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As reported by an edwards lifesciences field clinical specialist (fcs), approximately 5 years and 6 months post implantation of a 29mm sapien 3 valve in the aortic position, a valve in valve with a 26mm sapien 3 ultra valve due to severe calcification of the prosthetic leaflets.Patient symptoms before valve in valve was fatigue and heart failure.Per fcs, suboptimal commissural alignment, native anatomy appears consistent with bicuspid valve (sievers 0), underexpansion of the thv at the mid portion and significant calcification of the native anatomy.
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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), 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.Investigation results suggest/indicate the exact mechanism of the event is unknown therefore it is not possible to determine an exact cause, however there are patient comorbidities such as advanced age, history of aortic stenosis, and progression of disease that may have contributed to the event.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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