FDA Adverse Event Injury Summary report: N

VALVE IN CARTRIDGE, 7MM

MDR report key: 10260566 · Received July 10, 2020

Report

Report Number
3004450998-2020-00013
Event Type
Injury
Date Received
July 10, 2020
Date of Event
June 3, 2020
Report Date
July 10, 2020
Product Code
NJK
UDI-DI
00896506002279
PMA / PMN Number
PMA P180007
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
KY, US
Reporter Occupation
NURSE

Narratives

Additional Manufacturer Narrative · 1

A TOTAL OF SIX VALVES WERE PLACED IN THE PATIENT (2 X SVS-V5-00, 2 X SVS V6-00, AND 2 X SVS-V7-00) FOR A TOTAL OF SIX RELATED EVENT REPORTS FILED SEPARATELY ASSOCIATED WITH THE SAME PATIENT PROCEDURE. PNEUMOTHORAX IS THE MOST COMMON DEVICE RELATED SERIOUS ADVERSE EVENT THAT IS ASSOCIATED WITH THE SPIRATION VALVE SYSTEM. IN THE EMPROVE STUDY, THE INCIDENCE OF SERIOUS PNEUMOTHORAX WAS 14.2%, WITH OVER 75% OF THE SERIOUS PNEUMOTHORAX EVENTS OCCURRING WITHIN THE FIRST 3 DAYS POST-PROCEDURE. EARLY-ONSET PNEUMOTHORAX IN THE TREATMENT GROUP LIKELY RESULTED FROM LUNG CONFORMATION CHANGES DUE TO ACUTE REDUCTION IN LUNG VOLUME BY VALVE THERAPY, TRIGGERING RAPID EXPANSION OF THE IPSILATERAL NON-TARGETED LOBE LEADING TO A PNEUMOTHORAX. (CRINER GJ, DELAGE A, VOELKER K, ET AL. IMPROVING LUNG FUNCTION IN SEVERE HETEROGENOUS EMPHYSEMA WITH THE SPIRATION VALVE SYSTEM (EMPROVE). A MULTICENTER, OPEN-LABEL RANDOMIZED CONTROLLED CLINICAL TRIAL. AM J RESPIR CRIT CARE MED. 2019;200(11):1354-1362. DOI:10.1164/RCCM.201902-0383OC). HOWEVER, IT SHOULD BE NOTED THAT PNEUMOTHORAX EVENTS ARE ALSO RECOGNIZED AS AN INDICATOR OF SUCCESSFUL TARGET LOBE OCCLUSION AND WHEN MANAGED ACCORDING TO PUBLISHED EXPERT GUIDELINES (VALIPOUR A, SLEBOS DJ, DE OLIVEIRA HG, ET AL. EXPERT STATEMENT: PNEUMOTHORAX ASSOCIATED WITH ENDOSCOPIC VALVE THERAPY FOR EMPHYSEMA--POTENTIAL MECHANISMS, TREATMENT ALGORITHM, AND CASE EXAMPLES. RESPIRATION. 2014;87(6):513-521. DOI:10.1159/000360642), SUBJECTS WITH PNEUMOTHORAX EVENTS EXPERIENCED CLINICAL BENEFITS SIMILAR TO THAT IN SUBJECTS WITHOUT PNEUMOTHORAX EVENTS (CRINER GJ, DELAGE A, VOELKER K, ET AL. IMPROVING LUNG FUNCTION IN SEVERE HETEROGENOUS EMPHYSEMA WITH THE SPIRATION VALVE SYSTEM (EMPROVE). A MULTICENTER, OPEN-LABEL RANDOMIZED CONTROLLED CLINICAL TRIAL. AM J RESPIR CRIT CARE MED. 2019;200(11):1354-1362. DOI:10.1164/RCCM.201902-0383OC). THE REPORTED EVENT ALIGNS WITH THE EXPERIENCE IN THE EMPROVE CLINICAL TRIAL AND IS AN EXPECTED ADVERSE EVENT ASSOCIATED WITH THE SPIRATION VALVE SYSTEM. DEVICE REMAINS IMPLANTED.

Description of Event or Problem · 1

PATIENT WITH SEVERE EMPHYSEMA HAD SPIRATION VALVES PLACED IN THEIR LUNG. NO PRIOR EVIDENCE OF ATELECTASIS WAS DOCUMENTED. VALVES WERE PLACED INTO RIGHT UPPER LOBE ANTERIOR, APICAL, AND POSTERIOR SUB-SEGMENTS. PATIENT DEVELOPED A PNEUMOTHORAX AN HOUR TO HOUR AND A HALF AFTER PROCEDURE WAS PERFORMED. POST-PROCEDURE CHEST X-RAY AFTER TREATMENT OF PNEUMOTHORAX SHOWED ATELECTASIS AND VOLUME LOSS. INTERVENTIONS TO TREAT PNEUMOTHORAX INCLUDED CONSCIOUS SEDATION AND INSERTED CHEST TUBE WITH IMMEDIATE RESOLUTION. PATIENT EXHIBITED NO DISTRESS. VALVES REMAIN IN THE PATIENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
722410 VALVE IN CARTRIDGE, 7MM SPIRATION VALVE NJK SVS-V7-00 W03459-01 00896506002279

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention