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As reported to the implant patient registry (ipr), 8 years, 6 months, and 16 days post-implant of a 23 mm sapien 3 valve in the aortic position, the 23 mm sapien 3 valve was explanted, and a surgical valve was implanted.The reason for explant is degeneration.According to the medical records, the patient underwent a transcatheter aortic valve replacement (tavr) explant and an aortic valve replacement (avr) with a 23mm inspiris valve and an ascending aortic replacement with a 26mm non edwards graft.The patient tolerated the procedure well.The procedure was indicated due to severe symptomatic aortic stenosis and structural valve deterioration of the tavr valve.The intraoperative tee showed mean gradient of 53.5mmhg, marked sclerocalcification of the aortic valve leaflets, mild aortic valve regurgitation, well-positioned prosthetic valve with no paravalvular leak, leaflet excursion is severely limited.
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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), and device degeneration are known potential risks associated with the use of bioprosthetic heart valves.The ifu cautions that accelerated deterioration of the valve may occur in patients with an altered calcium metabolism.Long-term durability has not been established for the valve.Regular medical follow-up is advised to evaluate valve performance.Structural valve deterioration (svd) may be manifested as stenosis with thickened leaflets.Svd may be mild and not require any intervention or it may be moderate to severe.It can cause the heart to work harder to eject blood from the ventricle.Depending on the severity it could be an indication for valve replacement or medical intervention.Tissue calcification is a common failure mode.The mechanisms for bioprosthetic heart valve tissue calcification are not yet fully understood.Many factors can contribute to the onset and propagation of calcification including patient-related (e.G., patient age, disease state, immune status, and other co-morbidities), pharmacological, and intrinsic properties of the valve itself.It is widely understood that patients with chronic renal disease and prior history of calcific stenosis of the native valve may be predisposed to bioprosthetic calcification.During the manufacturing process, all sapien thv valves are 100% visually inspected for defects and 100% functionally tested for proper coaptation under physiological backpressure conditions prior to release for distribution.Therefore, it is highly unlikely that a manufacturing defect or device malfunction contributed to the event.In this case, there was no allegation or indication a manufacturing non-conformance contributed to this product problem.Investigation results suggest/indicate patient factors including hyperlipidemia 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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