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It was reported a patient with a 21mm 2700 aortic valve implanted for seven (7) years, ten months, underwent valve-in-valve procedure due to calcification and stenosis.The patient presented with heart failure.The tavr was successfully performed with a 23mm 9750tfx valve.The patient was transferred to the cv-icu for recovery.
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H10: additional manufacturer narrative: this device remains implanted in the patient as this is a valve-in-valve procedure.This device is not expected for return.The investigation is still in progress; therefore, a conclusion has yet to be established.A supplemental report will be submitted accordingly upon investigation completion.Edwards will continue to review and monitor all reported events.Trends are monitored on a monthly basis and if action is required, appropriate investigation will be performed.
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H10: additional manufacturer narrative: updated sections: d4 (expiration date), g3, g6, h2, h4, h6 (investigation findings, and investigation conclusions).A device history record (dhr) review is not required because there is no allegation of a malfunction which could be related to a manufacturing non-conformance and/or one was not suspected or confirmed through investigation; no labeling non-conformance/deficiency; no device-related infection; and no evidence of a product failure with regard to design, reliability, or use error.Per the instructions for use (ifu), structural valve deterioration (svd) is a known potential risk associated with bioprosthetic heart valves.Svd is a logical and expected consequence of the chemical, mechanical, and immunological processes associated with bhv implantation.The common endpoint of all these factors is calcification and degradation.Svd is an acquired condition, intrinsic to bioprosthetic valves, characterized by deterioration of the leaflets or supporting structures, leading to thickening, calcification, tearing, or disruption of the prosthetic valve materials.These changes result in valvular dysfunction manifesting as stenosis and/or regurgitation with a consequent drop in hemodynamic efficacy of the valve.Despite the advancements in the heart valve industry, svd commonly begins 7- 8 years after implantation, with a considerably increased rate in patients with pertinent comorbidities and/or an implant duration of greater than 10 years.Prior investigations and extensive literature review have shown that svd is predominantly related to patient factors and implant duration rather than to manufacturing issues.Events related to device design, manufacturing, or use error tend to manifest at an earlier implant duration.Based on the information available, the most likely root cause is patient factors, including hyperlipidemia, coronary artery disease and chemotherapy.
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