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.

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.

David Lederman started Abiomed 25 years ago to develop an artificial heart, the AbioCor. While the AbioCor development continues, a new management team has broadened the company's focus. Where Abiomed once pioneered heart replacement, they now are breaking new ground in heart recovery. The challenge is whether, armed with new products and clinical data, the company can change physicians' treatment patterns for acute heart failure patients.

CardiacAssist has gotten off the beaten path of ventricular assist device companies (VAD) vying for a piece of the congestive heart failure market. It is positioning its own implantable VAD as a percutaneous device that can serve the needs of cardiogenic shock patients, by bridging them to therapeutic interventions.