FDA Contegra Pulmonary Valved Conduit H020003 Instructions
- June 7, 2024
- FDA
Table of Contents
Contegra® Pulmonary Valved Conduit
H020003
Presentation to the Pediatric Advisory Committee September 12, 2017
Dora Vega, MD, PhD
Division of Epidemiology
Office of Surveillance and Biometrics
Center for Devices & Radiological Health
Device Description
- A glutaraldehyde-crosslinked, heterologous bovine jugular vein with a competent tri-leaflet venous valve
- Indica)ons for Use Correc)on or reconstruc)on of the right ventricular outflow tract (RVOT) in pa)ents aged < 18 years with any of the following congenital heart malformed)ons
- Pulmonary Stenosis (PS)
- Tetralogy of Fallot (TOF)
- Truncus Arteriosus (TA)
- Pulmonary Atresia (PA)
- Transpose)on with Ventricular Septal Defect (VSD) , and
– Replacement of previously implanted, but dysfunc)on, pulmonary homografts or valved conduits
Annual Distribution Numbers
- The HDE Annual Distribu)on Number (ADN) is currently defined as the number of devices reasonably needed to treat, diagnose, or cure a popular)on of 8,000 individuals in the United States
- The ADN for Contegra is 4,000 (based on original device approval)
- Since the last PAC review
- 372 sold
- 172 implanted: at least 163 implanted in pediatric (< 22-year-old) pa)ents
Medical Device Report (MDR) Review
- Date: 06/01/16 – 05/31/17
- 109 MDRs: 84 unique events: 1 death (pediatric), 83 injuries
Demographic Data | Value | MDRs containing demographic |
---|---|---|
Country | US: OUS | 89% : 11% |
(84 Total)
Patient Gender| Male: Female| 60% : 40%| 50: 34
(84 Total)
Patient Age| Pediatric: Adult| 98% : 2%| 81 : 2 (83 Total)
Pediatric patients: Age Range:1 month – 20 years
Average Age: 9.8 ± 5.3 years
MDR: Primary Reported Event
**by Patient Age and TTEO*
(MDR Date: 06/01/16 – 05/31/17)**
Primary Reported Event
| ****
MDR
(n)
| MDR by Patient Age (year)| TTEO (month)
---|---|---|---
Pediatric ( < 22)| Adult ( > 22)| Age not reported| ****
Range
| Mea n
Stenosis| 37| 36| 1| | 3 — 160| 73
The device replaced (reason not provided)| 35| 34| | 1| ****
3 — 158
| ****
71
Regurgitation| 5| 4| 1| | 50 — 136| 87
Arrhythmia| 2| 2| | | 0 — 0.3| 0.15
Aneurysm| 1| 1| | | 17| ——
Infection/Endocarditis (1 Death)| 2**| 2| | | 0.5 —
37| 19
Increased pressure gradient| 1| 1| | | 133| ——
Thrombus| 1| 1| | | 0.07| ——
Total| 84| 81| 2| 1|
- Time to Event Occurrence (TTEO)
** One MDR involved a potential tracheal compression. A total of 83 MDRs were injuries.
MDR: Poten<al Tracheal Compression
Case Summary (Updated on 9-8-2017)
-
Male neonate with a history of Truncus arteriosus type II corrected with a 14 mm Contegra implant and Rastelli procedure
-
Conduit replaced with a 12 mm Contegra for unclear reasons 2 weeks aYer first implant
– Issues reported included high airway pressure and suspected tracheal compression -
The patient expired 6 days aYer Contegra replacement
-
Cause of death: Pneumonia and Sepsis (unrelated to Contegra)
MDR: Primary Reported Problem
Comparison of MDRs – 2016 and 2017
Primary Reported Event | 2016 PAC | 2017 PAC |
---|---|---|
MDR Count (%) | MDR Count (%) | |
Stenosis | 28 (48 %) | 37 (44 %) |
Device replacement (reason not provided) | 22 (38 %) | 35 (42 %) |
Regurgitation | 2 (3.4 %) | 5 (6 %) |
Arrhythmia | 0 | 2 (2.3 %) |
Aneurysm | 0 | 1 (1.3 %) |
Infection/Endocarditis* | 2 (3.4 %) | 2 (2.3 %) |
Increased pressure gradients | 1 (1.7 %) | 1 (1.2 %) |
Thrombus | 0 | 1 (1.2 %) |
Conduit tear/breakdown | 2 (3.4 %) | 0 |
Device sizing issue | 1 (1.7 %) | 0 |
Total | 58 | 84 |
*. One MDR involved a potential tracheal compression.
Records identified through PubMed and Embase (06/01/16- 05/31/17) (n = 58)|
Duplicates Excluded (n=7
---|---
Titles and abstracts reviewed (n=51)| Records Excluded (n= 26)
- Non—relevant to Contegra (n=12)
- Past Reviews (n =7)
- Abstracts, no full text (n=3)
- In–vitro Study (n=2)
- Off—label use (LVOT placement, (n=1)
- Animal Study (n=1)
Full text articles assessed for eligibility
(n = 25)| Reviewed and excluded articles (n=24)
- Other Xenograft/device (n=12)
- Combined data (n=2)
- Review article (n=4)
- Non—relevant (Melody) (n=1)
- Unreported outcome (n=2)
- Modified device (n=1)
- Non—clinical study (n=1)
- Foreign Language (n=1)
The article included in the final review (n =1) 1 Case report
Case Report – 1 pa <ent
Falchettiet al. 2016
Contegra 12 mm: How Long Can It Last? World J
for Pediatric and Congenital Heart Surgery. 2016
Belgium
16 years freedom from failure -12 mm Contegra Background -Pre-implanta <on
- Pa<ent: 4 mo. old female (wt. 3kg) referred from another country with Type 1 TA, large VSD, RVH, right-sided or)c arch, grade 2/4 valve regurgitate)on, and well developed PA branches
- Implanta<on and Hospital Course:
- RVOT reconstruc)on with 12 mm Contegra
- The Main PA diameter measured 9 mm
- PA diameter mismatch results in a Z-score of + 2.5
- Pa)ent discharged POD16 for follow-up at referring country
TA= truncus arteriosus, VSD= ventricular septal defect, RVH= right ventricular hypertrophy, PA = pulmonary artery, PH = pulmonary hypertension, POD= post opera)on date
16 years -Post-implantation
- Referred for reopera)on due to conduit failure
- Healthy female : wt. 33kg/73 lbs; ht.156 cm/5’2”
- TTE: competent truncal valves, conduit stenosis, 110 mm Hg RVOT gradient, no regurgita)on, and normal RV and LV function
- CT scan: conduit diameter shrinkage to 9 mm and calcifica)on
- Replaced with a 22 mm pulmonary homography Poten<al factors contribu<ng to 16 years of freedom from failure
- Moderate oversizing: Z score of +2.5
- Suturing technique: Distal every suture, potentially contributing to avoidance of distal stenosis
RH= right heart, RVOT= right ventricular ouRlow tract, RV= right ventricle, LV= leY ventricle, TTE= Transthoracic Echocardiography, CT= computed tomography
FDA Conclusions
- MDR data review idetified a case of conduit replacement for an unclear reason(s). The FDA believes that currently there is insufficient information to determine if this was a case of tracheal compression due to the device
- Other Adverse Events reported in MDRs are known events addressed in the device IFU
- No new concerns were reported in the literature
FDA Recommendations
-
FDA will con)nue the conversa)on with the manufacturer for additional information regarding the suspected case of tracheal compression
-
FDA will continue device surveillance and report
the following to the PAC in 2018: -
Device Annual Distribu)on Numbers
-
MDR Data
-
Literature Review
Questions to the PAC
- Does the Commi4ee agree with CDRH’s conclusions and recommendations about surveillance and report of ADN, MDRs, and literature review?
- Does the Commi4ee have any additional comment(s)?
Office of Device Evaluation
Jonathan Reich
Changfu Wu| Office of the Center Director
Nia Benjamin
Vasum Peiris
Victoria Wagman
---|---
Office of Surveillance and Biometrics
George Aggrey
Kelly Bauer
Jiping Chen
Jose Delgado Donayre
Benjamin Eloff
Chih-Hsin “Jenny” Liu
Greg O’Connell
Nadezda Radoja
Erika Tang
Dora Vega
Aron yustin| Office on Pediatrics and Therapeutics
Judith Cope,
Robert “Skip” Nelson
Amy Odegaard
Kenneth Quinto
Pam Weinel
*() Slides prepared by**
Documents / Resources
| FDA
Contegra Pulmonary Valved Conduit
H020003
[pdf] Instructions
FDA, Contegra Pulmonary Valved Conduit, H020003
---|---
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