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Per the instructions for use (ifu), structural valve deterioration (svd) (wear, fracture, calcification, leaflet tear/tearing from the stent posts, leaflet retraction, suture line disruption of components of a prosthetic valve, thickening, stenosis), is a potential adverse event associated with bioprosthetic heart valves.Per a technical summary written by edwards lifesciences, calcific degeneration is a common cause of bioprosthetic heart valve failures.Many factors contribute to the onset and propagation of calcification.These include patient factors (age, disease state, pharmacological intervention, etc.), mechanical stress related to the valve's hemodynamic performance, and glutaraldehyde fixation of tissue.Of these, the fixation process is a relatively minor contributor to calcification for edwards' tissue valves due to subsequent anti-calcification treatments during manufacturing.Though numerous studies have been conducted on preventive calcification strategies in bioprosthetic heart valves, the causes of calcification are not fully understood and there are still no mechanisms or medical therapies which fully prevent bioprosthesis from calcifying.In this case, there was no allegation or indication a manufacturing non-conformance contributed to this product problem.The patient has medical history of hyperlipidemia and inflammatory conditions.Patients with these conditions are known to have a higher risk for developing svd.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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As reported by the field clinical specialist, approximately 6 years and 9 months following a transfemoral transcatheter aortic valve replacement procedure implanting a 23 mm sapien 3 valve, a potential valve in valve procedure is being planned.Per medical records received for the patient, the patient with chronic obstructive pulmonary disease (copd) and emphysema presented with worsening exertional dyspnea.The degenerated bioprosthetic aortic valve exhibited severe stenosis and regurgitation.A transthoracic echocardiogram noted the aortic valve had thickened leaflets with restricted motion, moderate aortic regurgitation and severe aortic stenosis with a mean gradient of 41.4 mmhg.A computerized tomography scan noted circumferential pannus along the internal aspect of the valve with posterior thickened leaflet, moderate calcification, severely restricted leaflet motion, and halt involving the commissures.It is being discussed whether to address the degenerated valve with a valve in valve or a surgical valve replacement.
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