MAUDE Adverse Event Report: MEDTRONIC HEART VALVES DIVISION RING ANNULOPLSTY TRICUSP CONTOUR 3D 32MM; RING, ANNULOPLASTY

Model Number 690R32

Device Problems Material Separation (1562); Appropriate Term/Code Not Available (3191)

Patient Problems Tricuspid Regurgitation (2112); Prolapse (2475)

Event Date 03/25/2015

Event Type  Injury  

Event Description

Medtronic received information from the patient's physician that one year, nine months post implant of this tricuspid annuloplasty ring, the device was explanted due to severe tricuspid valve regurgitation.At explant, approximately half a centimeter of the tricuspid ring at the middle of the posterior aspect had dehisced, causing the anterior leaflet to prolapse.An annuloplasty ring was implanted into the tricuspid position.No further adverse patient effects were reported.

Manufacturer Narrative

Product analysis: the device has not been returned, therefore no product analysis can be performed.Conclusion: without return of the product, no definitive conclusions could be drawn regarding the clinical observation.Should the device be returned or additional information become available, a supplemental report will be submitted.(b)(4).

Manufacturer Narrative

Conclusion: based on the available information, this event may be due to the patient¿s health conditions, status and co-morbidities.The clinical observation does not indicate a potential manufacturing issue.

Manufacturer Narrative

If information is provided in the future, a supplemental report will be issued.

• Brand Name: RING ANNULOPLSTY TRICUSP CONTOUR 3D 32MM
• Type of Device: RING, ANNULOPLASTY
• Manufacturer (Section D): MEDTRONIC HEART VALVES DIVISION; 1851 e deere ave; santa ana CA 92705
• Manufacturer (Section G): MEDTRONIC STRUCTURAL HEART; 8200 coral sea street ne; mounds view MN 55112
• Manufacturer Contact: paula bixby ; 8200 coral sea street ne; mounds view, MN 55112 ; 7635055378
• MDR Report Key: 4774539
• MDR Text Key: 18881324
• Report Number: 2025587-2015-00549
• Device Sequence Number: 1
• Product Code: KRH
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K101212
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,Company Representative,company representative
• Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date: 06/26/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/15/2015
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 03/07/2018
• Device Model Number: 690R32
• Device Catalogue Number: 690R32
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 06/26/2015
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 03/28/2013
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 00067 YR