Congratulation: Our coronary interventional team received a silver medal in the category of Specialty Feature of Hospitals and Clinics in 2006 from SNQ National Committee of Quality Grading for Biotechnology and Health Care
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Index > coronary intervention
發展沿革
心臟內科成立源起
19861月:高雄長庚心臟內科成立 19867月:高雄心臟內科成立心導管室,為當時台中以南地區第一個以心臟科為主的心導管室。198810月:進行介入性治療如經皮下冠狀動脈氣球整形術。
高雄長庚心臟血管介入性醫療之發展
  • 1988/10     首例(PTCA)冠狀動脈氣球擴張治療
  • 1992/10     首例急性心肌梗塞以PTCA治療
  • 1992/10     全國首創24小時待命介入性醫療小組
  • 1994/05     引進DCA粥狀硬化斑塊切除術技術
  • 1994/10     引進經橈動脈心導管術(亞洲首創)
  • 1995/11     施行置放冠狀動脈血管支架
  • 1997/10     引進高速研磨粥狀硬化斑塊技術
  • 1999/08     與核能研究所合作執行血管內放射治療術計劃
  • 2002/05     首例急性心肌梗塞以遠端保護血栓清除手術 (Distal protection thrombectomy)
  • 2002/04     經橈動脈腦血管攝影
  • 2004/04     經橈動脈行頸動脈支架置放手術(原創技術)
  • 全面的心臟血管介入性醫療服務及研究
    • 冠狀動脈疾病
    -急性心肌梗塞(AMI)緊急再通介入治療術
    -複雜性血管病變及慢性完全阻塞病灶
    -粥狀硬化斑塊清除技術
    -新型血管影像技術
    • 週邊血管疾病
    -頸及椎動脈支架置放手術
    -動靜脈廔管狹窄汽球擴張治療
    -主動脈剝離開窗術
    -腎動脈狹窄及週邊血管狹窄介入治療
    • 結構性心臟病
    -開放性動脈導管線圈栓塞及關閉器置放介入治療術
    -心房中膈缺損Amplatzer關閉置放介入治療術
    -風濕性心臟病僧帽瓣,主動脈瓣狹窄汽球擴張治療
    心臟血管介入性醫療團隊服務目標
    1.   本院為衛生署評鑑通過之醫學中心級教學醫院,提供訓練國內、外各級醫師與醫護人員之課程,提升心臟血管介入性醫療水準。
    2.   高雄長庚以既有心臟血管介入性醫療堅實之基礎,透過不斷的學習與精煉,提供高高屏地區心臟血管病患擁有“在地化的國際級醫療服務水準”。
    3.   心臟血管介入性醫療團隊對於本院必要任務: 醫學研究、鑽研、創新與開拓發展,不餘力。
    技術之創新突破與特殊性研究成績
    1.   1992年10月: 全國首創成立24小時待命介入性醫療團隊,以冠狀動脈氣球擴張術替代血栓溶解劑之治療,於 AMI 患者,有效減少因溶栓藥物所產生之併發症,並提高存活率。


    2.    2002年5月: 首例以遠端保護血栓清除術,治療AMI 病患,術後成功(回復正常冠狀動脈血流)比率 > 95%,大幅減少主動脈氣球幫浦器使用機會。


    3.   結合經
    “橈動脈心導管介入治療術”擴張病灶血管,並使用遠端保護裝置清除血栓,成功完成大部分 AMI 介入治療,減少傳統股動脈穿刺引起之併發症,相對減少臥床時間,住院天數,達到最佳臨床療效與經濟效益。


    4.   臨床研究代表性論文發表的成果 (Am J Cardiol  2001; 87:1184-1188  Chest  2002; 122:1322-1332  Am J Cardiol  2003; 92:1331-1335  Cathet Cardiovasc Intervent  2004; 61:503-511  Cathet Cardiovasc Intervent  2005; 64:35-42  Neurology  2006; 66:804-80


    AMI經橈動脈緊急血管再通治療

    傳統冠狀動脈血管再通術治療均由腹股動脈施行,其缺點為:容易出血,必要長時間臥床出血,住院時間延長,因消毒緣故個人隱私權暴露、舒適性亦差異

    經橈動脈緊急血管再通治療可減少穿刺血管及出血全併症(4.8%vs16.8%,P=0.023),因本院經橈動脈介入治療經驗豐富,故治療時間與傳統經腹股動脈介入治療相同(45.7+ 14.2 vs. 43.8 + 17.7分鐘,P=0.14)

    經橈動脈緊急血管再通治療結合冠狀動脈血栓清除裝置(PercuSurge Guard-Wire system)可大幅提升成功率(2003年開始)
     
    治療病患最多! 療效最好!


     
    服務研究項目的完整性表現
     
     
    獨步全球由橈動脈進行頸動脈血管支架網置放術成果

    首創橈動脈心導管介入治療術”研究與教學成果! (Cathet Cardiovasc Intervent  2005; 66:21-26  Cathet Cardiovasc Intervent  2006; 67:967-971  Cardiovasc Intervent Radiol  2007; 30:840-846)
     
    電氣燒灼術及心臟節律器的成果
     
     
     
    學術研究與教學成果 (心臟內科論文概況)
    1.  自2002年1月起至2008年6月止發表論文第一作者及指導作者共135篇
    • SCI期刊之第一作者有76篇
    • 國內期刊之第一作者有10篇
    1. 本團隊之研究成果榮獲心臟內科學(Heart Disease, A textbook of cardiovascular disease)教科書中引用,收錄於第1,237頁之 「Chapter 48 - Primary Percutaneous Coronary Intervention in the Management of Acute Myocardial Infarction」中。 (Chest 122:1322, 2002)
    學術與技術交流成功的“尊榮”
    國際受訓與參訪醫師
    • International Observational Fellow
    -Peter, W.T. Wang               (Walaysia)
    -Ali A. Yusuf                          (Egypt)
    • International Visiting Staff
    -K.W.Lau                                (Singapore)
    -Y.T.Lim        (Singapore)
    -Shigeru Saito      (Japan)           
    -Cheung-Wah Chang      (Hong Kong)
    -Wai-Kwong Chan               (Hong Kong)
    -Zhu Guo Yin                         (China)

    國際交流
    • 介入治療團隊亦曾受邀赴國外專題演講或手術示範。
    -法國巴黎(PCR)
    -印度孟買.沙烏地阿拉伯
    -日本(東京-Topic Live、神戶-CCT-Japan Live、橫濱-Shonan Kamakura Live、倉敷-Kurashiki Central Hospital、札晃-Japan Circulation Meeting 、京都-Red Cross 2nd Hospital、Kokura Live
    -南韓首爾(Angioplasty Summit-Asan Medical Center、釡山(Tong-Oh University)
    -新加坡(Singapora Live,National Heart Center)
    -馬來西亞沙勞越(Norman Medical Center),National Heart Center, Kulalunpo
    -香港(Queen Elizabeth Hospital, Queen Mary Hospital,etc.)
    -澳門(澳景醫院)
    -大陸地區(武漢,杭州,蘇州,廣州,南京,上海,天津,北京,淐州,西安,蘭州,銀川等城市)
    高雄長庚承辦心臟血管介入治療國際型會議
    2001年4月由本科與中華民國心臟學會合辦國際心臟血管介入治療現場實況手術示範研討會,與國外專家包括:美國、加拿大、法國、日本、南韓、新加坡等

    2004年9月承辦台灣介入性心臟血管醫學會粥狀硬化斑塊高速研磨術訓練研討會現場實況轉播手術示範

    2005年9月受邀由本科於CCT-Japan 2005神戶大會中進行立即衛星實況轉播手術示範(台灣首次,全世界心血管介入頂尖專家約4,000人參與)

    2006年5月承辦台灣介入性心臟血管醫學會經橈動脈心導管介入治療術研討會現場實況轉播手術示範
    基礎研究的代表作
    1)    自體骨髓間質幹細胞移植於心肌梗塞後的大白鼠
            (Circ J 2008; 72:1336-1345) 此論文被撰寫雜誌封面
    2)     自體骨髓間質幹細胞移植於急性心肌梗塞的迷你豬 (已投稿)
    3)     自體骨髓間質幹細胞移植對於擴張性心肌病變老鼠治療的成效
             (Crit Care Med  2008; 已被接受等待發表)

    4)     以骨髓內皮原生細胞治療肺動脈壓過高疾病
            (Crit Care Med  2008; 36:873-880)

    對於急性中風後疾病研究代表作,近三年來研究代表作

    腦中風患者之血小板活性,內皮細胞功能,及發炎介質之時間性之變化 (Stroke  2004; 35:1683-1687)

    急性缺血性腦中風病患其血液中的循環內皮原生細胞與腦中風嚴重度之關聯性 (Stroke 2008; 39:69-74)
    心臟內科近四年來研究件數
    年度
    94
    95
    96
    97
    CMRP
    4
    3
    5
    4
    NMRP
    3
    3
    3
    2
     
    近三年來心臟內科的研究代表作
    1.      Yip HK, Lu CH, Yang CH, Chang HW, Hung WC, Cheng CI, Chen SM, Wu CJ.  Levels and value of platelet activity in patients with severe internal carotid artery stenosis.  Neurology  2006; 66:804-808
    2.      Yip HK, Chang LT, Sun CK, Chen MC, Yang CH, Hung WC, Hsieh YK, Fang CY, Hang CL, Wu CJ, Chang HW.   Platelet activity is a biomarker of cardiac necrosis and predictive of untoward clinical outcomes in patients with acute myocardial infarction undergoing primary coronary stenting.  Circ J  2006; 70:31-36 
    3.      Wu CJ, Chang HW, Hung WC, Yang CH, Chen YH, Su CY, Yip HK.  N-terminal pro-brain natriuretic peptide is a biomarker of congestive heart failure and predictive of 30-day untoward clinical outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.  Circ J  2006;70:163-168  
    4.      Wu CJ, Cheng CI, Hung WC, Fang CY, Yang CH, Chen CJ, Chen YH, Hang CL, Hsieh YK, Chen SM, Yip HK.  Feasibility and safety of transbrachial approach for patients with severe carotid Artery stenosis undergoing stenting.  Cathet Cardiovasc Intervent  2006; 67:967-971    
    5.      Yip HK, Chang LT, Sun CK, Yang CH, Hung WC, Cheng CI, Chua S, Yeh KH, Wu CJ, Fu M.  Impact of clopidogrel on suppression of circulating levels of soluble CD40 ligand in patients with unstable angina undergoing coronary stenting.  Am J Cardiol  2006; 97:192-194    
    6.      Yip HK, Sun CK, Chang LT, Chen MC, Liou CW.  Time course and prognostic value of plasma levels of N-terminal pro-brain natriuretic peptide in patients after ischemic stroke.  Circ J  2006;70:447-452 
    7.      Chen SM, Hsieh YK, Guo BF, Fang CY, Yip HK et al.  Angiographic and clinical outcome in ST-segment elevation myocardial infarction patients receiving an adjunctive double bolus regimen of tirofiban for primary percutaneous coronary intervention.  Circ J  2006; 70:536-541 
    8.      Yip HK, Sun CK, Chang LT, Wu CJ.  Strong correlation between serum levels of inflammatory mediators and their distribution in infarct coronary.  Circ J  2006; 70:838-845  
    9.      Youssef AA, Wu CJ, Hang CL, Yip HK.  Impact of PercuSurge device conjugative with intracoronary administration of nitroprusside on no-reflow phenomenon following primary percutaneous coronary intervention.  Circ J  2006; 70:1538-1542  
    10.   Chen MC, Yip HK, Chen CJ, Yang CH, Wu CJ, Chen YH, Chai HT, Lee CP, Chang HW.  No age-related change in circulating endothelial progenitor cells in healthy subjects.  Jpn Heart J  2006; 47; 95-105   
    11.   Chang LT, Sun CK, Chiang CH, Yip HK.  Impact of simvastatin and losartan on anti-inflammatory effect: in vitro study.  J Cardiovasc Pharmacol  2007; 49:20-26    
    12.   Yip, HK, Lai SL, Lan MY, Liou, Liou CW, et al.  Time course of platelet activation and von Willebrand Factor in patients with nonvalvular atrial fibrillation after ischemic stroke: evaluation of prognostic determinants.  Circ J  2007; 71: 321-326    
    13.    Youssef AA, Change LT, Hang CL, Wu CJ, Cheng CI, Yang CH, Sheu JJ, Chai HT, Chua S, Yeh KH, Yip HK.  Level and value of interleukin-18 in patients with acute myocardial infarction undergoing primary coronary angioplasty.  Circ J  2007; 71:703-708  
    14.    Yip HK, Wang PW, Chang LT, Youssef AA, Sheu JJ, Lee FY, Wu CJ.  Cytotoxic T lymphocyte antigen 4 gene polymorphism associated with ST-segment elevation acute myocardial infarction.  Circ J  2007; 71:1213-1218    
    15.    Yip HK, Youssef AA, Chang LT, Yang CH, Sheu JJ, Chua S, Yeh KH, Lee FY, Wu CJ, Hang CL.  Association of interleukin-10 level with increased 30-day mortality in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention.  Circ J  2007; 71:1086-1091
    16.   Cheng CI, Wu CJ, Fang CY, Youssef AA, Chen CJ, Chen SM, Yang CH, Hsueh SK, Yip HK, Chen MC, Fu M, Hsieh YK.  Feasibility and safety of transradial stenting for unprotected left main coronary artery stenosis.  Circ J   2007; 71:855-861
    17.   Yip HK, Youssef AA, Chang WN, Lu CH, Yang CH, Chen SM, Wu CJ.  Feasibility and safety of transradial arterial approach for simultaneous right and left vertebral artery angiographic studies and stenting.  Cardiovasc Intervent Radiol  2007; 30:840-846
    18.   Youssef AA, Chang LT, Sheu JJ, Lee FY, Chua S, Yeh KH, Yang CH, Wu CJ, Yip HK.  Association between circulating level of CD40 ligand and angiographic morphologic features that indicate high-burden thrombus formation in patients with acute myocardial infarction undergoing primary coronary intervention.  Cir J  2007; 71:1857-1861   
    19.    Yuen CM, MD, Chiu CA, Chang LT, Liou CW, Lu CW, Youssef AA, Yip HK.  Level and value of interleukin-18 in patients after acute ischemic stroke.  Circ J  2007; 71:1691-1696 
    20.    Yip HK, Sun CK, Chang LT, Wu CJ, Chua S, Fu M.  Strong suppression of high-sensitivity C-reactive protein level and its mediated pro-atherosclerotic effects with simvastatin: in vivo and in vitro studies.  Int J Cardiol  2007; 121:253-260  
    21.   Chen MC, Chen CJ, Yang CH, Wu CJ, Fang CY, Hseih YK, Chang HW.  Interleukin-18: a strong predictor of the extent of coronary artery disease in patients with unstable angina.  Heart and Vessels  2007; 22:371-375 
    22.   Yip HK, Chang LT, Sun CK, Youssef AA, Sheu JJ, Wang CJ.  Shock wave therapy applied to rat bone marrow–derived mononuclear cells enhance formation of cells stained positive for CD31 and vascular endothelial growth factor.  Circ J  2008; 72:150-156 
    23.   Yip HK, Chang LT, Chang WN, Lu CH, Liou CW, Lan MY, Liu JS, Youssef AA, Chang HW.  Level and value of circulating endothelial progenitor cells in patients after acute ischemic stroke.  Stroke  2008; 39:69-74 
    24.   Yip HK, Chang LT, Sun CK, Sheu JJ, Chiang CH, Youssef AA, Lee FY, Wu CJ, Fu M.   Autologous transplantation of bone marrow-derived endothelial progenitor cells attenuates monocrotaline-induced pulmonary arterial hypertension in rats.  Critical Care Medicine  2008;36:873-880 
    25.   Chang LT, Sun CK, Sheu JJ, Chiang CH, Youssef AA, Lee FY, Wu CJ, Yip HK.  Cilostazol therapy attenuates monocrotaline-induced pulmonary arterial hypertension in rat model.  Circ J  2008; 72:825-831  
    26.   Yip HK, Chang LT, Wu CJ, Sheu JJ, Youssef AA, Pei SN, Lee FY, Sun CK.  Autologous bone marrow-derived mesenchymal stem cell therapy prevents the damage of viable myocardium and improves rat heart function following acute anterior myocardial infarction.  Circ J  2008;72:1336-1346  
    27.    Cheng CI, Hsueh SK, Lee FY, Wu CJ, Fang CY, Sheu JJ, Chen SM, Yang CH, Hsieh YK, Chen MC, Fu M, Yip HK.  Circ J  2008; 72:1598-1604
    28.    Chen MC, Chen CJ, Yang CH, Liu WH, Fang CY, Hseih YK, Chang HW.  Relationship of the percentage of circulating endothelial progenitor cell to the severity of coronary artery disease.  Heart and Vessels  2008; 23:47-52
    29.   Chen MC, Chang JP, Hwang CC, Chang HW, Chen CJ, Yang CH, WH Liu.  Differentiation of atrial cardiomyocytes in cardiac valve disease.  Cardiovasc Pathology  2008; 17:156-165
    30.   Chen MC, Chang JP, Liu WH, Yang CH, Chen YL, Tsai TH Wang YH, Pang KL.  Increased inflammatory cell infiltration in the atrial myocardium of patients with atrial fibrillation.  Am J Cardiol  2008; 102:861-865  
    31.    Sun CK, Chang LT, Sheu JJ, Chiang CH, Lee FY, Wu CJ, Chua S, Fu M, Yip KH.  Bone marrow-derived mononuclear cell therapy alleviates left ventricular remodeling and improves heart function in rat dilated cardiomyopathy.  Crit Care Med  2008 (in press) 
    未來展望
  • 心血管介入治療新技術之發展(左主幹病變、慢性阻塞病變、周邊血管病變)
  • 國際醫療(介入性心導管治療)
  • 心衰竭治療中心
  • 心臟血管中心 (整合心臟內、外科醫療資源以提供病患整合性治療)
  • 接受訓練更多international observational fellows
  • 期待進行臨床骨髓幹細胞移植治療心血管疾病的研究
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    Chang Gung Memorial Hospital - Kaohsiung Medical Center Division of Cardiology

    Design by Kun-Yao Wang / Control