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As reported by the field clinical specialist (fcs), approximately 6 years, 3 months, 1 day post transfemoral tavr procedure with a 29mm sapien 3 valve, the valve presented stenosis.The patient underwent a successful valve in valve procedure with a 26mm sapien 3 ultra resilia valve.Per additional information received, the patient presented shortness of breath with a mean gradient of 56.5mmhg and a peak gradient of 97.9mmhg.The valve area/index of the failed valve was 0.54 cm2.The leaflets were calcified with limited mobility.The patient was discharged home.During the valve in valve procedure, the balloon on the 26mm commander delivery system burst circumferentially during valve deployment at full inflation with +1cc.During withdrawal, there were difficulties.However, the balloon was able to be pulled back into the 14fr esheath+ and removed.A new 14fr esheath+ was inserted.The patient was stable and the esheath+ was removed with successful groin closure.The patient was sent to recovery.There was no injury to the patient.Per report, bav was performed pre-implant.Valve alignment was performed in a straight section.
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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.Although the exact cause and source of the calcification cannot be determined, it is possible patient factors not provided may have caused or 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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