was reported to be 4.9%, with 0.5% of the study population who presented with regurgitation of moderate or greater in severity.
  In Taiwan, the main etiology of AR has shifted from rheumatic disease to either congenital or degenerative disease as in Western Europe and North America. From a recent study based on a total population of 23,880,332 (2017 Taiwan census), the prevalence of aortic valve, mitral valve, and multiple valve diseases (both aortic and mitral) were 0.5%, 3.1%, and 0.6%. In this report, we will describe more in detail about the epidemiology and current status of treatment for AR based on the Taiwan’s National Health Insurance Research Database (NHIRD) and surgical registry of Taiwan Association of Thoracic and Cardiovascular Surgery (TATCS).