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As reported by the field clinical specialist (fcs) approximately 5 years, 5 months and 7 days post transfemoral transcatheter aortic valve replacement (tavr) with a 26 mm sapien 3 ultra valve the valve was failing due to aortic stenosis.According to the physician the patient was in congestive heart failure (chf) due to the aortic stenosis; the patient had come to the hospital and was treated, stabilized, and sent home.The patient was being worked up for a tavr redo.The patient expired two days after being seen at the hospital, the reason for death is unknown.Per medical records the valve had severe bioprosthetic aortic valve stenosis and the ct of the heart, showed the tavr valve in place however the tavr valve leaflets are calcified.The patient was brought into the emergency department presenting with syncope.The patient was noted to have positive cardiac markers and was admitted.
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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 patient factors (coronary artery disease, cardiomyopathy, and hypercholesterolemia) 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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