K Number
K053021
Device Name
ESTECH CLEARVIEW MV ATRIAL DEPRESSOR
Manufacturer
Date Cleared
2006-01-26

(92 days)

Product Code
Regulation Number
870.4420
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The ESTECH Clearview™ MV Atrial Depressor is intended to remove excess fluids from the surgical field for filtering and return to the patient during cardiopulmonary bypass of up to 6 hours. It can also be used to retract tissue to increase visibility.
Device Description
The Estech Clearview™ MV Atrial Depressor is a sterile, single use, surgical instruments intended for the collection of blood and other fluids from the surgical field for return through the cardiotomy system during open heart surgery. The a molded polymer proximal connector is intended to connect into cardiopulmonary bypass system to return blood and fluids into the extracorporeal circulation circuit, most typically during stoppedheart surgical procedures. The Estech Clearview™ MV Atrial Depressor has an integrated shaft designed to connect to the Estech Small Incision Retractor. The retractor creates access to the surgical field via thoracotomy or mini-sternotomy. When mounted to the retractor, the Estech Clearview™ MV Atrial Depressor can also be used to retract tissues while collecting fluids.
More Information

Not Found

No
The device description and intended use are purely mechanical and do not mention any computational or analytical capabilities that would suggest AI/ML. The "Mentions AI, DNN, or ML" and "Mentions image processing" fields are explicitly marked as "Not Found".

No
The device aids in fluid management and tissue retraction during surgery, but it does not directly treat a disease or condition.

No.
The device description states that the device is a surgical instrument intended to collect blood and fluids and retract tissue during surgery. It is not described as providing a diagnosis or analyzing data for diagnostic purposes.

No

The device description clearly states it is a sterile, single-use surgical instrument made of molded polymer, indicating it is a physical hardware device, not software.

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

Here's why:

  • Intended Use: The primary intended use is to remove excess fluids from the surgical field and return them to the patient during cardiopulmonary bypass, and to retract tissue. This is a surgical procedure, not a diagnostic test performed on samples outside the body.
  • Device Description: The description details a surgical instrument designed for fluid collection and tissue retraction during open heart surgery. It connects to a cardiopulmonary bypass system.
  • Lack of Diagnostic Elements: There is no mention of analyzing samples, detecting specific substances, or providing diagnostic information about a patient's condition.
  • Performance Studies: The performance studies focus on biocompatibility and preclinical performance related to fluid collection and retraction, not diagnostic accuracy.

IVD devices are used to examine specimens (like blood, urine, tissue) from the human body to provide information for diagnosis, monitoring, or screening. This device operates directly within the surgical field during a procedure and does not perform such analysis.

N/A

Intended Use / Indications for Use

The ESTECH Clearview™ MV Atrial Depressor is intended to remove excess fluids from the surgical field for filtering and return to the patient during cardiopulmonary bypass of up to 6 hours. It can also be used to retract tissue to increase visibility.

Product codes

DTS

Device Description

The Estech Clearview™ MV Atrial Depressor is a sterile, single use, surgical instruments intended for the collection of blood and other fluids from the surgical field for return through the cardiotomy system during open heart surgery. The a molded polymer proximal connector is intended to connect into cardiopulmonary bypass system to return blood and fluids into the extracorporeal circulation circuit, most typically during stoppedheart surgical procedures.

The Estech Clearview™ MV Atrial Depressor has an integrated shaft designed to connect to the Estech Small Incision Retractor. The retractor creates access to the surgical field via thoracotomy or mini-sternotomy. When mounted to the retractor, the Estech Clearview™ MV Atrial Depressor can also be used to retract tissues while collecting fluids.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

surgical field

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

Biocompatibility testing consistent with ISO 10993 is presented in Section 15. All components of the Estech Clearview™MV Atrial Depressor passed the testing.

Preclinical performance data was supplied to demonstrate that the Estech Clearview™M MV Atrial Depressor can meet its labeled performance claims, and to demonstrate substantial equivalence with the predicate device

Key Metrics

Not Found

Predicate Device(s)

K982891, K963756

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.4420 Cardiopulmonary bypass cardiotomy return sucker.

(a)
Identification. A cardiopulmonary bypass cardiotomy return sucker is a device that consists of tubing, a connector, and a probe or tip that is used to remove blood from the chest or heart during cardiopulmonary bypass surgery.(b)
Classification. Class II (special controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

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Endoscopic Technologies, Inc.

KOS 3021 RG 1 of 2

ESTECH Clearview MV Atrial Depressor Premarket Notification

Section 5: 510(k) Summary

Device Information:

CategoryComments
Sponsor:Estech
4135 Blackhawk Plaza Circle.
Suite 150
Danville, CA 94506
Tel: 925-648-3500
Correspondent Contact
Information:Craig Coombs
Coombs Medical Device Consulting
1193 Sherman Street
Alameda, CA 94501
Tel: 510-337-0140
Fax: 510-337-0416
Device Common Name:Cardiopulmonary bypass cardiotomy return sucker
Device Classification & Code:Class II, DTS (21 CFR 870.4420)
Device Classification Name:Sucker, Cardiotomy Return, Cardiopulmonary
Bypass
Device Proprietary Name:Estech Clearview™ MV Atrial Depressor

Predicate Device Information:

| Predicate Devices: | California Medical Laboratories Rigid Tip
Suction Wands (K982891)
IBC Cardiac Suction Wand (K963756) |
|-----------------------------------------|------------------------------------------------------------------------------------------------------------|
| Predicate Device Manufacturers: | California Medical Laboratories
International Biophysics Corporation |
| Predicate Device Common Name: | Cardiopulmonary bypass cardiotomy return
sucker |
| Predicate Device Classification: | 21 CFR 870.4420 |
| Predicate Device Classification & Code: | Class II, DTS |

b. Date Summary Prepared

13 January 2006

c. Description of Device

The Estech Clearview™ MV Atrial Depressor is a sterile, single use, surgical instruments intended for the collection of blood and other fluids from the surgical field for return through the cardiotomy system during open heart surgery. The a molded polymer proximal connector is intended to connect into cardiopulmonary bypass system to return blood and fluids into the extracorporeal circulation circuit, most typically during stoppedheart surgical procedures.

The Estech Clearview™ MV Atrial Depressor has an integrated shaft designed to connect to the Estech Small Incision Retractor. The retractor creates access to the surgical field

1

via thoracotomy or mini-sternotomy. When mounted to the retractor, the Estech Clearview™ MV Atrial Depressor can also be used to retract tissues while collecting fluids.

d. Intended Use

The ESTECH Clearview™ MV Atrial Depressor is intended to remove excess fluids from the surgical field for filtering and return to the patient during cardiopulmonary bypass of up to 6 hours. It can also be used to retract tissue to increase visibility.

e. Comparison to Predicate Device

The Estech Clearview™ MV Atrial Depressor is substantially equivalent in intended use. technology, design and materials to the predicate devices.

The Estech Clearview™ MV Atrial Depressor is substantially equivalent to the California Medical Laboratories Rigid Tip Suction Wands (K982891) and the IBC Cardiac Suction Wand (K963756).

The current and predicate devices are sterile, single use, surgical instruments intended for the collection of blood and other fluids from the surgical field for return through the cardiotomy system during open heart surgery.

f. Summary of Supporting Data

Biocompatibility testing consistent with ISO 10993 is presented in Section 15. All components of the Estech Clearview™MV Atrial Depressor passed the testing.

Preclinical performance data was supplied to demonstrate that the Estech Clearview™M MV Atrial Depressor can meet its labeled performance claims, and to demonstrate substantial equivalence with the predicate device

2

Image /page/2/Picture/2 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a stylized eagle with three lines representing its wings and body. The eagle is enclosed in a circle of text that reads "DEPARTMENT OF HEALTH AND HUMAN SERVICES - USA".

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JAN 2 6 2006

Coombs Medical Device Consulting c/o Mr. Craig Coombs President 1193 Sherman Street Alameda, CA 94501

Re: K053021

ESTECH Clearview™M MV Atrial Depressor Regulation Name: Cardiopulmonary Bypass Cardiotomy Return Sucker Regulatory Class: II Product Code: DTS Dated: January 10, 2006 Received: January 12, 2006

Dear Mr. Coombs:

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 interstatc 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, I'DA may publish further announcements concerning your device in the Federal Register.

3

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 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), 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 (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours.

Duna R. Lichner

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

Enclosure

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KØ53Ø21

Endoscopic Technologies, Inc.

ESTECH Clearview MV Atrial Depressor Requested Information - K053021

Section 4: Indications for Use Statement

510(k) Number (if known): Ko53021

ESTECH Clearview™ MV Atrial Depressor Device Name:

Indications For Use:

The ESTECH Clearview™ MV Atrial Depressor is intended to remove excess fluids from the surgical field for filtering and return to the patient during cardiopulmonary bypass of up to 6 hours. It can also be used to retract tissue to increase visibility.

Prescription Use _____________________________________________________________________________________________________________________________________________________________

AND/OR

Over-The-Counter Use

(Part 21 CFR 801 Subpart D)

(21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Darra R. Vac

Page 1 of ____________________________________________________________________________________________________________________________________________________________________

(Division Sign-Off) Division of Cardiovascular Devices

510(k) Number_k05302 | _______________________________________________________________________________________________________________________________________________________