| Model Number |
NVRO-29 |
| Medical Device Problem Code |
Adverse Event Without Identified Device or Use Problem (2993)
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| Health Effect - Clinical Code |
Heart Block (4444)
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| Date of Event |
06/29/2026
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Type of Reportable Event
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Serious Injury
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Event or Problem Description
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It was reported that on (b)(6) 2026, a 29mm navitor vision valve was selected for implant using a flexnav delivery system (ds).The patient has a prior medical history of right bundle branch block (rbbb) and left anterior fascicular block (lafb) with qrs duration of 144ms.The length of the membranous septum was 4.4mm.There was calcification extending beneath the aortic annular plane in the interventricular septum.Pre-implant balloon aortic valvuloplasty (pre-bav) was performed by using an unspecified balloon and the patient went into a complete heart block.A temporary pacing wire was placed to stabilize the rhythm.During the procedure, the valve was able to be implanted successfully at a depth of 3mm on the non-coronary cusp (ncc).The patient remained hemodynamically stable throughout the procedure and there was no clinically significant delay reported.On the following day, a permanent pacemaker was placed to resolve the event.The patient had an extended hospitalization.The patient was discharged.
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Additional Manufacturer Narrative
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An event of heart block was reported intra-procedure.Patient has a history of rbbb/lafb.There was calcification extending beneath the aortic annular plane in the interventricular septum.The reported unexpected medical intervention and surgery are results of case-specific circumstances, as temporary pacemaker were performed, subsequently permanent pacemaker was implanted due to heart block.The device history record was reviewed to ensure that each manufacturing and inspection operation was performed, and the product met all specifications.A returned device assessment could not be performed as the device remains implanted and was not returned for analysis.There was calcification extending beneath the aortic annular plane in the interventricular septum which may have caused the reported complications, and based on the all available information the cause for the reported heart block could be related to patient calcification, however, this could not be determined.There is no indication of a product quality issue with respect to labeling design or manufacturing of the device.
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Event or Problem Description
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It was reported that on (b)(6) 2026, a 29mm navitor vision valve was selected for implant using a flexnav delivery system (ds).The patient has a prior medical history of right bundle branch block (rbbb) and left anterior fascicular block (lafb) with qrs duration of 144ms.The length of the membranous septum was 4.4mm.There was calcification extending beneath the aortic annular plane in the interventricular septum.Pre-implant balloon aortic valvuloplasty (pre-bav) was performed by using an unspecified balloon and the patient went into a complete heart block.A temporary pacing wire was placed to stabilize the rhythm.During the procedure, the valve was able to be implanted successfully at a depth of 3mm on the non-coronary cusp (ncc).The patient remained hemodynamically stable throughout the procedure and there was no clinically significant delay reported.On the following day, a permanent pacemaker was placed to resolve the event.The patient had an extended hospitalization.The patient was discharged.
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Additional Manufacturer Narrative
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The device remains implanted in patient.The device will not be returned for evaluation.Investigation is not yet complete.A follow-up report will be submitted with all additional relevant information.
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Search Alerts/Recalls
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