CardiacAssist operates in the market for acute heart failure, with TandemHeart a pump designed to reverse multi-organ failure, to help the heart recover, or at the very least, keep patients alive so they can move on to the next therapeutic option. A lot has happened since Start-Up spoke with CardiacAssist back in 2002. The company's TandemHeart gained 510(k) clearance in 2003, and by January 2009, more than 1,500 TandemHeart procedures had been performed. The pace of adoption is accelerating. Now, with sales of $10 million, and a steady 40% growth rate, the company is no longer dependent upon venture capital.

After struggling for years to gain momentum, the ventricular assist device market appears finally to be coming of age. Second-generation VAD designs are performing well and seem to have largely addressed the pump durability and safety issues of the past that stymied growth and prevented this market from reaching its full potential. In the process, these new pumps, and their third-generation counterparts now waiting in the wings, are revitalizing interest in VADs among both physicians and patients, and propelling this potential multibillion dollar market to the forefront once again.

After cutting his teeth on heart pump technology at re-start Impella, Rolf Kaese thought he had found the perfect vehicle to build a ventricular assist device business at Berlin Heart. But now Kaese is starting over and so is Berlin Heart after a falling out between the two, in a tale that's an object lesson to anyone who's ever had to begin again.