K Number
K192238
Device Name
AC3 Series Intra-Aortic Balloon Pump (IABP)
Date Cleared
2019-11-12

(85 days)

Product Code
Regulation Number
870.3535
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The AC3™ Intra-Aortic Balloon Pump is clinically indicated for use for the following conditions: - · Acute Coronary Syndrome - · Cardiac and Non-Cardiac Surgery - · Complications of Heart Failure
Device Description
The AC3™ Series IABP System provides counter-pulsation therapy to adult patients with impaired left ventricular (LV) function. It provides hemodynamic support of blood pressure and reduced cardiac work through volume displacement principles. The IABP is attached to an intra-aortic balloon catheter which is inserted into the femoral artery and positioned in the descending thoracic aorta. The IABP delivers Helium (HE) into the IAB catheter during diastole to displace blood above and below the IAB, increasing blood pressure and perfusion to organs close to the IAB catheter. The IABP deflates or removes HE from the IAB catheter just prior to or in the early phase of systole, reducing the pressure in the aorta and therefore the pressure the LV must generate to open the aortic valve and eject its contents into the circulatory system. This results in a decrease in work and oxygen demand. The AC3™ Series IABP System consists of two main components: - . The pump control/display module which incorporates a touch screen and keypad for system operation, and - The pneumatic drive module which is incorporated into the body of the device ● The AC3™ Series IABP is designed to be used with 30, 35, 40 and 50cc Intra-aortic balloons with the appropriate connectors.
More Information

Not Found

No
The summary describes a mechanical pump system for counter-pulsation therapy and does not mention any AI or ML components or functionalities.

Yes
The device is described as providing "counter-pulsation therapy" and "hemodynamic support of blood pressure and reduced cardiac work" for specific medical conditions, which clearly indicates a therapeutic purpose.

No

The device description clearly states its purpose is to provide counter-pulsation therapy and hemodynamic support (treatment), not to diagnose conditions.

No

The device description clearly outlines hardware components including a pump control/display module, a pneumatic drive module, and the intra-aortic balloon catheter itself. While software is mentioned for verification and validation, the core functionality relies on physical hardware.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Device Function: The AC3™ Intra-Aortic Balloon Pump is a therapeutic device that provides mechanical support to the heart and circulatory system by physically manipulating blood flow within the aorta. It does not analyze biological samples.
  • Intended Use: The intended use is to treat conditions like Acute Coronary Syndrome and Heart Failure by improving hemodynamic function, not to diagnose them through laboratory analysis.
  • Device Description: The description details a mechanical pump and balloon catheter system that interacts directly with the patient's circulatory system, not with in vitro samples.

Therefore, the AC3™ Intra-Aortic Balloon Pump falls under the category of a therapeutic medical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The AC3 Intra-Aortic Balloon Pump is clinically indicated for use for the following conditions:

  • Acute Coronary Syndrome
  • Cardiac and Non-Cardiac Surgery
  • Complications of Heart Failure

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

DSP

Device Description

The AC3™ Series IABP System provides counter-pulsation therapy to adult patients with impaired left ventricular (LV) function. It provides hemodynamic support of blood pressure and reduced cardiac work through volume displacement principles. The IABP is attached to an intra-aortic balloon catheter which is inserted into the femoral artery and positioned in the descending thoracic aorta.

The IABP delivers Helium (HE) into the IAB catheter during diastole to displace blood above and below the IAB, increasing blood pressure and perfusion to organs close to the IAB catheter. The IABP deflates or removes HE from the IAB catheter just prior to or in the early phase of systole, reducing the pressure in the aorta and therefore the pressure the LV must generate to open the aortic valve and eject its contents into the circulatory system. This results in a decrease in work and oxygen demand.

The AC3™ Series IABP System consists of two main components:

  • The pump control/display module which incorporates a touch screen and keypad for system operation, and
  • The pneumatic drive module which is incorporated into the body of the device

The AC3™ Series IABP is designed to be used with 30, 35, 40 and 50cc Intra-aortic balloons with the appropriate connectors.

The AC3™ Series IABP System offers two modes of operation:

  • Autopilot Mode, where most functions are automatically selected and controlled by the IABP
  • Operator Mode, where an operator can control most settings and selections.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

femoral artery, descending thoracic aorta

Indicated Patient Age Range

adult patients

Intended User / Care Setting

The users consist of trained hospital personnel in Intensive care areas, Cardiac Cath Labs, Cardiac Operating Rooms and emergency departments. This device is for in-hospital use and for transport between departments in a specific hospital or between facilities as required by the patient condition and treatment required.

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)

Software Verification testing has been completed to demonstrate that the software requirements have been met. All testing met the expected results. System verification and validation testing was also conducted, and all results met the required specifications.

The IABP systems were verified through software validation and system verification testing. The results of the testing met the acceptance criteria and performed similar to the predicate device (AutoCAT2 and AC3 Ver.3.7). The testing demonstrates that the catheter is substantially equivalent to the predicate device.

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.

K162820

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

§ 870.3535 Intra-aortic balloon and control system.

(a)
Identification. An intra-aortic balloon and control system is a prescription device that consists of an inflatable balloon, which is placed in the aorta to improve cardiovascular functioning during certain life-threatening emergencies, and a control system for regulating the inflation and deflation of the balloon. The control system, which monitors and is synchronized with the electrocardiogram, provides a means for setting the inflation and deflation of the balloon with the cardiac cycle.(b)
Classification. (1) Class II (special controls) when the device is indicated for acute coronary syndrome, cardiac and non-cardiac surgery, or complications of heart failure. The special controls for this device are:(i) Appropriate analysis and non-clinical testing must be conducted to validate electromagnetic compatibility and electrical safety of the device;
(ii) Software verification, validation, and hazard analysis must be performed;
(iii) The device must be demonstrated to be biocompatible;
(iv) Sterility and shelf-life testing must demonstrate the sterility of patient-contacting components and the shelf life of these components;
(v) Non-clinical performance evaluation of the device must demonstrate mechanical integrity, durability, and reliability to support its intended purpose; and
(vi) Labeling must include a detailed summary of the device- and procedure-related complications pertinent to use of the device.
(2) Class III (premarket approval) when the device is indicated for septic shock and pulsatile flow generation.
(c)
Date premarket approval application (PMA) or notice of completion of product development protocol (PDP) is required. A PMA or notice of completion of a PDP is required to be filed with the Food and Drug Administration on or before March 31, 2014, for any intra-aortic balloon and control system indicated for septic shock or pulsatile flow generation that was in commercial distribution before May 28, 1976, or that has, on or before March 31, 2014, been found to be substantially equivalent to any intra-aortic balloon and control system indicated for septic shock or pulsatile flow generation that was in commercial distribution before May 28, 1976. Any other intra-aortic balloon and control system indicated for septic shock or pulsatile flow generation shall have an approved PMA or declared completed PDP in effect before being placed in commercial distribution.

0

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left, there is a seal with the words "HUMAN SERVICES-USA" around the edge. To the right of the seal, there is a blue square with the letters "FDA" in white. Next to the blue square, the words "U.S. FOOD & DRUG ADMINISTRATION" are written in blue.

November 12, 2019

Arrow International, Teleflex Deb Fleetham Manager, Regulatory Affairs 16 Elizabeth Drive Chelmsford, Massachusetts 01824

Re: K192238

Trade/Device Name: AC3 Series Intra-Aortic Balloon Pump (IABP) Regulation Number: 21 CFR 870.3535 Regulation Name: Intra-Aortic Balloon and Control System Regulatory Class: Class II Product Code: DSP Dated: October 11, 2019 Received: October 15, 2019

Dear Deb Fleetham:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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.

1

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); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance)and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

Fernando Aguel Assistant Director DHT2B: Division of Circulatory Support, Structural and Vascular Devices OHT2: Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known)

K192238

Device Name

AC3 Series Intra-Aortic Balloon Pump (IABP)

Indications for Use (Describe)

The AC3 Intra-Aortic Balloon Pump is clinically indicated for use for the following conditions:

  • · Acute Coronary Syndrome
  • · Cardiac and Non-Cardiac Surgery
  • · Complications of Heart Failure
Type of Use (Select one or both, as applicable)
Prescription Use (Part 21 CFR 801 Subpart D)
Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

3

2 510(k) Summary

[As required by 21 CFR 807.92]

Date Prepared: November 7, 2019

510(k) Number: K192238

Submitter's Name / Contact Person

Manufacturer
Arrow International, Inc.
A Subsidiary of Teleflex
16 Elizabeth Drive
Chelmsford, MA 01824 USA
Establishment Registration # 3010532612

Contact Person Deb Fleetham Manager, Regulatory Affairs Cardiac-Interventional BU Tel: 612-403-3806 Fax: 763-656-4253

General Information

Trade NameAC3™ SERIES IAB Pump
Common / Usual NameIAB Pump
Product CodeDSP
Classification Name21 CFR 870.3535 – Intra-Aortic Balloon Pump, System
Predicate DeviceK162820, AC3™ IAB Pump – cleared March 31, 2017

Device Description

The AC3™ Series IABP System provides counter-pulsation therapy to adult patients with impaired left ventricular (LV) function. It provides hemodynamic support of blood pressure and reduced cardiac work through volume displacement principles. The IABP is attached to an intra-aortic balloon catheter which is inserted into the femoral artery and positioned in the descending thoracic aorta.

The IABP delivers Helium (HE) into the IAB catheter during diastole to displace blood above and below the IAB, increasing blood pressure and perfusion to organs close to the IAB catheter. The IABP deflates or removes HE from the IAB catheter just prior to or in the early phase of systole, reducing the pressure in the aorta and therefore the pressure the LV must generate to open the aortic valve and eject its contents into the circulatory system. This results in a decrease in work and oxygen demand.

The AC3™ Series IABP System consists of two main components:

  • . The pump control/display module which incorporates a touch screen and keypad for system operation, and
  • The pneumatic drive module which is incorporated into the body of the device ●

The AC3™ Series IABP is designed to be used with 30, 35, 40 and 50cc Intra-aortic balloons with the appropriate connectors.

4

The AC3™ Series IABP System offers two modes of operation:

  • Autopilot Mode, where most functions are automatically selected and controlled by the . IABP
  • Operator Mode, where an operator can control most settings and selections.

Indications for Use

The AC3™ Intra-Aortic Balloon Pump is clinically indicated for use for the following conditions:

  • Acute Coronary Syndrome
  • . Cardiac and Non-Cardiac Surgery
  • Complications of Heart Failure

Verification and Validation Testing

The software changes were developed in accordance with IEC 62304, Medical Device Software – Software Lifecycle Processes and in accordance with FDA Guidance "General Principles of Software Validation: Final Guidance for Industry and FDA Staff." Software Verification testing has been completed to demonstrate that the software requirements have been met. All testing met the expected results. System verification and validation testing was also conducted, and all results met the required specifications.

Technological Comparison to Predicate

The AC3™ IABP system with Ver. 3.11 software is similar in design and identical in Indications for Use to the predicate, AC3™ IABP system (V3.7). The AC3 IABP system with Ver. 3.11 software was aligned with the AutoCAT2 IABP system (predicate to AC3) for the Helium Loss 2 alarm. The differences between the subject AC3 system and the predicate IABP systems were evaluated to provide evidence that the AC3 IABP System is substantially equivalent to the predicate systems. The IABP systems were verified through software validation and system verification testing. The results of the testing met the acceptance criteria and performed similar to the predicate device (AutoCAT2 and AC3 Ver.3.7). The testing demonstrates that the catheter is substantially equivalent to the predicate device.

Table: Substantial Equivalence Comparison
CharacteristicSubject DevicePredicate Device
AC3TM IABP System with SW V3.11AC3TM IABP System with
SW V3.07
(K162820)
Device
ClassificationClass IISame
Regulation21 CFR 870.3535Same
Product CodeDSP – Intra-aortic balloon and control systemSame
Table: Substantial Equivalence Comparison
Subject DevicePredicate Device
CharacteristicAC3™ IABP System with SW V3.11AC3™ IABP System with
SW V3.07
(K162820)
Indications for
UseThe AC3™ Intra-Aortic Balloon Pump is clinically
indicated for use for the following conditions:
• Acute Coronary Syndrome
• Cardiac and Non-Cardiac
• Surgery Complications of Heart Failure
There are no changes to the Indications for UseSame
Intended UseThe AC3™ Series IABP system is intended to provide
counterpulsation therapy to adult patients with
impaired Left ventricular function. The users consist of
trained hospital personnel in Intensive care areas,
Cardiac Cath Labs, Cardiac Operating Rooms and
emergency departments. This device is for in-hospital
use and for transport between departments in a specific
hospital or between facilities as required by the patient
condition and treatment required.Same
Compatible
Disposable
Balloon Catheters30, 35, 40, and 50cc Intra-aortic balloon cathetersSame
Display13.3" High-Resolution touchscreen display including 6
hard keys for frequently used or safety functions.
Hard keys and text are both backlit (LED) and color
coded for visibility in the dark
AC3™ IABP Display head has a color-coded corner switch
that illuminates when an alarm is active.Same
Operational
ModesTwo Operational Modes: Autopilot and Operator mode
Autopilot mode includes:
• Automatic trigger selection
• Automatic ECG/Arterial Pressure (AP) source
selection
• Automatic timing method selection and timing
control
• Best Signal Analysis
• Deflation Timing ManagementSame
Table: Substantial Equivalence Comparison
CharacteristicSubject DevicePredicate Device
AC3™ IABP System with SW V3.11AC3™ IABP System with
SW V3.07
(K162820)
Operator mode includes:
Seven modes for trigger selection ECG Source: 2 Selection and 1 key press to change leads ECG gain: Automatic, Manual and User adjustable AP Source: 3 Selections AP Scaling: Automatic, Manual and User selectable Touchscreen has the timing controls under the Timing Key. A reminder message is shown if the user leaves the timing screen in 1 2 or lower assist
FiberOptix® TechnologyAllows Arterial Pressure (AP) to be measured by FiberOptic method while using Arrow FiberOptix IAB catheters. The AC3™ Series IABP system has an updated position for the FOS connectionSame
SterilityNon-SterileSame

5

6

Substantial Equivalence Conclusion

The AC3™ IABP with V3.11 software is substantially equivalent to the specified predicate device based on comparisons of the device functionality, principle of operation, technological characteristics, and indications for use. The change to the software and results of subsequent software verification and validations tests do not raise new or different questions of safety or effectiveness; therefore, the AC3™ IABP with V3.11 software is substantially equivalent to the predicate device.