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H11: additional manufacturer narrative: svd is an acquired condition, intrinsic to bioprosthetic valves, characterized by deterioration of the leaflets or supporting structures, leading to thickening, calcification, tearing, or disruption of the prosthetic valve materials.These changes result in valvular dysfunction manifesting as stenosis and/or regurgitation with a consequent drop in hemodynamic efficacy of the valve.Svd commonly occurs with a considerably increased rate after 10 years.Prior investigations and extensive literature review have shown that it is predominantly related to patient factors and implant duration rather than to manufacturing issues.There is no evidence to suggest a manufacturing defect caused or contributed to the reported event.Based on the information available, the most likely cause is patient factors, including an implant duration of 10 or more years.Edwards will continue to review and monitor all reported events.Trends are monitored on a monthly basis and if action is required, appropriate investigation will be performed.
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It was reported and learned through medical records that a patient with a 29mm 7300tfx mitral valve is under evaluation for a valve-in-valve procedure after an implant duration of 13 years, 7 months due to structural valve deterioration and severe mitral stenosis.The patient presented with nyha class iii iv heart failure , shortness of breath with minimal activity, progressive fatigue, lower extremity edema.Per medical records, pre op tte demonstrated mean gradient up to 13.5 mmhg, trivial mitral regurgitation, severe tricuspid regurgitation, right ventricular systolic pressure 80 mmhg, ejection fraction 70%, and ascending aorta 46 mm.The patient underwent induction for transcatheter mitral valve replacement, however developed cardiogenic shock with decompensated right heart failure, followed by pea arrest requiring cpr and epinephrine and ventricular tachycardia treated with amiodarone.Tee demonstrated severe rv dysfunction and bilateral pleural effusions.The procedure was aborted due to decompensation on induction of anesthesia.Post procedurally, the patient developed acute hypoxemic respiratory failure, bilateral pleural effusions requiring thoracostomy with greater 3 l output, right pneumothorax, and chest wall trauma following cpr, requiring mechanical ventilation with vasopressor and inotropic support.The hospital course was complicated by cirrhosis with ascites, chronic renal insufficiency with acute worsening, anemia requiring transfusion, cellulitis, and persistent cardiogenic shock.At the time of documentation, the patient remained in icu, intubated, on vasopressor and inotropic support, with goals of care discussion and dnr status consistent with patient wishes.This is an 82-year-old male patient.
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