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Edwards received notification of a transcatheter tricuspid valve replacement (ttvr) procedure involving the evoque system.At final valve deployment, the valve was well seated at annulus in all aspects.The delivery system was carefully navigated out to the right atrium.One minute after valve deployment, the patient developed complete heart block and asystole.An internal temporary venous pacemaker was placed.The patient is reported to be in stable condition.
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The following sections were updated/corrected/added: b4, g3, g6, h2, h6, and h11.The complaint for valve interacts with conduction system was confirmed with other empirical evidence.The device history record review was completed, and this device passed all manufacturing and sterilization inspections.No nonconformances related to the complaint event were identified.Per the instructions for use (ifu), conduction system disturbance and/or heart block which may require treatment (including permanent pacemaker) are potential adverse events.Heart block and other conduction disturbances are common in patients with underlying cardiovascular disease and can be exacerbated or aggravated with standard intra-operative medications or anesthesia.Such events are related to the patient's underlying condition.Other mechanisms for conduction abnormalities could be related to coronary obstruction due to air embolism, coronary spasm and/or local edema affecting the av node.Conduction disturbances have also been documented during transcatheter cardiac procedures as a result of direct interaction with cardiac anatomy, especially in patients with underlying conduction abnormalities.Other potential causes include trauma by a guidewire or delivery system.Additionally, cardiac conduction system complications are known risks with tricuspid valve interventions due to the proximity of the atrioventricular node (av node) to the septal leaflet of the tricuspid valve.These conduction disturbances can lead to post-operative heart block requiring pacemaker implantation.Nevertheless, a definitive root cause cannot be determined.Since there are no confirmed product or labeling/ifu/training material non-conformances affecting distributed product and no other triggers have been met, no preventative or corrective actions were required.
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