K Number
K040744
Device Name
ATRILAZE SOFT TISSUE ABLATION SYSTEM
Manufacturer
Date Cleared
2004-11-30

(252 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The MedicalCV, Inc. Atrilaze™ Soft Tissue Ablation System is indicated for delivery of 810nm laser light to soft tissue to include cardiac tissue during surgical procedures. Indications include the incision, dissection, vaporization, ablation, or coagulation of soft tissue.
Device Description
The Altrilaze Soft Tissue Ablation System consists of a generator designed for the delivery of 810nm laser light and a hand held fiber optic light delivery device (probe) fitted with a standard SMA 905 connector at the proximal rond. The system may be used in conjunction with surgical treatment for hemostasis, incision, ablation, coaeglytion and vaporization of tissue as required by the clinician.
More Information

No
The summary describes a laser ablation system with a generator and fiber optic delivery device, focusing on physical parameters and tissue effects. There is no mention of AI, ML, image processing, or data-driven decision making.

Yes
The device is indicated for surgical procedures involving incision, dissection, vaporization, ablation, or coagulation of soft tissue, which are all therapeutic actions.

No

The device is described as an "Ablation System" used for surgical procedures like incision, dissection, vaporization, ablation, and coagulation of soft tissue. It is a therapeutic device, not a diagnostic one.

No

The device description explicitly states it consists of a "generator" and a "hand held fiber optic light delivery device (probe)", which are hardware components.

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 delivery of laser light to soft tissue during surgical procedures for purposes like incision, dissection, vaporization, ablation, or coagulation. This is a direct intervention on living tissue within the body.
  • Device Description: The device is a laser system with a hand-held probe designed for surgical use.
  • Anatomical Site: The device is used on soft tissue, including cardiac tissue, which is within the body.
  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body (like blood, urine, or tissue) to detect diseases, conditions, or infections. This device does not perform such tests on samples.

The device is a surgical tool used for therapeutic or procedural purposes on living tissue, not for diagnostic testing of samples outside the body.

N/A

Intended Use / Indications for Use

The MedicalCV, Inc. Atrilaze™ Soft Tissue Ablation System is indicated for delivery of 810nm laser light to soft tissue to include cardiac tissue during surgical procedures. Indications include the incision, dissection, vaporization, ablation, or coagulation of soft tissue.

The Atrilaze™ Ablation System is not indicated for the treatment of cardiac arrhythmias.

The risk of actual damage to adjacent organs from the instrument exists and perforation, rupture or tearing of tissue, may occur as a complication of laser use. Burns can occur if the laser energy is not correctly applied. These complications may be serious.

Product codes

OCL, GEX

Device Description

The Altrilaze Soft Tissue Ablation System consists of a generator designed for the delivery of 810nm laser light and a hand held fiber optic light delivery device (probe) fitted with a standard SMA 905 connector at the proximal rond. The system may be used in conjunction with surgical treatment for hemostasis, incision, ablation, coaeglytion and vaporization of tissue as required by the clinician.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

soft tissue to include cardiac tissue

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)

The results of biocompatibility testing support that the materials used in the manufacture of the Altrilaze Soft Tissue Ablation disposable probe are non-toxic, non-hemolytic, and non-pyrogenic. All biocompatibility testing was conducted under Good Laboratory Practices per 21 CFR Part 58. Performance testing for the Atrilaze Soft Tissue Aboation System y rluded compliance to manufacturing specifications for Power Output, Tip Pull-Off, Pressure and Flow for the fiber optic delivery device, also visual evaluation of the lesions obtained using the Altrilaze Soft Tissue Ablation System on cardiac tissue was performed. Testing demonstrated that the Altrilaze Soft Tissue Ablation System is substantially equivalent to the predicated and ablation of soft tissue.

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

Not Found

Predicate Device(s)

K001975, K013201

Reference Device(s)

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

§ 878.4810 Laser surgical instrument for use in general and plastic surgery and in dermatology.

(a)
Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.
(b)
Classification. (1) Class II.(2) Class I for special laser gas mixtures used as a lasing medium for this class of lasers. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 878.9.

0

Section II

12040144

NOV 3 0 2004

Summary of Safety and Effectiveness (as required by 21 CFR 807.92)

Atrilaze™ Soft Tissue Ablation System

| Submitter: | MedicalCV, Inc.
9725 South Robert Trail
Inver Grove Heights, MN 55077
USA | Contact: | Denny Steger
V.P. RA/QA
Phone: 651 452 3000
Fax: 651 452 4948 |
|------------------|------------------------------------------------------------------------------------|----------------------|------------------------------------------------------------------------|
| Date of Summary: | November 18, 2004 | Classification Name: | Laser Instrument,
Surgical Powered |
| Common Name: | Surgical Laser Instrument | Proprietary | Atrilaze™ Soft Tissue
Ablation System |

Description of Device: The Altrilaze Soft Tissue Ablation System consists of a generator designed for the delivery of 810nm laser light and a hand held fiber optic light delivery device (probe) fitted with a standard SMA 905 connector at the proximal rond. The system may be used in conjunction with surgical treatment for hemostasis, incision, ablation, coaeglytion and vaporization of tissue as required by the clinician.

The MedicalCV Atrilaze Soft Tissue Ablation System is Statement of Intended Use: indicated for the delivery of 810nm laser light to soft tissue to include cardian tissue, driving surgical procedures. Indications include the incision, excision, dissection, vaportization, ablation or coagulation of soft tissue.

The Atrilaze Ablation System is not indicated for the treatment of cardiac Warning: arrhythmias.

The risk of actual damage to adjacent organs from the instrument exists and perforation, rupture or tearing of tissue, may occur as a complication of laser use. Burns can occur if the laser energy is not correctly applied. These complications may be serious.

1

Technological Comparison: The Atrilaze Soft Tissue Ablation System is a self contained compact surgical laser that utilizes gallium aluminum arsenide (GaAAs) semiconductor diodes to generate near-infrared laser radiation. A fiber optic delivery system (probe) is coupled to the laser via an SMA 905 connector to deliver laser radiation to the target tissue(s). For purposes of this submission, the Atrilaze Soft Tissue Ablation System was compared to the following predicate device(s):

  • Biolitec/Ceramoptec Ceralas D10-25 Fiber-coupled Diode Laser System (K001975) .
  • CardioFocus Diode Laser System (K013201) .

The results of biocompatibility testing support that the materials used in the Testing: manufacture of the Altrilaze Soft Tissue Ablation disposable probe are non-toxic, non-hemolytic, and non-pyrogenic. All biocompatibility testing was conducted under Good Laboratory Practices per 21 CFR Part 58. Performance testing for the Atrilaze Soft Tissue Aboation System y rluded compliance to manufacturing specifications for Power Output, Tip Pull-Off, Pressure and Flow for the fiber optic delivery device, also visual evaluation of the lesions obtained using the Altrilaze Soft Tissue Ablation System on cardiac tissue was performed. Testing demonstrated that the Altrilaze Soft Tissue Ablation System is substantially equivalent to the predicated and ablation of soft tissue.

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 stylized eagle with three stripes forming its body and wing. The eagle faces to the right. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the eagle.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MedicalCV, Inc c/o Mr. Denny Steger

Vice President Regulatory Affairs/Quality Assurance 9725 South Robert Trail Inver Grove Heights, MN 55077

Re: K040744 Trade/Device Name: Atrilaze™ Soft Tissue Ablation System Regulation Number: 21 CFR 878.4810 Regulation Name: Laser surgical instrument for use in general and plastic surgery and in dermatology Regulatory Class: II (two) Product Code: OCL, GEX Dated: August 31, 2004 Received: September 1, 2004

FEB 2 1 2008

Dear Mr. Steger:

This letter corrects our substantially equivalent letter of November 30, 2004.

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 (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 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.

3

Page 2 - Mr. Denny Steger

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.

This letter will allow you to continue 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), please contact the Office of Compliance at (240) 276-0120. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

el.qmee

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

Enclosure

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Page 1 of 1

Indications for Use Statement

K040744 510(K) Number:

Atrilaze™ Ablation System Device Name:

Indications for Use: The MedicalCV, Inc. Atrilaze™ Soft Tissue Ablation System is indicated for delivery of 810nm laser light to soft tissue to include cardiac tissue during surgical procedures. Indications include the incision, dissection, vaporization, ablation, or coagulation of soft tissue.

The Atrilaze™ Ablation System is not indicated for the treatment of Warning: cardiac arrhythmias.

The risk of actual damage to adjacent organs from the instrument exists and perforation, rupture or tearing of tissue, may occur as a complication of laser use. Burns can occur if the laser energy is not correctly applied. These complications may be serious.

Prescription Use X (Per 21 CFR 801.109) OR

Over-the-Counter Use

(Please do not write below this line - Continue on another page if necessary)

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)

Division of General, Restorative.

and Neurological Devices

510(k) Number K040744