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Edwards received notification of a transcatheter tricuspid valve replacement (ttvr) procedure involving the evoque system.Immediately following deployment, the patient went into complete heart block (chb).The underlying rhythm was atrial fibrillation and right bundle branch block (rbbb).Temporary pacing was initiated using the wire in the rv, and additional access was obtained for lv pacing while awaiting ep.Ep subsequently placed a leadless pacemaker across the valve.No patient injury occurred during the procedure.
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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 based on the information provided by the field clinical specialist.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.Available information suggests the valve interaction with the native conduction system together with pre-existing patient conditions such as right bundle branch block (rbbb) likely contributed to the event.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.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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