FDA Adverse Event Injury Summary report: N

CARPENTIER-EDWARDS PERIMOUNT MAGNA EASE PERICARDIAL BIOPROSTHESIS

MDR report key: 20168957 · Received September 9, 2024

Report

Report Number
2015691-2024-06921
Event Type
Injury
Date Received
September 9, 2024
Date of Event
January 1, 2009
Report Date
October 15, 2024
Manufacturer
EDWARDS LIFESCIENCES
Product Code
DYE
PMA / PMN Number
P860057
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

CORRECTED DATA H10 (RELATED REPORT NUMBERS). THE RELATED REPORT NUMBERS HAVE BEEN ADDED.

Additional Manufacturer Narrative · 0

UPDATED INFORMATION TO SECTION H6 (INVESTIGATION FINDINGS AND INVESTIGATION CONCLUSIONS). ADDED INFORMATION TO SECTION H10 (RELATED REPORT NUMBERS). H11. ADDITIONAL NARRATIVE/DATA: THE SERIAL NUMBER WAS NOT PROVIDED. THEREFORE, THE DEVICE HISTORY RECORD (DHR) COULD NOT BE REVIEWED. ADDITIONALLY, THE DEVICE WAS NOT RETURNED TO EDWARDS FOR FURTHER INVESTIGATION, AS THE VALVE REMAINED IMPLANTED DUE TO A VALVE-IN-VALVE REPLACEMENT, AND NO IMAGES OR MEDICAL RECORDS WERE PROVIDED. STRUCTURAL VALVE DETERIORATION (SVD) IS A LOGICAL AND EXPECTED CONSEQUENCE OF THE CHEMICAL, MECHANICAL, AND IMMUNOLOGICAL PROCESSES ASSOCIATED WITH BHV IMPLANTATION. THE COMMON ENDPOINT OF ALL THESE FACTORS IS CALCIFICATION AND DEGRADATION. 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. PRIOR INVESTIGATIONS AND EXTENSIVE LITERATURE REVIEW HAVE SHOWN THAT SVD IS PREDOMINANTLY RELATED TO PATIENT FACTORS AND IMPLANT DURATION RATHER THAN TO MANUFACTURING ISSUES. EVENTS RELATED TO DEVICE DESIGN, MANUFACTURING, OR USE ERROR TEND TO MANIFEST AT AN EARLIER IMPLANT DURATION. THE INSTRUCTIONS FOR USE (IFU) HAVE BEEN REVIEWED AND NO INADEQUACIES HAVE BEEN IDENTIFIED WITH REGARD TO WARNINGS, CONTRAINDICATIONS, AND THE DIRECTIONS/CONDITIONS FOR THE SUCCESSFUL USE OF THE DEVICE. THE REPORTED TYPE OF EVENT IS INCLUDED IN THE IFU. A DEFINITIVE ROOT CAUSE CANNOT BE CONCLUSIVELY DETERMINED; HOWEVER, PATIENT FACTORS LIKELY CAUSED OR CONTRIBUTED.

Additional Manufacturer Narrative · 0

H11: ADDITIONAL MANUFACTURER NARRATIVE: ARTICLE CITATION: HECHT S, ZENSES AS, BERNARD J, TASTET L, COTE N, DE FREITAS CAMPOS GUIMARAES L, PARADIS JM, BEAUDOIN J, O'CONNOR K, BERNIER M, DUMONT E, KALAVROUZIOTIS D, DELAROCHELLIERE R, MOHAMMADI S, CLAVEL MA, RODES-CABAU J, SALAUN E, PIBAROT P. HEMODYNAMIC AND CLINICAL OUTCOMES IN REDO-SURGICAL AORTIC VALVE REPLACEMENT VS. TRANSCATHETER VALVE-IN-VALVE. STRUCT HEART. 2022 OCT 28;6(6):100106. DOI: 10.1016/J.SHJ.2022.100106. PMID: 37288124; PMCID: PMC10242565. THIS IS ONE OF FIVE MANUFACTURER REPORTS BEING SUBMITTED FOR THIS ARTICLE. RELATED REPORT NUMBERS WILL BE PROVIDED IN THE SUPPLEMENTAL REPORTS SUBMITTED FOR THIS ARTICLE. THE DEVICE WAS NOT RETURNED FOR EVALUATION, NO OTHER DETAILS REGARDING THIS EVENT, OR WHAT COMORBIDITIES THE PATIENT HAD, WERE PROVIDED. ATTEMPTS TO RETRIEVE THE DEVICE AND ADDITIONAL INFORMATION WERE UNSUCCESSFUL. THE DATES OF THE EVENTS ARE UNKNOWN; HOWEVER, THE ARTICLE PROVIDED THE FOLLOWING DATE RANGE (FROM 2009 UNTIL 2017). THEREFORE, 1-JAN-2009 IS USED AS THE OCCURRENCE DATE. THE INVESTIGATION IS STILL IN PROGRESS; THEREFORE, A CONCLUSION HAS YET TO BE ESTABLISHED. A SUPPLEMENTAL REPORT WILL BE SUBMITTED ACCORDINGLY UPON INVESTIGATION COMPLETION. 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.

Description of Event or Problem · 0

THROUGH REVIEW OF MEDICAL ARTICLE "HEMODYNAMIC AND CLINICAL OUTCOMES IN REDO-SURGICAL AORTIC VALVE REPLACEMENT VS. TRANSCATHETER VALVE-IN-VALVE", THE FOLLOWING EVENT(S) WAS/WERE IDENTIFIED AS PERTAINING TO AN EDWARDS DEVICE: SIX (6) PATIENTS WITH MAGNA EASE VALVES IMPLANTED IN THE AORTIC POSITION UNDERWENT VALVE-IN-VALVE REPLACEMENT DUE TO STRUCTURAL VALVE DETERIORATION AFTER AN UNKNOWN IMPLANT DURATION.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2020811 CARPENTIER-EDWARDS PERIMOUNT MAGNA EASE PERICARDIAL BIOPROSTHESIS REPLACEMENT HEART-VALVE DYE EDWARDS LIFESCIENCES 3300TFX

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Required Intervention| L| H