MAUDE Adverse Event Report: HEARTWARE, INC. HEARTWARE VENTRICULAR ASSIST SYSTEM - PUMP; VENTRICULAR (ASSISST) BYPASS

Model Number 1103

Device Problems Increase in Suction (1604); Pumping Problem (3016)

Patient Problems Cardiac Arrest (1762); Pneumonia (2011); Sepsis (2067); Tachycardia (2095); Respiratory Failure (2484); Heart Failure/Congestive Heart Failure (4446); Lactate Dehydrogenase Increased (4567)

Event Date 10/30/2021

Event Type  Death  

Manufacturer Narrative

Investigation of this event is pending and a supplemental report will be sent upon its completion.Additional information has been requested regarding the event details of the event, but it was not available at the time of this report.If additional information is received, the event will be updated and a supplemental report will be sent.If information is provided in the future, a supplemental report will be issued.

Event Description

It was reported that the ventricular assist device (vad) exhibited a power and flow drop, and the patient had ventricular tachycardia (vt) and the vad was thought to have suction.The patient was admitted with cardiac arrest due to vt and was cardioverted.During the hospital admission, the patient experienced volume overload, and was subsequently transferred to the intensive care unit (icu) and intubated.The patient appeared to be septic, but the origin of sepsis was unclear.An echocardiogram revealed right ventricle (rv) failure.The patient was started on nitric oxide and continuous veno-venous hemodialysis (cvvhd).The patient's symptoms were thought to be due to volume overload.Lactate dehydrogenase (ldh) was noted to be slightly elevated.The vad remains in use.No further patient complications have been reported as a result of this event.

Event Description

It was further reported that the patient had been intubated for respiratory failure, and had pneumonia.Multiple family meetings held and patient was extubated, woke up, and wanted everything turned off, including the vad.The patient's family decided to withdraw care and patient passed away.

Manufacturer Narrative

A supplemental report is being submitted for additional information.Newly added b2, b5 for patient death and h6 for additional coding.Investigation of this event is pending and a supplemental report will be sent upon its completion.Medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.

Manufacturer Narrative

A supplemental report is being submitted for device evaluation.Product event summary: the ventricular assist device (vad) was not returned for evaluation.The reported low flow event was confirmed via log file analysis which revealed a decrease in power consumption and estimated flows on (b)(6) 2021 and thirteen (13) low flow alarms logged on (b)(6) 2021.One (1) low flow alarm was also logged on (b)(6) 2021.There was no evidence of suction events within the analyzed period; as a result, the reported suction event could not be confirmed.Information received from the site indicated that the patient experienced ventricular tachycardia (vt); the patient was admitted with cardiac arrest due to vt and was cardioverted.While admitted, the patient experienced volume overload and was intubated.Additionally, the patient appeared to be septic, but the origin of sepsis was unclear.An echocardiogram revealed right ventricle (rv) failure.The patient was started on nitric oxide and continuous veno-venous hemodialysis.Of note, the patient's symptoms were thought to be due to volume overload.It was further reported that the patient had been intubated for respiratory failure and had pneumonia.It was decided to withdraw care and the patient subsequently expired.Based on the risk documentation, possible causes of the reported low flow event may be attributed to multiple factors including but not limited to thrombus at the inflow cannula/outflow graft, constriction at the outflow graft, and/or poor v ad filling.Based on the available information, the device may have caused or contributed to the reported event.Per the instructions for use, cardiac arrhythmia, sepsis, rv failure, respiratory dysfunction, and death are known potential complications associated with the implantation of a vad.There was no evidence that the patient had a history of similar adverse events.Possible clinical factors that may have contributed to this event include the patient¿s pre-existing history and related comorbidities, the progression of their underlying disease, issues related to the therapeutic use of anticoagulant and antiplatelet medications and the patient's complex post-operative course.There are possible patient, pharmacological and procedural factors that may have contributed to this event.Investigation of this event is completed and the file will be closed.If new information is received, the file will be re-opened and a supplemental will be submitted.### medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.

• Brand Name: HEARTWARE VENTRICULAR ASSIST SYSTEM - PUMP
• Type of Device: VENTRICULAR (ASSISST) BYPASS
• Manufacturer (Section D): HEARTWARE, INC.; 14400 nw 60th ave; miami lakes FL 33014
• Manufacturer (Section G): HEARTWARE, INC.; 14400 nw 60th ave; miami lakes FL 33014
• Manufacturer Contact: paula bixby ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635055378
• MDR Report Key: 12813130
• MDR Text Key: 280766542
• Report Number: 3007042319-2021-08030
• Device Sequence Number: 1
• Product Code: DSQ
• UDI-Device Identifier: 00888707000017
• UDI-Public: 00888707000017
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P100047
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,Company Representative
• Reporter Occupation: Physician Assistant
• Type of Report: Initial,Followup,Followup
• Report Date: 01/26/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/15/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Expiration Date: 04/30/2019
• Device Model Number: 1103
• Device Catalogue Number: 1103
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 01/20/2022
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 04/30/2017
• 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): Life Threatening; Death; Hospitalization; Required Intervention
• Patient Age: 59 YR
• Patient Sex: Female
• Patient Weight: 133 KG