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Edwards received notification of a transcatheter tricuspid valve replacement (ttvr) procedure involving the evoque system.Following evoque valve deployment, a conduction disturbance was noted during removal of the delivery system, with the valve positioned at 0-5 mm and remaining stable.The patient developed unresolved 2:1 heart block, and due to low hemodynamics, re-heparinization was avoided.A permanent pacemaker was implanted on same day post deployment.
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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 empirical evidence.Based on the device history record (dhr) review, there were no non-conformances related to the issue observed and the device passed all manufacturing specifications.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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