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Edwards received notification from a field clinical specialist that a 26mm sapien xt valve, implanted in the aortic position, is failing after an implant duration of 10 years and 11 months due to stenosis.A valve in valve procedure was scheduled.Through follow up with the valve clinic coordinator, it was reported that the patient passed away prior to the valve in valve procedure.The patient's valve was stenotic and the patient had symptoms of fatigue and edema.The patients co-morbidities included nonalcoholic steatohepatitis (nash), diabetes mellitus (dm), anemia and chronic respiratory failure.The patient's recent echo showed a left ventricular ejection fraction (lvef) of 65-70%, moderate aortic stenosis s/p tavr, moderate tricuspid regurgitation, mild-moderate mitral regurgitation, moderate-severe mitral annular calcification, and no mitral stenosis.
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Per the instruction for use (ifu), valve stenosis is a potential risk associated with bioprosthetic heart valves.Per the valve academic research consortium (varc), valve stenosis can result from a number of factors, including pannus, calcification, support structure deformation (out-of round configuration), trauma (cardia-pulmonary resuscitation, blunt chest trauma), endocarditis, prosthetic valve thrombosis, and native leaflet prolapse impeding prosthetic leaflet motion.Valve stenosis may result in symptoms such as shortness of breath and decreased exercise tolerance, which may be accompanied by an increased gradient across the valve.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 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 (nonalcoholic steatohepatitis (nash), diabetes mellitus (dm), anemia and chronic respiratory failure) caused or contributed to the vent.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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Follow up was performed to obtain additional information on whether the device caused or contributed to the patient's death or if the death was due to the patient's preexisting comorbidities.However, as no additional information or the cause of death was able to be determined.B2, h1, and h6: health effect impact code/health effect clinical code were updated on a conservative basis.The conclusion remains the same.
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