The market for cardiac assist devices has, in the past, been focused on end-stage patients waiting for a heart transplant, a niche market. But now, growth is accelerating in all sectors, from acute cardiac support to the long-term support of end-stage heart failure patients. Start-Up revisits CardiacAssist, CircuLite, and MicroMed.

Orqis Medical slid in under the wire to present late-breaking clinical results for a landmark trial in congestive heart failure at the American College of Cardiology meeting in Chicago in April. Relative to the trial's design, the results were somewhat mixed. The company failed to meet its clinical trial endpoints, but demonstrated significant improvements in a very sick acute heart failure population in a first-of-its kind study, and therefore, proof-of-principle of its novel approach. So, what appears at first glance to be bad news, is actually pretty good news.

Heart failure is a huge growing market in which devices are looking to succeed where drugs have provided only limited benefit. Paracor is taking on the role of David In a field dominated by the Goliaths in cardiac rhythm management and their powered devices. The company is betting that its strategy to focus first on a mechanical approach offers a better alternative for many patients not well-served by current therapies.

Medical device investors who have avoided heart failure, because of the long and uncertain development course of ventricular assist devices, should take another look. The minimally invasive revolution in heart failure, to some extent a logical extension of interventional cardiology's migration into other areas of structural heart disease like heart valves and PFOs, is providing new device opportunities, which have the potential to get to market sooner and at the same address an even larger patient population than heart failure devices that came before.