LEVITRONIX CENTRIMAG BACK-UP CONSOLE

{0}------------------------------------------------ K 051209 SEP = 8 2005 # 510(k) Summary Attachment 4. # 510(k) Summary for Levitronix CentriMag Back-Up Console This summary of 510(k) safety and effectiveness information is being submitted in the submitted of the Madinal Devices Act (SMDA) of 1990 and Title 21 of This summary of 510(c) salely and enections of 1990 and Title 21 of in accordance with the Safe Medical Devices Act (SMDA) of 1990 and Title 21 of the Safe Medical Province B in accordance with the Sale Medical Devices 7.0. (1.1.1.1.) the Code of Federal Regulations, Part 807, and in particular §807.92. ## Application Information: A. | Date Prepared: | May 10, 2005 | |-----------------------------|---------------------------------------------------------------------------------------------------------------| | Submitter's Name & Address: | Levitronix LLC<br>45 First Avenue<br>Waltham, MA 02451 | | Contact Person: | Farzad Parsaie<br>V.P., RA/QA<br>Ph: (781) 622-5075<br>Fax: (781) 622-5090<br>e-mail: fparsaie@levitronix.com | #### Device Information: B. | Trade or Proprietary Name: | Levitronix CentriMag® Back-Up Console | |----------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------| | Common or Usual Name: | Cardiopulmonary Bypass Pump<br>Console | | Classification Name: | Class II, DWA, 21 CFR - 870.4380<br>Control, Pump Speed, Cardiopulmonary<br>Bypass | | Performance Standard: | Performance standards do not currently<br>exist for these devices. None<br>established under section 514 of the<br>Food, Drug and Cosmetic Act. | #### C. Predicate Device: Levitronix CentriMag Console (K020271) {1}------------------------------------------------ #### Device Description D. The Levitronix CentriMag Back-Up Console is a microprocessor-based The Levitronix CentriMag Back-op Sonerates the primary Motor control signal, device. The microprocessor generates the pinhaly outputs, and provides monitors system sensors, generates front display outputs, and provides monitors system sensors, generates the sensor data for use in alarm functions. The microprocessor acquires the sensor data for used alarm functions. The fillcroprocessor acquires the summeric screen is used is to display monitored data. The CentriMag Back-Up Console uses single phase AC power and is care and is a mate of a c o a RM In addition, each Back-Up The CentriMag Back-Op Console associate in addition, each Back-Up capable of a liow Tate of up to one of eld replaceable internal battery Console contains a non-rechargeable, field vepass that is capable of maintaining Back-Up Console functionality in the event of a loss of AC Power. #### Intended Use ய் The Levitronix CentriMag Back-Up Console is indicated for use with the The Levitronix CentriMag Back-Op Sonosia System and as a Levitronix CentriMag Extracorporeal Blood Pumping System and as a Levitronix CentriMag Extracorporcur Drived Console. The Levitronix CentriMag back-up To the Centrilian Thinary Sononic ted to pump blood through Extracorporeal Blood Fulliping Oystem is instructeal circulatory support for the extracorporeal bypass cirodicter on existent more). It is also periods approphate to cardiopalmonaly by provinsystems (for periods indicated for use in extracorporound cardiopulmonary bypass (e.g., up to six frours) not requiring comport during mitral valve reoperation, surgery valvaloplacty, on or aorta, liver transplants etc). #### Technological Characteristics г. Levitronix CentriMag Back-Up Console has technological The The Levitronix - Ochanniag - Daily of Chicate device. The differences between Characteristics similar to the processes are limited to flow and pressure the proposed capabilities and associated alarm scheme. The Levitronix CentriMag Back-Up Console is a microprocessor-based The Levillonix Ochthilag Back of generates the primary Motor control signal, device. The microprocessor gonerates front display outputs, and provides monitors system schools, gonerator from the sensor data for use in alami functions. The millions and alams. An alphanumeric screen is used to display monitored data. The CentriMag Back-Up Console uses single phase AC power and is The CentriMag Backeop Consele association, each Back-Up Capable of a llow falls of up co on- field replaceable internal battery Console contains a non-roonary-k-Jp Console functionality in the event of a loss of AC Power. {2}------------------------------------------------ # Comparison to Predicate Device G. The Levitronix CentriMag Back-Up Console has indications for use which The Levitronix Centriviag Back-Op Console device, is composed of the is substantially equivalent to the predicate device, has equivalent same of equivalent materials as the produces functional characteristics design features as the predicate device, and has functional characteristics. design features as the predicate ucvio, and neadicate device. Due to which are the same or equivalent to those of the predicate design which are the same of equivalence to use, materials of composition, design the equivalency of indications for use, materials in the evice raises no new safety or effectiveness issues. ## Summary of Performance Data H. The performance characteristics of the Levitronix CentriMag Back-Up The performance characterisates of the Levith Levith Levith performance Console were lested and computed with the commercially available predicate device. {3}------------------------------------------------ Image /page/3/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features the department's name encircling a symbol. The symbol is a stylized representation of a human figure, with three overlapping profiles suggesting a sense of community and support. The profiles are black, and the text is also black. Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 SEP - 8 2005 Levitronix LLC c/o Mr. Farzad Parsaie VP, RA/QA 45 First Avenue Waltham, MA 02451 Re: K051209 CentriMag® Extracorporeal Blood Pumping System Regulation Number: 21 CFR 870.4380 Regulation Name: Cardiopulmonary Bypass Pump Speed Control Regulatory Class: Class II Product Code: KFM Dated: August 2, 2005 Received: August 3, 2005 Dear Mr. Parsaie: We have reviewed your Section 510(k) premarket notification of intent to market the device We have reviewed your Section 510(x) premated is substantially equivalent (for the indications referenced above and have determined the device is substant also in interstate referenced above and have decembed the arrived medicate devices marketed in interstate for use stated in the enclosue) to the enactment de of the Medical Device Amendments, or to commerce prior to May 28, 1970, the chacultence with the provisions of the Federal Food. Drug, devices that have been reciassince in accordance while approval application (PMA). and Cosmetic Act (Act) that do not require approval of a previsions of the Act . The and Cosmetic Act (Act) that do not require approvate experal controls provisions of the Act. The You may, therefore, market the device, seejeer to the . general controls provisions of the Act include requirements for annual registration and general controls provisions of the Fectiners required in against misbranding and adulteration. If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it If your device is classified (See above) this existing major regulations affecting your device can may be subject to such additional controls. Existing major may be subject to such additional controlis. Existing in and Register be found in the Code of Pouchal Regarines with the Federal Register. {4}------------------------------------------------ Page 2 - Mr. Farzad Parsaie Please be advised that FDA's issuance of a substantial equivalence determination does not mean r that FDA has made a determination that your device complies with other requirements of the Act that I DA has made a doterminations administered by other Federal agencies. You must of any I callared and regarantents, including, but not limited to: registration and listing (21 Comply with an the Hot STequirements, 01); good manufacturing practice requirements as set CFR in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic forth in the qualis) 3500110 (Sections 531-542 of the Act); 21 CFR 1000-1050. product radiation only of provisions (sketing your device as described in your Section 510(k) This letter will anow you to organization of substantial equivalence of your device to a legally promatice notification: "The Dr. Interessification 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 If you desire spocific acries ion your 240) 276-0120. Also, please note the regulation entitled, Connect the Office of Course to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small other general miorination on your response 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, uma R. lochner Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {5}------------------------------------------------ # Indications for Use 510(k) Number (if known): K051209 Device Name: CentriMag® Back-Up Console Indications For Use: The Levitronix CentriMag Back-Up Console is indicated for use with the Levitronix The Levitronix Ochthing Back op Sping System and as a back-up to the CentriMag CentriMag Extracorpored. Blood Pamping of Extracorporeal Blood Pumping System is Frinary Gollson. The Ectirents Son.net contracorporeal bypass circuit for extracorporeal indicated to pump blood through the to cardiopulmonary bypass (up to six hours). circulatory support for ponous appropreal circulatory support systems (for periods up It is also indicated for ase in extraosme cardiopulmonary bypass (e.g., valvuloplasty, to 'six' nours', not 'requiring 'ochiple' outdiving surgery of the vena cava or aorta, liver transplants etc). × Prescription Use (Part 21 CFR 801 Subpart D) AND/OR Over-The-Counter Use (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) Donna R. Vochner (Division Sign-Off) Division of Cardiovascular Devices 510(k) Number Kost 209 Page 1 of _1 _________________________________________________________________________________________________________________________________________________________________