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Edwards received notification from the implant patient registry that a patient with a 9750tfx 20mm sapien 3 ultra valve, implanted in the aortic position, underwent an explant procedure after an implant duration of 1 year and 3 months.Per the medical records, the patient presented with elevated prosthetic gradients (mean 55mmhg) on echo.Under general anesthesia, the patient had an aortic valve replacement and explant of the tavr valve.
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The event reported is an anticipated in the risk management documentation for transcatheter heart valve procedures.A previous investigation into this type of event is captured in an edwards lifesciences technical summary and applies to this complaint.Additional assessment of the failure mode is not required at this time.Due to the unavailability of the complaint device , engineering was unable to perform any visual inspection, functional testing, or dimensional analysis.Per the technical summary, the ifu, current risk mitigations include design and manufacturing controls, and training manuals have been reviewed, no inadequacies have been identified with regards to warnings, contraindications, and the directions/conditions for the successful use of the device.Through extensive complaint investigations, stenosis/increased gradient events for the s3, s3u, s3ur valves post-implantation have not been associated with device malfunctions or manufacturing nonconformances.Rather, the root cause for these events have historically been due to patient factors (atherosclerosis, thrombosis, endocarditis, rheumatic fever, pannus formation) and/or procedural factors (under-deployed valve, valve size selection, patient-prosthesis mismatch).The complaint of valve increased gradients was objectively confirmed based on the provided medical records.The available information suggests patient factors likely contributed to the event as medical records note a history of hyperlipidemia.Atherosclerosis is the buildup of calcification, plaque, or fatty material on the valve over time.These deposits often come with age and make the valve tissue stiff, narrow, and unyielding which can contribute to increased gradients or stenosis.Factors such as but not limited to renal failure, patients undergoing hemodialysis / renal replacement therapy, hypercholesterolemia, hyperlipidemia, and/or diabetes mellitus can further contribute to atherosclerosis.Complaint histories for all reported events are reviewed against trending control limits on a monthly basis, and any excursions above the control limits are assessed and documented as part of this monthly review.Since no edwards product defects or labeling deficiencies were identified, no corrective or preventative action is required.
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