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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC HEART VALVES DIVISION RING 620RG29 DURAN ANCORE ANNULOPLASTY C; RING, ANNULOPLASTY

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MEDTRONIC HEART VALVES DIVISION RING 620RG29 DURAN ANCORE ANNULOPLASTY C; RING, ANNULOPLASTY Back to Search Results
Model Number 620RG29
Device Problems Inadequacy of Device Shape and/or Size (1583); Deformation Due to Compressive Stress (2889); Material Twisted/Bent (2981); Material Split, Cut or Torn (4008)
Patient Problem No Information (3190)
Event Date 03/28/2019
Event Type  Injury  
Manufacturer Narrative
Product analysis: no product was returned.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 immediately post implant of this 29mm mitral annuloplasty ring, it was explanted and replaced with a non-medtronic ring of a larger size.The physician intended to implant a 31mm medtronic ring originally, but the hospital did not have one in stock, and therefore the physician attempted the 29mm ring of the same model.It was noted that the patient's annulus was too large compared to the 29mm ring.No additional adverse patient effects were reported. .
 
Manufacturer Narrative
Product analysis: upon receipt at medtronic¿s quality laboratory, the ring was discolored showing evidence of blood contact.The ring appeared to have been modified into a band with each end cut.Deformations and bends were noted along the ring.Radiography revealed deformation along the ring; however, no calcification and/or fractures were observed.Conclusion: surgeons often attempt to repair valves in lieu of replacing them in an effort to preserve the native anatomy.There are times when valve repair is attempted using a repair device and subsequent post-repair evaluation demonstrates an inadequate result.Failures in the acute period (less than 30 days from implant) are often unsuccessful repairs.This is potentially due to, but not limited to, suboptimal anatomy, surgical technique or inappropriate sizing, and not a malfunction of the device.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.
 
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Brand Name
RING 620RG29 DURAN ANCORE ANNULOPLASTY C
Type of Device
RING, ANNULOPLASTY
Manufacturer (Section D)
MEDTRONIC HEART VALVES DIVISION
1851 e deere ave
santa ana CA 92705
MDR Report Key8533176
MDR Text Key142544592
Report Number2025587-2019-01282
Device Sequence Number1
Product Code KRH
UDI-Device Identifier00643169793392
UDI-Public00643169793392
Combination Product (y/n)N
PMA/PMN Number
K032810
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Type of Report Initial,Followup
Report Date 07/15/2019
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received04/19/2019
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator Health Professional
Device Expiration Date02/25/2023
Device Model Number620RG29
Device Catalogue Number620RG29
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer04/29/2019
Date Manufacturer Received06/19/2019
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
Patient Outcome(s) Required Intervention;
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