MAUDE Adverse Event Report: BERLIN HEART GMBH EXCOR BLOOD PUMP PU VALVES, 15 ML IN/OUT Ø 9MM; VENTRICULAR ASSIST DEVICE

Model Number P15P-001

Device Problem Output Problem (3005)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 10/13/2019

Event Type  malfunction  

Manufacturer Narrative

The excor blood pump, s/n (b)(4), was in use by the patient from (b)(6) 2019 until (b)(6) 2019 (152 days).We have reviewed the production records of the excor blood pump, s/n (b)(4).This pump was produced according to our specification.The blood pump is designed with a triple layer membrane separating the air chamber from blood chamber for safety reasons.The entire membrane consists of an air-side layer, a middle layer and a blood-side layer.In case of disruption in one of the triple layers, there are two more layers that will maintain the integrity of the air and blood chambers.A detailed investigation of the returned pump is currently ongoing and a report will be provided as soon as available.

Event Description

Berlin heart gmbh was contacted by the (b)(6) distributor to report about a reduced pump function of the excor blood pump of a patient supported in the lvad configuration.The distributor provided berlin heart ca personnel with video material of the blood pump at the time of the incident.The affected blood pump was exchanged in the clinic by trained professionals without complications.The patient was not negatively affected by the incident and is doing well.

Manufacturer Narrative

During initial visual examination of the returned blood pump, an air cushion could be detected between the membranes.For further analysis the pump was disassembled and the membrane layers were individually examined.A leak was detected in the air-side layer along the rolling radius of the stabilization ring.Furthermore, graphite agglomerates were found between the membranes.The middle layer and the blood-side layer of the triple layer membrane were found to be intact.The thickness of the defect membrane layer and the adjacent layer of the returned blood pump was re-measured at fixed points.The thickness of the individual layers at all the fixed locations in the air-side and middle layer was found to be within specification.The cause of the failure was most likely the graphite particles that formed due to an abrasion between the layers.This caused increased friction at points, which finally led to the defect in the air-side layer of the tripple layer membrane.As a result of this defect, air got in and formed an air cushion, causing the reduced pump performance (incomplete filling and emptying).

• Brand Name: EXCOR BLOOD PUMP PU VALVES, 15 ML IN/OUT Ø 9MM
• Type of Device: VENTRICULAR ASSIST DEVICE
• Manufacturer (Section D): BERLIN HEART GMBH; wiesenweg 10; berlin, 12247 ; GM 12247
• MDR Report Key: 9296323
• MDR Text Key: 197588412
• Report Number: 3004582654-2019-00084
• Device Sequence Number: 1
• Product Code: DSQ
• UDI-Device Identifier: 04260090040157
• UDI-Public: 04260090040157
• Combination Product (y/n): N
• PMA/PMN Number: P160035
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,foreign
• Remedial Action: Replace
• Type of Report: Initial,Followup
• Report Date: 11/08/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/08/2019
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 01/31/2020
• Device Model Number: P15P-001
• Device Catalogue Number: P15P-001
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/25/2019
• Date Manufacturer Received: 10/14/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Age: 1 YR