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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC HEART VALVES DIVISION CG FUTURE BAND; RING, ANNULOPLASTY

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MEDTRONIC HEART VALVES DIVISION CG FUTURE BAND; RING, ANNULOPLASTY Back to Search Results
Model Number 638RL30
Device Problems Gradient Increase (1270); Insufficient Information (3190)
Patient Problems Mitral Valve Stenosis (1965); Fibrosis (3167); No Information (3190)
Event Date 05/14/2018
Event Type  Injury  
Manufacturer Narrative
Conclusion: without the return of the product, no definitive conclusion can be made regarding the clinical observation.If information is provided in the future, a supplemental report will be issued.
 
Event Description
Medtronic received information that 5 years post implant of this mitral annuloplasty ring, the ring was explanted and replaced with bioprosthetic valve. the reason for the explant was not reported.  no additional adverse patient effects were reported. .
 
Manufacturer Narrative
Medtronic received additional information that the mitral annuloplasty ring was replaced due to moderate mitral stenosis with a mean gradient between 8 and 12 mmhg.It was reported the mitral valve was thickened, not very pliable, and demonstrated significant fibrosis, specifically at the previous alfieri stitch.The ring was successfully replaced and no additional adverse patient effects were reported. if information is provided in the future, a supplemental report will be issued.
 
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Brand Name
CG FUTURE BAND
Type of Device
RING, ANNULOPLASTY
Manufacturer (Section D)
MEDTRONIC HEART VALVES DIVISION
1851 e deere ave
santa ana CA 92705
Manufacturer (Section G)
MEDTRONIC HEART VALVES DIVISION
1851 e deere ave
santa ana CA 92705
Manufacturer Contact
paula bixby
8200 coral sea street ne
mounds view, MN 55112
7635055378
MDR Report Key8009477
MDR Text Key125149288
Report Number2025587-2018-02850
Device Sequence Number1
Product Code KRH
UDI-Device Identifier00613994758651
UDI-Public00613994758651
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K061127
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,health
Reporter Occupation Physician
Type of Report Initial,Followup
Report Date 12/10/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator Health Professional
Device Expiration Date02/06/2018
Device Model Number638RL30
Device Catalogue Number638RL30
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received 10/17/2018
Initial Date FDA Received10/26/2018
Supplement Dates Manufacturer Received11/14/2018
Supplement Dates FDA Received12/10/2018
Date Device Manufactured02/18/2013
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Patient Outcome(s) Required Intervention;
Patient Age69 YR
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