K Number
K120158
Device Name
CORONARY SINUS GUIDE AND LATERAL VEIN INTRODUCER KITS
Date Cleared
2012-08-14

(209 days)

Product Code
Regulation Number
870.1340
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
For the introduction of various types of pacing or defibrillator leads and catheters.
Device Description
The Thomas Medical Products, Inc. (TMP) Coronary Sinus Guide & Lateral Vein Introducer Kits (CSG/LVI) are intended to access the coronary venous system. either alone or in a telescopic assembly with other introducers. The CSG/LVI Introducers serve as a conduit to quide devices, including guidewires, pacemaker or defibrillator leads, and catheters, or to deliver contrast medium into specific branches of the coronary venous system. CSG/LVI introducers are intended to introduce left ventricular leads through their lumen. They have direct contact to the inner heart. CSG/LVI introducers come with various curve configurations and lengths to facilitate access to the coronary sinus OS and sub-selective access to angulated lateral vein branches. CSG/LVI introducers are designed as single use devices and for short term application (< 24 hours). Only medical doctors and medical personnel, who are well trained in cardiology, should apply these introducers. The Coronary Sinus Guide Introducer has a peel-away sheath with break-away hemostasis valve. The Lateral Vein Introducer has a break-away hub with integrated handle that requires no cutting and provides a secure grip during slicing, reducing, reducing the risk of lead displacement. The Lateral Vein Introducers have a shaft design with three (3) gradually decreasing stiffness segmentations from proximal to distal. The shaft is reinforced by a metal broid from the proximal end until approximately 0.175 inch from the distal end. The shaft is coated by a medical-grade coating that provides enhanced lubricity when advanced through the Coronary Sinus Guide Introducer. The proximal end of the CSG/LVI Introducers are equipped with a hemostasis valve that reduces the risk of blood loss and air embolism and a side-port with 3-way stopcock to allow fluid infusion and contrast injection. There are differing various versions of the introducer curves that are used according to the anatomy of the present coronary vasculature. The distal soft tip has a tapered outer diometer and the distal tip further contains a polymeric x-roy marker for enhanced visibility under fluoroscopy. Package contents (Coronary Sinus Guide Introducer Kit): - One (1) Coronary Sinus Guide Introducer - One (1) P.T.F.E. coated guidewire - One (1) Curved braided guiding core or non-braided guiding core - One (1) Straight vessel dilator - One (1) Transvalvular Insertion Tool (T.V.I.) - One (1) 18 g XTW needle - One (1) 12 cc syringe Package contents (Lateral Vein Introducer Kit): - One (1) Lateral Vein Introducer - One (1) Transvalvular Insertion Tool (T.V.I.) - One (1) Slicer - One (1) Target Vein Selector Merit Impress Radiology Catheter, k053171
More Information

No
The device description focuses on the physical characteristics, materials, and mechanical function of the introducer kits. There is no mention of software, algorithms, data processing, or any terms related to AI or ML. The performance studies are limited to biocompatibility, simulated use, and physical/dimensional testing, which are typical for mechanical devices and do not involve AI/ML evaluation metrics.

No

The device is an introducer used to guide other therapeutic devices (e.g., pacemaker or defibrillator leads) into the coronary venous system, but it does not provide therapy itself.

No

Explanation: The device is intended to introduce various types of pacing or defibrillator leads and catheters, or to deliver contrast medium. It acts as a conduit for other devices and substances, but does not itself provide a diagnosis.

No

The device description clearly outlines physical components such as introducers, guidewires, dilators, needles, and syringes, and describes their material properties and physical characteristics. There is no mention of software as a component of the 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 introduction of pacing or defibrillator leads and catheters into the coronary venous system. This is a surgical/interventional procedure, not a diagnostic test performed on samples taken from the body.
  • Device Description: The device is a physical introducer designed to guide other medical devices into a specific anatomical location within the body. It is used in vivo (within the living body), not in vitro (in glass, i.e., outside the body).
  • Lack of Diagnostic Function: The device itself does not perform any diagnostic testing or analysis of biological samples. Its function is purely mechanical and procedural.

IVD devices are typically used to examine specimens such as blood, urine, or tissue to detect diseases, conditions, or infections. This device does not fit that description.

N/A

Intended Use / Indications for Use

For the introduction of various types of pacing or defibrillator leads and catheters.

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

DYB

Device Description

The Thomas Medical Products, Inc. (TMP) Coronary Sinus Guide & Lateral Vein Introducer Kits (CSG/LVI) are intended to access the coronary venous system, either alone or in a telescopic assembly with other introducers. The CSG/LVI Introducers serve as a conduit to guide devices, including guidewires, pacemaker or defibrillator leads, and catheters, or to deliver contrast medium into specific branches of the coronary venous system. CSG/LVI introducers are intended to introduce left ventricular leads through their lumen. They have direct contact to the inner heart. CSG/LVI introducers come with various curve configurations and lengths to facilitate access to the coronary sinus OS and sub-selective access to angulated lateral vein branches. CSG/LVI introducers are designed as single use devices and for short term application (

§ 870.1340 Catheter introducer.

(a)
Identification. A catheter introducer is a sheath used to facilitate placing a catheter through the skin into a vein or artery.(b)
Classification. Class II (performance standards).

0

K120158 p.1. of 4

Coronary Sinus Guide & Lateral Vein Introducer Kits

Traditional 510(k

SECTION 5:510(k) SUMMARY
----------------------------

.

E.

[as required by section 807.92(c)]

Submitter's Information: A.

AUG 1 4 2012

Name:Thomas Medical Products, Inc.
Address:65 Great Valley Parkway
Malvern, PA 19355
Telephone Number:610.651.5000
Facsimile:610.651.5003
Contact Person:Tim Stoudt
Title:Regulatory Affairs Manager
Date Submission Prepared:January 11, 1012

в. Device Information:

Coronary Sinus Guide & Loteral Vein Introducer Kits Trade name: Classification Name(s): Cotheter Introducer (21 CFR §870.1340) Coronary Sinus Guide & Lateral Vein Introducer Kits Common or usual name(s):

C. Legally marketed device to which equivalence is claimed:

  • (a) Thomas Medical Products, Inc. SafeSheath Coronary Sinus Guide & Lateral Vein Introducer Kits (K003731)
  • (b) Merit Medical Systems, Inc. Impress Radiology Catheter (K053171)
  • (c) Biotronik, Inc. ScoutPro ACS Coronary Sinus Lead Introducer System (K101776)

D. Description of changes:

The reason for this submission is due to improvements made to the SafeSheath Coronary Sinus Guide & Lateral Vein Introducer Kits designed to provide greater protection against environmental factors known to degrade polymers. The specific changes are:

| Element of
modification | Predicate device
K003731 | Modified
device | Reason for modification |
|----------------------------|-----------------------------|-------------------------------------|-------------------------------------------------------------------------------|
| UV Stabilization | None | 0.15 - 0.20%
Tinuvin 783
w/w | To provide UV stabilization. |
| Heat Stabilization | None | 0.08 - 0.12%
Irganox 1010
w/w | To provide long-term
thermal stabilization |
| RO tip material | Pebax 4033 w/
80% M10 W | Pebax MX-
1205 w/80%
C5 W | Material optimization to
provide greater stability
against degradation. |

Description of the device:

The Thomas Medical Products, Inc. (TMP) Coronary Sinus Guide & Lateral Vein Introducer Kits (CSG/LVI) are intended to access the coronary venous system. either alone or in a telescopic assembly with other introducers. The CSG/LVI Introducers serve as a conduit to quide devices, including guidewires, pacemaker or defibrillator leads, and catheters, or to deliver contrast medium into specific branches of the coronary venous system. CSG/LVI introducers are intended to introduce left ventricular leads through their lumen. They have direct contact to the inner heart. CSG/LVI introducers come with various curve configurations and lengths to facilitate access to the coronary sinus OS and sub-selective access to angulated lateral vein branches. CSG/LVI introducers are designed as single use devices and for short

1

term application (