VENTRIO LIGHT HERNIA PATCH WITH TRM ANTIMICROBIAL COATING

K113229 · C.R. Bard, Inc. · FTL · Jul 20, 2012 · General, Plastic Surgery

Device Facts

• Record ID: K113229
• Device Name: VENTRIO LIGHT HERNIA PATCH WITH TRM ANTIMICROBIAL COATING
• Applicant: C.R. Bard, Inc.
• Product Code: FTL · General, Plastic Surgery
• Decision Date: Jul 20, 2012
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.3300
• Device Class: Class 2
• Attributes: Therapeutic

Indications for Use

The Ventrio™ Light Hernia Patch is indicated for use in the reconstruction of soft tissue in procedures involving soft tissue repair where weakness exists, such as for the repair of hernias. TRM Antimicrobial Coating has been shown to reduce or inhibit microbial colonization on the device.

Device Story

Self-expanding, nonabsorbable sterile surgical mesh; used for soft tissue/hernia repair. Composed of two layers of knitted polypropylene monofilament mesh forming a positioning pocket; stitched with PTFE thread to an ePTFE sheet. Includes SorbaFlex™ Memory Technology (polydioxanone monofilament in a polypropylene sleeve) for stability and insertion ease. Surfaces coated with TRM Antimicrobial Coating (bioresorbable L-tyrosine succinate polymer, rifampin, and minocycline) to inhibit microbial colonization for up to 7 days. Implanted by surgeons in clinical settings. Polypropylene side facilitates tissue in-growth; ePTFE side minimizes visceral tissue attachment. PDO component degrades via hydrolysis in 6-8 months. Device provides mechanical support for tissue defects.

Clinical Evidence

No human clinical trials. Evidence includes ISO 10993 biocompatibility testing, bench testing of physical/functional characteristics, and in vivo studies. Porcine study (4 weeks post-implantation) evaluated tissue attachment, mesh contracture, in-growth, and inflammatory response. Two in vivo dorsal rabbit infection models assessed microbial colonization and abscess formation. Analytical/in vitro testing confirmed drug content, impurity profiles, kinetic drug release, and polymer degradation.

Technological Characteristics

Materials: knitted polypropylene monofilament, ePTFE, PTFE thread, polydioxanone (PDO) monofilament (dyed with D&C Violet No. 2). Coating: L-tyrosine succinate polymer with rifampin and minocycline (115 ug/cm²). Sterilization: Ethylene oxide (EtO). Form factor: self-expanding patch with positioning pocket. Connectivity: N/A.

Indications for Use

Indicated for patients requiring soft tissue reconstruction or hernia repair. No specific age or gender contraindications stated.

Regulatory Classification

Identification

Surgical mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Examples of surgical mesh are metallic and polymeric mesh for hernia repair, and acetabular and cement restrictor mesh used during orthopedic surgery.

Predicate Devices

• Bard Ventrio Hernia Patch (K081777, K100229)
• Pivit AB Antimicrobial Mesh (K053656)
• Pivit AB-ST Antimicrobial Mesh (K093524)

Submission Summary (Full Text)

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### 510(K) SUMMARY OF SAFETY AND EFFECTIVENESS

This 510(k) Summary is provided per the requirements of section 807.92(c).

### Submitter Information:

JUL 20 2012

| Submitter's Name: | Stephanie Baker, BS, MBA<br>Regulatory Affairs Project Manager |
|-----------------------|----------------------------------------------------------------|
| Address: | Davol Inc., Subsidiary of C. R. Bard, Inc. |
| | 100 Crossings Boulevard |
| | Warwick, RI 02886 |
| Telephone: | [phone] |
| Fax: | [phone] |
| Device Name: | |
| Trade Name: | VentrioTM Light Hernia Patch with TRM<br>Antimicrobial Coating |
| Antimicrobial Coating | |
| Common/Usual Name: | Surgical Mesh<br>Polymeric Surgical Mesh |
| Classification Name: | Mesh, Surgical, Polymeric<br>Antimicrobial Agent |
| Classification Code: | Class II, § 878.3300, Product Code FTL |

#### Predicate Device Names:

- Bard Ventrio Hernia Patch, K081777 (Davol Inc.), FDA cleared on September . 29,2008; K100229 – Special (Davol Inc.), FDA cleared on April 21,2010
- Pivit AB Antimicrobial Mesh, K053656 (TyRx Pharma, Inc.), FDA cleared on ● July 14, 2006
- Pivit AB-ST Antimicrobial Mesh, K093524 (TyRx Pharma, Inc), FDA cleared . on March 26,2010

## PREMARKET NOTIFICATION FOR VENTRIO™ LIGHT HERNIA PATCH WITH TRM ANTIMICROBIAL COATING

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#### Device Description:

The proposed Ventrio Light Hernia Patch with TRM Antimicrobial Coating is a selfexpanding, nonabsorbable, sterile prosthesis. It contains two primary layers of monofilament polypropylene mesh to form a positioning pocket. This pocket is stitched with a polytetrafluroethylene (PTFE) monofilament thread to an expanded polyfluoroethylene (ePTFE) sheet. The two primary layers of polypropylene mesh are constructed of a lighter weight, "larger-pore" (as defined below), knitted polypropylene monofilament approximately 0.0043" in diameter. The polypropylene mesh used in the proposed device weighs approximately 51% less per unit area than the polypropylene mesh used in the posterior layer of the predicate Ventrio Hernia Patch (0.024 g/in' versus 0.049 g/in2). The pore size of the mesh used in the proposed product is 0.082 in2 as compared to 0.019 in for the mesh used in the posterior layer of the predicate Ventrio Hernia Patch. The device contains SorbaFlex™ Memory Technology, which provides memory and stability to the device, facilitating ease of initial insertion, proper placement, The SorbaFlex Memory Technology is comprised of an extruded and fixation. polydioxanone (PDO) monofilament that is contained within a knitted polypropylene mesh sleeve. The PDO monofilament is dyed violet with D&C Violet No. 2 and fully degrades in vivo by means of hydrolysis with absorption essentially complete in 6-8 months.

The proposed Ventrio Light Hernia Patch surfaces are coated with TRM Antimicrobial Coating, which is comprised of a bioresorbable L-tyrosine succinate polymer (T) and antimicrobial agents rifampin (R) and minocycline (M). The coating is shaded orange in color due to the color of the antimicrobial agents. The TRM Antimicrobial Coating has been shown to reduce or inhibit microbial colonization on the device during the initial healing process for up to 7 days following surgery. The bioresorbable L-Tyrosine succinate polymer is essentially absorbed in 6 - 8 months based on in vitro studies.

The fascial side of the Ventrio Light Hernia Patch (polypropylene) allows a prompt fibroblastic response through the interstices of the mesh, allowing for tissue in-growth into the device. The visceral side of the device (ePTFE) has a submicronic porosity to minimize tissue attachment to the device.

#### Intended Use:

The Ventrio Light Hernia Patch is indicated for use in the reconstruction of soft tissue in procedures involving soft tissue repair where weakness exists, such as for the repair of hernias. The TRM Antimicrobial Coating has been shown to reduce or inhibit microbial colonization on the device.

### PREMARKET NOTIFICATION FOR VENTRIO™ LIGHT HERNIA PATCH WITH TRM ANTIMICROBIAL COATING

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### Summary of Similarities and Differences in Technological Characteristics, Performance and Intended Use:

The proposed Ventrio Light Hernia Patch with TRM Antimicrobial Coating is similar in intended use and in technological characteristics and performance when compared to the predicate devices Ventrio Hernia Patch, Pivit AB and Pivit AB-ST. All devices are intended for use in the reconstruction and repair of soft tissue deficiencies where weakness exists such as hernia repair. In addition, all devices are similar in technological characteristics with regard to materials, design, sterilization, packaging and labeling, Where minor technological differences exist between the proposed device and the predicate devices, performance testing demonstrates that these differences do not adversely affect the safety and effectiveness of the proposed device.

The proposed device, Ventrio Light Hernia Patch with TRM Antimicrobial Coating and the predicate devices Ventrio Hernia Patch, Pivit AB and Pivit AB-ST are all composed of knitted polypropylene monofilament mesh. Both the proposed device and the predicate device, Ventrio Hernia Patch, contain two primary layers of monofilament polypropylene mesh to form a positioning pocket stitched with PTFE monofilament to an ePTFE sheet. The proposed device has the same mesh configuration as the predicate, Ventrio Hernia Patch, except for four modifications, three of which are considered minor modifications.

The first minor modification involves the polypropylene monofilament mesh layer of the device. The proposed device is constructed of two primary layers of lighter weight, larger pore knitted polypropylene monofilament while the predicate Ventrio Hernia Patch contains only one layer of lighter weight, larger pore knitted polypropylene monofilament.

The second minor modification involves the polypropylene mesh surrounding the PDO monofilament recoil ring. In both the proposed and predicate devices, the PDO monofilament recoil ring is contained within polypropylene mesh. However, in the predicate device (small circle, large circle, small oval, medium oval and large oval sizes only) the PDO monofilament is contained by two layers of knitted mesh stitched with PTFE monofilament thread while in the proposed device the PDO monofilament is contained within a knitted polypropylene mesh sleeve is also used to contain the PDO monofilament in the extra large sizes of the predicate device.

The last minor modification involves the sizes of the devices. The predicate Ventrio Hernia Patch is marketed in 9 sizes, while the proposed device will be marketed in 5 sizes only (small circle, large circle, small oval, medium oval and large oval). In addition to the three minor modifications described above, one other modification includes the addition of the TRM antimicrobial coating containing the antimicrobial agents rifampin and minocycline to the proposed device as discussed below. Both the proposed device and the

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predicate Ventrio Hernia Patch are packaged in the same materials. Tyyek and foil, and undergo ethylene oxide (EtO) sterilization.

The proposed and predicate devices Pivit AB and Pivit AB-ST are composed of knitted polypropylene mesh. The predicate devices Pivit AB and Pivit AB-ST are composed a single layer of knitted polypropylene mesh while the proposed device contains two primary layers of knitted polypropylene mesh stitched to an ePTFE sheet with PTFE monofilament thread. In addition, the proposed device contains an absorbable PDO recoil ring while the predicate devices Pivit AB and Pivit AB-ST do not contain any recoil mechanism. Both the proposed and predicate devices are coated with a bioresorbable Ltyrosine succinate polymer coating containing the antimicrobial agents rifampin and minocycline. The proposed device has the antimicrobial agents rifampin and minocycline (minocycline hydrochloride) in equal concentrations of approximately 115 ug/cm² while the predicate devices Pivit AB and Pivit AB-ST have the antimicrobial agents in equal concentrations of 86.11 ug/cm². Both the proposed device and the predicate devices Pivit AB and Pivit AB-ST are packaged in the same materials. Tyvek and foil. The predicate devices Pivit AB and Pivit AB-ST are gamma sterilized while the proposed device is sterilized with EtQ.

#### Performance Data:

Biocompatibility testing in accordance to the ISO 10993 series was conducted on the proposed finished device and the results indicate that the device is biocompatible per these standards.

Laboratory bench testing was performed to compare both physical and functional characteristics of the proposed device to those of the predicate device Ventrio Hernia Patch. In addition, an in vivo porcine study was performed to evaluate peritoneal tissue attachment, mesh contracture, mechanical tissue in-growth, and host inflammatory response associated with the proposed device at 4 weeks post-implantation. Two in vivo dorsal rabbit infection model studies were also performed to determine the amount of microbial colonization and macroscopic abscess formation associated with the proposed device after implantation and direct inoculation with bacteria. Analytical and in vitro testing was also performed on the proposed and predicate devices and include speed to kill, kinetic drug release (KDR), drug content and impurity, and polymer degradation testing.

#### Conclusion:

Results of the testing performed in support of this submission demonstrate that the Ventrio Light Hernia Patch with TRM Antimicrobial Coating is substantially equivalent to currently marketed predicate devices, Ventrio Hernia Patch, Pivit AB and Pivit AB-ST and is safe and effective for its intended use. In addition, the results of the testing show

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that the components in the proposed device, specifically ePTFE and PDO, have no interaction with the TRM antimicrobial coating and do not affect the release profile of the antimicrobial agents rifampin and minocycline.

# PREMARKET NOTIFICATION FOR VENTRIO™ LIGHT HERNIA PATCH WITH TRM ANTIMICROBIAL COATING

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### DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/5/Picture/1 description: The image shows the seal of the Department of Health & Human Services (HHS) of the United States. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" around the perimeter. Inside the circle is an abstract emblem that resembles an eagle or bird-like figure with stylized wings.

#### Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

C.R. BARD, Incorporated % Ms. Stephanie Baker, BS, MBA Regulatory Affairs Project Manager 100 Crossings Boulevard Warwick, Rhode Island 02886

Re: K113229

Trade/Device Name: Ventrio™ Light Hernia Patch with TRM Antimicrobial Coating Regulation Number: 21 CFR 878.3300 Regulation Name: Surgical mesh Regulatory Class: Class II Product Code: FTL Dated: July 18, 2012 Received: July 19, 2012

Dear Ms. Baker:

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. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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.

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); good manufacturing practice requirements as set

JUL 20 2012

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Page 2 - Ms. Stephanie Baker, BS, MBA .

forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification 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 contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Mark N. Melkerson
Director

Director Division of General, Restorative and Neurological Devices Office of Device Evaluation

Center for Devices and Radiological Health

Enclosure

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K 113229

#### INDICATION FOR USE STATEMENT

#### To be determined 510(k) Number (if known):

Device Name:

Ventrio™ Light Hernia Patch with TRM Antimicrobial Coating

The Ventrio™ Light Hernia Patch is indicated for use in the reconstruction of soft tissue in procedures involving soft tissue repair where weakness exists, such as for the repair of hernias. TRM Antimicrobial Coating has been shown to reduce or inhibit microbial colonization on the device.


(Division Sign ):T) Division of Sugical, Orthopedic, and Restorative Devices

510(k) Number: K113225

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)