K Number
K020693
Device Name
AORTIC CANNULA, METAL J-TIP (24FR) MODEL #CF00100; AORTIC CANNULA, PLASTIC J-TIP (24FR) MODEL #CF00101
Manufacturer
Date Cleared
2002-09-05

(185 days)

Product Code
Regulation Number
870.4210
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The EMBOL-X Aortic Cannula is indicated for the perfusion of the ascending aorta during cardiopulmonary bypass (CPB) surgery where procedures may require the hemostatic introduction and removal of compatible intravascular devices into the vascular system.
Device Description
The EMBOL-X® Aortic Cannula consist of a standard 3/8" ID wire reinforced tube body having a curved J-tip end and a flange for suture attachment. Attached to the side of the J-tip end is an Introducer port having a single lumen housing and a removable self-venting keyed snap-lock Obturator. The outer portion of the J-tip includes a radiused groove that accepts the complimentary radiused distal end of the provided Obturator. With the Obturator inserted, the Obturator provides a smooth, minimally disruptive fit along the J-tip's radiused groove. Removal of the Obturator from the Introducer port reveals a channel through which a physically compatible device may be introduced through the Introducer's hemostatic valve and along the groove of the J-tip. The Introducer port acts as an intravascular hemostasis conduit that can accommodate the introduction of intravascular devices with an exit diameter ranging from 12 FR to 14 FR in size. The Obturator is removed only when intravascular access with a device is necessary. The EMBOL-X Aortic Cannulas have an insertion diameter size of 24 FR. All models are a J-tip configuration whose tips are made from metal or plastic. The device is packaged sterile and non-pyrogenic, is single use only, and come with a separate optional use porous vent plug for cannula venting.
More Information

Not Found

Not Found

No
The device description focuses on the physical components and mechanical function of a cannula and introducer system. There is no mention of software, algorithms, data processing, or any terms related to AI or ML.

No
The device is described as an aortic cannula used for perfusion and introduction/removal of other devices during bypass surgery. Its function is to facilitate the surgical procedure, not to directly treat a disease or condition itself.

No

The provided text describes a surgical device used during cardiopulmonary bypass, specifically an aortic cannula for vessel perfusion and introduction of other devices during the procedure. There is no mention of it being used to diagnose conditions or gather diagnostic information.

No

The device description clearly details physical components like a tube body, J-tip, flange, Introducer port, and Obturator, indicating it is a hardware device.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for the "perfusion of the ascending aorta during cardiopulmonary bypass (CPB) surgery" and the "hemostatic introduction and removal of compatible intravascular devices into the vascular system." This describes a surgical device used directly on a patient's vascular system.
  • Device Description: The description details a cannula with a tube body, tip, introducer port, and obturator. These are all components of a surgical instrument designed for physical intervention within the body.
  • Lack of Diagnostic Function: There is no mention of the device being used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. IVDs are used to test samples like blood, urine, or tissue outside the body.

Therefore, the EMBOL-X Aortic Cannula is a surgical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The EMBOL-X Aortic Cannula is indicated for the perfusion of the ascending aorta during cardiopulmonary bypass (CPB) surgery where procedures may require the hemostatic introduction and removal of compatible intravascular devices into the vascular system.

Product codes (comma separated list FDA assigned to the subject device)

DWF

Device Description

The EMBOL-X® Aortic Cannula consist of a standard 3/8" ID wire reinforced tube body having a curved J-tip end and a flange for suture attachment. Attached to the side of the J-tip end is an Introducer port having a single lumen housing and a removable self-venting keyed snap-lock Obturator. The outer portion of the J-tip includes a radiused groove that accepts the complimentary radiused distal end of the provided Obturator. With the Obturator inserted, the Obturator provides a smooth, minimally disruptive fit along the J-tip's radiused groove. Removal of the Obturator from the Introducer port reveals a channel through which a physically compatible device may be introduced through the Introducer's hemostatic valve and along the groove of the J-tip. The Introducer port acts as an intravascular hemostasis conduit that can accommodate the introduction of intravascular devices with an exit diameter ranging from 12 FR to 14 FR in size. The Obturator is removed only when intravascular access with a device is necessary. The EMBOL-X Aortic Cannulas have an insertion diameter size of 24 FR. All models are a J-tip configuration whose tips are made from metal or plastic. The device is packaged sterile and non-pyrogenic, is single use only, and come with a separate optional use porous vent plug for cannula venting.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

ascending aorta

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

In-vitro bench test results for joint strength, gasket seal integrity, and flow rate characteristics was substantially equivalent or better than in performance to the predicate device(s).

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

Not Found

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing.

(a)
Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to cannulate the vessels, perfuse the coronary arteries, and to interconnect the catheters and cannulas with an oxygenator. The device includes accessory bypass equipment.(b)
Classification. Class II (performance standards).

0

SEP 5 2002

Image /page/0/Picture/1 description: The image shows a sequence of alphanumeric characters, specifically "K020693". The characters are written in a bold, sans-serif font, and they appear to be handwritten or stylized. The numbers are clearly distinguishable, and the overall image is simple and straightforward.

510(k) SUMMARY

SUBMITTER'S NAME:EMBOL-X®, INC.
ADDRESS:645 Clyde Ave, Mountain View, CA
PHONE NUMBER:(650) 390-0280
FAX NUMBER:(650) 390-0282
CONTACT PERSON:Edwin Lee
DATE PREPARED:July 3, 2002
TRADE NAME:Aortic Cannula
COMMON NAME:Aortic Cannula
CLASSIFICATION
NAME:Cardiopulmonary Bypass Vascular Cannula
PREDICATE
DEVICE(S):a) EMBOL-X® Introducer
b) DLP® Curved Metal Tip Arterial Cannula
DEVICE
DESCRIPTION:The EMBOL-X® Aortic Cannula consist of a standard 3/8" ID wire reinforced tube
body having a curved J-tip end and a flange for suture attachment. Attached to the
side of the J-tip end is an Introducer port having a single lumen housing and a
removable self-venting keyed snap-lock Obturator. The outer portion of the J-tip
includes a radiused groove that accepts the complimentary radiused distal end of
the provided Obturator. With the Obturator inserted, the Obturator provides a
smooth, minimally disruptive fit along the J-tip's radiused groove. Removal of
the Obturator from the Introducer port reveals a channel through which a
physically compatible device may be introduced through the Introducer's
hemostatic valve and along the groove of the J-tip. The Introducer port acts as an
intravascular hemostasis conduit that can accommodate the introduction of
intravascular devices with an exit diameter ranging from 12 FR to 14 FR in size.
The Obturator is removed only when intravascular access with a device is
necessary. The EMBOL-X Aortic Cannulas have an insertion diameter size of 24
FR. All models are a J-tip configuration whose tips are made from metal or
plastic. The device is packaged sterile and non-pyrogenic, is single use only, and
come with a separate optional use porous vent plug for cannula venting.
INTENDED USE:The EMBOL-X Aortic Cannula is indicated for the perfusion of the ascending
aorta during cardiopulmonary bypass (CPB) surgery where procedures may
require the hemostatic introduction and removal of compatible intravascular
devices into the vascular system.
The intended use is substantially equivalent to that of the predicates.
TECHNOLOGICAL
CHARACTERISTICS
COMPARISON:The EMBOL-X Aortic Cannula is technologically and substantially equivalent to
the predicate devices. The EMBOL-X Aortic Cannula combines the predicate
arterial cannula design with the predicate EMBOL-X Introducer design into one
device. The device's principle operating functions and technological
characteristics have remained unchanged.
BIOCOMPATIBILITY:All materials used in the EMBOL-X Aortic Cannula are shown to be
biocompatible.

1

biocompatible.

In-vitro bench test results for joint strength, gasket seal integrity, and flow rate PERFORMANCE characteristics was substantially equivalent or better than in performance to the TESTS: predicate device(s).

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" arranged around the top half of the circle. Inside the circle is a stylized image of a caduceus, a symbol often associated with medicine and healthcare, featuring a staff with a serpent entwined around it.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

5 2002 SEP

Embol-X c/o Mr. Edwin Lee 645 Clyde Avenue Mountain View, CA 94043-2208

Re: K020693

Aortic Cannula Regulation Number: 870.4210 Regulation Name: CPB Catheter, cannula, tubing Regulatory Class: Class II (two) Product Code: DWF Dated: June 28, 2002 Received: July 1, 2002

Dear Mr. Lee:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807): labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

3

Page 2 - Mr. Edwin Lee

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4646. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97), Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours.

Dalk Telle

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Ver/ 3 - 4/24/96

EMBOL-X®, Inc. Applicant:

K020693 510(K) NUMBER (IF KNOWN):

Device Name: Aortic Cannula

Indications For Use:

The EMBOL-X Aortic Cannula is indicated for the perfusion of the ascending aorta during cardiopulmonary bypass (CPB) surgery where procedures may require the hemostatic introduction and removal of compatible intravascular devices into the vascular system.

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Concurrence of CDRH, Office of Device Evaluation (ODE)

Division of Cardiovascular & Respiratory Devices
510(k) Number K020693

Prescription Use X
(Per 21 CFR 801.109)

OR

.

Over-The-Counter Use ____________

(Optional Format 1-2-96)