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Edwards received notification from a field clinical specialist that a patient with a sapien xt valve implanted in the aortic position for 9 years and 10 months, underwent a valve in valve procedure with a 20mm sapien 3 ultra resilia valve due to stenosis.The patient was symptomatic with shortness of breath and fatigue.Comorbidities include hypertension, hyperlipidemia, and heart failure.This patient was discharged and is in stable condition.
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Supplemental report submitted to correct h6 and h11.H11: per the instructions for use (ifu), structural valve deterioration (wear, fracture, calcification, leaflet tear/tearing from the stent posts, leaflet retraction, suture line disruption of components of a prosthetic valve, thickening, stenosis), and device degeneration are known potential risks associated with the use of bioprosthetic heart valves.The ifu cautions that accelerated deterioration of the valve may occur in patients with an altered calcium metabolism.Long-term durability has not been established for the valve.Regular medical follow-up is advised to evaluate valve performance.Structural valve deterioration (svd) may be manifested as stenosis with thickened leaflets.Svd may be mild and not require any intervention or it may be moderate to severe.It can cause the heart to work harder to eject blood from the ventricle.Depending on the severity it could be an indication for valve replacement or medical intervention.Tissue calcification is a common failure mode.The mechanisms for bioprosthetic heart valve tissue calcification are not yet fully understood.Many factors can contribute to the onset and propagation of calcification including patient-related (e.G., patient age, disease state, immune status, and other co-morbidities), pharmacological, and intrinsic properties of the valve itself.It is widely understood that patients with chronic renal disease and prior history of calcific stenosis of the native valve may be predisposed to bioprosthetic calcification.During the manufacturing process, all sapien thv valves are 100% visually inspected for defects and 100% functionally tested for proper coaptation under physiological backpressure conditions prior to release for distribution.Therefore, it is highly unlikely that a manufacturing defect or device malfunction contributed to the event.In this case, there was no allegation or indication a manufacturing non-conformance contributed to this product problem.Investigation results suggest that patient related factors (hypertension, hyperlipidemia, and heart failure) caused or contributed to this event.A review of edwards lifesciences risk management documentation was performed for this case.The reported event is an anticipated risk of the transcatheter heart valve procedure, additional assessment of this adverse event is not required at this time.Complaint histories for all reported events are reviewed against trending control limits monthly, and any excursions above the control limits are assessed and documented as part of this monthly review.As such, neither a product risk assessment, nor corrective or preventative actions are required at this time.
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Edwards received notification from a field clinical specialist that a patient with a sapien xt valve implanted in the aortic position for 9 years and 10 months, underwent a valve in valve procedure with a 20mm sapien 3 ultra resilia valve due to stenosis.The patient was symptomatic with shortness of breath and fatigue.Comorbidities include hypertension, hyperlipidemia, and heart failure.This patient was discharged and is in stable condition.Per the medical records, the patient's most recent echo report prior to intervention showed mild jet of aortic valve regurgitation and an aortic valve mean gradient of 30mmhg.
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Supplemental report submitted to include additional information received through follow-up.Updated b5, b7, and h6 - device codes.Corrected a2 and a3.The investigation is in progress, a supplemental report will be submitted.
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