In the early 1990s, St. Jude Medical was the market leader in its sole product area: mechanical heart valves, which placed it among the most profitable of device companies. Demographics, however, limited heart valves' future growth opportunities and St. Jude needed to diversify, moving into cardiac rhythm management (CRM), cardiology catheters, and vascular access devices, while also expanding in cardiac surgery. The diversification process went anything but smoothly, the company missed its numbers, and investors were quick to punish St. Jude for its integration missteps. In the past year, however, the company has become one of Wall Street's few device darlings, ranking number one in 2000 for returns among device stocks. The company's growth is largely the result of sticking to a strategy that has St. Jude well-positioned in CRM's traditional markets, while also poised to pursue huge new opportunities in atrial fibrillation and, to a lesser degree, congestive heart failure. And St. Jude has not forgotten its base: cardiac surgery, where the company has introduced new sutureless anastomotic technology for minimally invasive coronary bypass surgery.

Established heart valve companies are putting out second and third generation devices, while start-ups are developing novel technologies to overcome the drawbacks associated with mechanical and tissue valves. The replacement valve market is essentially flat; future growth will come from macro factors such as an aging population or improving economies in third world countries, but companies continue to improve products to retain or capture market share from each other. Meanwhile, start-ups see a new market opening up for percutaneous technologies. Such technologies promise to offer a solution for patients who aren't candidates for surgery. Early intervention could also delay the need for valve replacement procedures. While new heart valves aren't readily adopted by conservative surgeons that already have a host of options that are proven to be safe, interventional cardiologists are eager for the new procedures that the percutaneous technologies promise.

Having built one of the strongest medical device franchises in its pacemaker and implantable defibrillator businesses, Medtronic is leveraging its expertise in cardiac rhythm management to tackle two related cardiac problems of similarly enormous potential.

Functional electrostimulation devices.