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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 progression of the patient's disease process and comorbidities (hypertension, hyperlipidemia) may have caused or contributed to this 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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As reported by an edwards lifesciences field clinical specialist, a 23mm sapien 3 valve, implanted in the aortic position, required reintervention after an implant duration of 6 years and 4 months.The failure modes were identified as stenosis, mild central regurgitation, and calcification.Mean/peak valve gradients were above 50mmhg.The patient was symptomatic with wheezing, shortness of breath, atypical chest pain, and acute pulmonary edema.A valve-in-valve procedure was performed with a 23mm sapien 3 ultra resilia valve.The valve was successfully deployed.Post procedure mean gradient measured 6mmhg, with no paravalvular leak or aortic insufficiency.The patient was stable post procedure.
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