| Sources |
- [S76] Atchley Funeral Home Records, Volume III, 1974-1986, Larry D. Fox, (Smoky Mountain Historical Society), 2 Jun 1984.
Elbert Everet Ogle obituary
- [S26] Berry Funeral Home, (www.berryfuneralhome.com), 19 Jul 2013.
Wilma Christine Ogle Sutton obituary
- [S142] Newspaper Article, Health & Lifestyles, 2 Jul 2012.
A pioneer’s heart
Knoxville man makes history as Parkwest’s first TAVR patient
At 88, Roy Ogle became a pioneer.
Roy and Katy Ogle will mark their 66th anniversary July 6. Roy, who worked his way through four puzzle books before the surgery, says the waiting was the hardest part.
Of course, he didn’t have a lot of choices. With the aortic valve of his heart closing in, Ogle was running out of breath, out of options and out of time.
Once accustomed to walking three miles a day, he soon found himself gasping for air after taking only a few steps from his front door in Farragut Commons.
“I couldn’t walk to the street without getting out of breath,” said Ogle. “I didn’t really feel bad – I just couldn’t do anything. My breath was just getting shorter and shorter.”
Even worse, Ogle’s aortic valve had become so hardened that he was not a candidate for the usual fix – open heart surgery. In short, his condition was “inoperable.”
So when surgeons at Parkwest Medical Center offered him hope through a procedure known as transcatheter aortic valve replacement (or TAVR for short), Ogle was ready – even if Parkwest’s new $2.2 million TAVR operating room wasn’t.
“The day we heard about this, you could hear them hammering down the hall,” said Ogle’s wife, Katy. “They were still building the operating room for it.”
“The toughest part was the waiting,” said Ogle, who spent the interim pretty much confined to his recliner and working his way through four find-a-word puzzle books.
But on June 6 – five days after his 88th birthday and one month shy of the Ogles’ 66th wedding anniversary – Roy Ogle made history, becoming Parkwest’s firstever TAVR patient in a four-hour surgery so successful that he was out of the hospital within four days and driving two days after that.
Although performed in Europe for a decade, TAVR is still so rare in the United States (less than 10 percent of aortic valve replacements) it’s available at only about 150 hospitals nationwide. Parkwest is the only Knoxville hospital to offer it.
The procedure, most often reserved for elderly patients like Ogle, involves replacing the diseased aortic valve with a collapsible prosthetic fashioned from the valve of a cow. The valve, designed by California-based Edwards Lifesciences and approved by the Food and Drug Administration just last year, can collapse to the diameter of a pencil. It is guided to the heart through a catheter inserted into the femoral artery through a small incision in the groin.
In comparison to the rigors of open heart surgery, TAVR may seem mild. Dr. Chadwick Stouffer, the cardiothoracic surgeon who led the team of physicians during Ogle’s surgery, agrees the recovery time can be briefer but emphasizes TAVR is still serious surgery performed while the heart continues to beat.
“Certainly the pain is more significant and activities more limited after an openheart operation, but TAVR is still a big operation, just with a little incision,” said Stouffer, adding that it should not be viewed as merely an alternative to open heart surgery.
Patients must meet strict criteria before being deemed suitable for TAVR by both the doctors and Edwards Lifesciences. Furthermore, the procedure – performed in a modern, hybrid operating room with sophisticated imaging equipment – requires a multidisciplinary team of doctors (two cardiothoracic surgeons, two interventional cardiologists and a cardiac anesthesiologist) who must work as “interchangeable parts.”
“For each of the cases, there is a primary operator whose job is to position the valve. The secondary operator helps deploy the valve once it’s positioned correctly. The third and fourth physicians help with each of these steps as well as with the interpretation of the X-ray and angiographic images,” Stouffer explained. “As our experience grows, we will be able to perform the TAVR with one cardiothoracic surgeon and one cardiologist for each case. The unique and exciting thing about this operation is that it allows the cardiologist and the cardiothoracic surgeon to work side by side for the benefit of the patient. For the first time, the skill sets of each of these specialties are overlapping.”
Before performing Ogle’s surgery, Stouffer and the rest of the TAVR team – Dr. Lee Collins, Dr. Nicholaos Xenopoulos, Dr. Mike Ayres and Dr. Thomas Pollard – flew to California with Ogle’s records for patient evaluation and fundamentals training by Edwards’ proctors.
“This served several purposes,” said Stouffer. “First, the Edwards proctors had the chance to review all of the information on our proposed patients and assess our capability to evaluate patients as possible candidates for the TAVR. It also allowed us to learn from physicians who have performed hundreds of TAVRs as part of the trial leading to its approval by the FDA. The process by which every patient should be navigated through the initial evaluation, surgery, discharge and follow-up was specifically emphasized. Finally, we had the opportunity for ‘hands-on’ placement of these valves in a very hightech simulator.”
Meanwhile, back in Knoxville, Roy Ogle sat in his recliner, working his puzzle books and waiting to hear if he would be approved for the surgery.
“He wasn’t nervous at all. He was perfectly calm, and I was too,” said Katy Ogle. “The toughest part was waiting for it to happen.”
Roy Ogle, recalling the intense pain his wife had following her open heart surgery in 1995, said his surgery was virtually painless, except for a large intravenous tube placed in his jugular vein. “That’s the only pain I had,” he said incredulously. “I didn’t have any pain from the operation at all. Nurses offered me pain pills, but I really didn’t need any. I wasn’t hurting.”
“Dr. Stouffer came into Roy’s room in CCU that afternoon with his nurse and was taking pictures of Roy, Roy and me, him and Roy, Roy and his nurse,” said Katy Ogle. “He was like a kid at a party. He was just so excited.”
Stouffer admits that Ogle’s surgery was reason for celebration. Not only did it give the Ogles more – and better – time together, but it also signals that there is now an alternative available to others like Roy Ogle who are running out of breath and options.
Since Ogle’s surgery, Parkwest has successfully completed three more TAVR operations, but Stouffer emphasizes any hope of TAVR routinely replacing open heart surgery is “not in the foreseeable future.”
“This technology is still in its infancy and long-term data are not yet available,” he said. “I do feel that as experience grows and the technology improves, more people with valve disease will be treated with this less invasive, transcatheter approach.”
Because there is no long-term data available, it’s not known how long Ogle’s new prosthetic valve will last. For now, however, it’s given Roy and Katy Ogle the comfort of knowing they’ll be able to celebrate their 66th wedding anniversary July 6.
“The doctors told Roy he was a pioneer,” beamed Katy Ogle. “I’m just glad to have him a few more years.”
- [S142] Newspaper Article, Health & Lifestyles, 1 Jul 2013.
TAVR: Year of changing lives at Parkwest
Mr. Roy Ogle (seated L), the first recipient of TAVR, and his wife, Katy (seated R), celebrate the oneyear anniversary of his procedure with physicians (standing L to R) Dr. Thomas Pollard, Dr. Chadwick Stouffer and Dr. Nicholaos Xenopoulos. Dr. Mike Ayres (not pictured) is also part of the TAVR team. Roy Ogle, the first patient who received this breakthrough valve replacement procedure at Parkwest, commemorated his 89th birthday on Saturday, June 1, by walking for 89 minutes, which totaled four and a half miles.
It was a virtual replay – Dr. Chadwick Stouffer did the cutting and Roy Ogle was on the receiving end. But this time it really was a piece of cake as Parkwest Medical Center recently celebrated the one-year anniversary of its first transcatheter aortic valve replacement (TAVR) procedure.
The celebration, featuring a cake emblazoned “TAVR Changing Lives,” was in honor of all of its TAVR patients and in recognition of Ogle’s progress since becoming the first to undergo the procedure June 6, 2012.
In the year since, Parkwest’s multidisciplinary TAVR team of cardiothoracic surgeons Stouffer and Dr. Thomas Pollard, interventional cardiologists Drs. Mike Ayres and Nicholaos Xenopoulos, and cardiac anesthesiologist Dr. Lee Collins offered hope to 54 more men and women who had run out of options and out of time.
Ogle’s surgery came five days after his 88th birthday, but the average age of the 55 TAVR patients was 81. The youngest was 62 and the oldest was 96. In most cases, the patients were discharged from the hospital within three to six days, although at least one patient was released after just two days.
Deemed inoperable for traditional open-heart surgery, 26 of these patients received their new heart valve via a catheter tube inserted into the femoral artery while 29 had the valve delivered via a catheter inserted through the rib cage. In either case, recovery is markedly shorter than the traditional open-heart surgery.
“I am very proud of our whole team and everyone that has made this possible,” said Stouffer. “It has been a lot of work, but worth every minute of it. Our team did not expect to do 50 cases in the first year, but I am so happy that we have been able to change more lives than we imagined.”
Parkwest Director of Patient Care Services Trish Chaloux and Jill Strevel, manager of Cath Lab/Cardiac Diagnostics have played significant roles in the development of the program and its success. Sheilah Vartan, the nurse navigator who works closely with the TAVR team and becomes close friends with the patients, remarked about the program’s success.
“It has been an amazing journey,” said Vartan. “It feels as though I have this big, giant family that I look after. I’m their biggest fan and I’m filled with gratitude that they let me be a part of their lives. To see patients after surgery brings a lot of joy to all members of the TAVR team. The difference in their quality of life is often profound. The families of the patients are also so relieved and excited to see the changes in their family members. They actually experience activities with them that they have not been able to enjoy together in years. I am always so amazed and thrilled to see what TAVR can do for these patients.”
It was Stouffer who first made the proposal to offer TAVR when he arrived at Parkwest three years ago. “I think that the first reaction contained some skepticism given the novelty of the procedure,” said Stouffer. “But as the TAVR data became more robust, it was clear that this procedure would have a huge impact on cardiovascular surgery and on patients with severe aortic stenosis.”
Once given the green light, a TAVR team was formed, a valve clinic opened, and a $2.6 million hybrid operating room was constructed. The operating room was still being built when Ogle was selected as the first patient.
Before that first surgery, the team also underwent extensive training in California at Edwards LifeSciences, maker of the artificial valve, and continued learning throughout the year, becoming more efficient with both patient workup and the operation itself. The operative time grew shorter and the number of doctors required in the hybrid OR fell from seven in Ogle’s surgery to just four.
Does that mean the surgery is becoming easier?
“Every TAVR the team does is fairly technically challenging,” said Stouffer. “Honestly we have learned something from every case we have done. We have improved as an operating team and have become more efficient, but I am not sure if I would use the word ‘easy’ and TAVR in the same sentence.”
Still, the TAVR work is laying a foundation for treating other heart problems.
“One of the biggest lessons we have learned is how under-treated severe aortic stenosis is in our area and in the United States,” said Stouffer. “Certainly, as the technology advances, I expect that we will be able to apply similar techniques to other failing heart valves. On a theoretical level, the concept of the Valve Clinic and the multi-disciplinary approach to our patients will serve as a model for treating many patients with other complex cardiac diseases.”
The bottom line, of course, is that TAVR has given 55 men and women a chance at life they may not have had without it.
That’s a fact not lost on Roy Ogle’s daughter Peggy as she posted a note on Parkwest’s Facebook page on Father’s Day. “Thank you, TAVR team, for giving my Dad a new life!” she wrote. “Without each of you I’m not too sure we would have been celebrating Father’s Day with our dad today! We are so blessed to have such a wonderful man as our father and are equally blessed to have had each member of the TAVR team in our lives. Thank you for all you do and for the many lives you are changing!”
For more information about the TAVR or the valve centers of Covenant Health, visit www.covenanthealth.com/heartcare or call 541-4500.
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1924 - (99 years)
, d. 2 Jun 1984 (Age 83 years) 