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Structural Heart Disease

Minimally invasive surgery, like TAVR (transcatheter aortic valve replacement), offers the potential for less scarring, less blood loss, less pain, and a faster recovery.

Cardiac conditions relating to the heart valves, vessels, or walls are considered to be part of structural heart disease. While some structural heart conditions are congenital in nature, others may develop over time through wear and tear on the heart or be caused by separate disease processes. Septal defects, valvular disease resulting in valve leakage or regurgitation, and aortic stenosis are examples of structural heart disease.

Surgical treatment is indicated for structural heart disease, with the latest cardiac innovations occurring through minimally invasive procedures in the cath lab. Minimally invasive surgery, like TAVR (transcatheter aortic valve replacement), offers the potential for less scarring, less blood loss, less pain, and a faster recovery. More importantly, these groundbreaking cardiac procedures give hope to patients who, in the past, were told undergoing conventional open heart surgery was not possible.


Covenant Health was the first to bring TAVR to East Tennessee, and we continue to lead the region in TAVR cases. The first TAVR was performed at Parkwest Medical Center on June 6, 2012. Between then and December 31, 2015, the Covenant Heath TAVR team has performed 245 TAVR surgeries. Our annual average of 70 cases per year is more than double the average of 30 cases per year at the 223 other medical centers that participated in the PARTNER (Placement of Aortic Transcatheter) Valves Trial.

“The data is very favorable,” says Rick Lassiter, Parkwest chief administrative officer. “We do nearly twice as many TAVR procedures on average, and our mortality rate for the procedure is well below the national median. We also have lower rates of major vascular injury, valvular leakage and bleeding.”

The TAVR Team

The Covenant Health TAVR physician team is made up of physicians from Parkwest Medical Center, Fort Sanders Regional Medical Center, and Methodist Medical Center. Team members include cardiothoracic surgeons Michael Maggart, MD, and Thomas Pollard, MD; interventional cardiologists Thomas Ayres, MD, Ayaz Rahman, MD, and Nicholaos Xenopoulos, MD; and anesthesiologists Lee Collins, MD, Samuel McIlrath, MD, and Jeffery Ollis, MD. “A successful TAVR requires precise, simultaneous execution of a set of tasks,” says Dr. Pollard. “The skill set required to perform these tasks crosses multiple medical and surgical specialties.”

The TAVR team also includes nurses and technicians with specialized training, and a nurse navigator who provides education, a plan of care, emotional support, and guidance through the TAVR experience. The navigator also acts as a liaison between the medical team and the patient and family.

Even the operating room used for TAVR procedures is multidisciplinary in design. A unique surgical room, known as a hybrid operating room, combines the resources of a cardiac catheterization lab and an operating room, including the imaging equipment needed for minimally invasive procedures.

Who Should Have TAVR?

The ideal TAVR candidate:

  • Presents with symptoms typical of severe aortic stenosis (shortness of breath, syncope and, in some cases, evidence of congestive heart failure)
  • Has undergone a Transthoracic Echocardiogram (TTE), with a mean gradient > 40mmHg or jet velocity greater than 4.0m/s or initial aortic valve area of < 0.8 cm2
  • Has not been responsive to noninvasive treatments
  • Is unable to tolerate traditional AVR (through sternum) surgery