A year ago, Viking Systems Inc. reinvented itself based on the belief that it has found a way to take advantage of the public model to acquire small medical device companies and provide incentives to their entrepreneurial founders to work towards the greater good of an integrated company. Viking will use combinations of stock, cash, and royalties tied to the future performance of products to acquire companies, products or services for the surgical suite that have strong intellectual property and revenues in the $500,000 to $10 million range. The idea is to take advantage of the medical device industry's fragmentation, both in terms of the large number of one-product companies that exist, and the requirement, in Viking's new target market-minimally invasive surgery--for numerous parts and pieces found within different types of companies. Its first acquisition was the visualization business of Vista Medical Technologies.

Traditional coronary artery bypass graft (CABG) surgery has been refined to be the most effective long-term treatment for occluded coronary arteries. Yet it remains a major surgical procedure that is traumatic for patients. Various minimally-invasive approaches to cardiac surgery have been developed but adoption rates are slow because these new procedures don't yet measure up to traditional CABG and because heart surgeons are slow adopters of new technology. Recent discoveries in coronary physiology have opened the door for new approaches to creating cardiac perfusion in a patient with occluded vessels. But this requires physicians to re-think what they were taught in medical school. One such approach, which involves direct vascularization from the ventricle, is being pursued by three companies: Percardia, HeartStent and Ventrica. Another company, TransVascular, is taking a broader approach by using the venous system to bypass arterial blockages. Approaches that require physicians to think differently about basic science, along with the tortuous clinical and regulatory path for new cardiac surgery devices and the cautious nature of cardiothoracic surgeons, present significant challenges to these start-up companies.

Medical researchers have known for more than 50 years that cold can be an important cardio- and neuroprotectant, but concerns about the side effects of deep hypothermia and sloppy, time-consuming procedures turned physicians away. Advances in device design as well as new research on the value of mild hypothermia have unlocked the potential of the therapy to function as a temperature management tool in surgery and critical care, to protect against injury from emboli in cardiac surgery, in resuscitation and trauma, and perhaps the biggest opportunities, in stroke and heart attacks.

In two dramatically different surgical markets, new technologies promise to improve visual access to difficult-to-reach places in the body. The first market builds on improvements in endoscopy, the second is driven by advances in diagnostic imaging.