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As reported by implant patient registry, a patient underwent explant of their 23mm sapien 3 valve in the aortic position approximately 9 years and 4 months post transcatheter aortic valve replacement (tavr) procedure.The device was explanted and replaced with an edwards surgical valve.According to the medical record review, this patient was admitted for acute on chronic heart failure exacerbation and was diuresed for volume overload.Tte showed thickened and calcified leaflets, severe aortic stenosis (valve area of 0.5cm2) , mean gradient of 47mmhg, and severe mitral regurgitation.The patient underwent a redo sternotomy avr and mvr.
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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.The exact cause of the event was unable to be determined but may have been related to progression of disease, implant duration, and patient factors such as age, a history of hypertension, hyperlipidemia, stenosis, coronary artery disease and/or the mechanisms described above.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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