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As reported to the implant patient registry (ipr), 6 years, 3 months, and 27 days post-implant of a 26 mm sapien 3 ultra valve in the aortic position, the 26 mm sapien 3 ultra valve was explanted due to calcification and an inspiris resilia was implanted.According to the medical records, the patient presented for a transcatheter aortic valve replacement (tavr) vs surgical aortic valve replacement (savr) evaluation after a syncopal episode.The patient also reports constant shortness of breath at rest and with activity.Tte showed an ejection fraction (ef) of 65-70% and severely stenotic bioprosthetic aortic valve (26mm sapien).The ct scan showed heavy calcifications of the tavr leaflets.The patient went for tavr a explant and a 23mm inspiris was placed, and additionally the mitral valve was replaced with a 31mm epic porcine valve.There were no procedural complications.
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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/indicate dyslipidemia, coronary artery disease, and diabetes mellitus ii could 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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