Take a fast-food loving culture, mix in a sedentary lifestyle, and, not surprisingly, you get a lot of heart disease in the U.S.
The trend doesn’t appear to be changing anytime soon, as the Baby Boomers get older, and an estimated 18 million U.S. adults are living with some form of cardiovascular disease. So if you’re a medical device entrepreneur, it generally means there’s a lot of demand if you invent something great that treats cardiovascular conditions and you can get it past regulators. And the place to be to spot many things new and innovative for the treatment of heart disease is the Transcatheter Cardiovascular Therapeutics conference, which runs from Sept. 21 to 25 in Washington DC.
This is a huge confab, expected to draw more than 12,000 cardiologists, medical device entrepreneurs, venture capitalists, and sales and marketing reps for all the major med device makers, including many from the San Francisco Bay Area. Take a glance at the sponsor list, and you’ll see who has a stake here—Abbott Laboratories (NYSE: ABT), AstraZeneca (NYSE: AZN), Boston Scientific (NYSE: BSX), Johnson & Johnson’s Cordis unit (NYSE: JNJ), Edwards LifeSciences (NYSE: EW), Medtronic (NYSE: MDT), and The Medicines Company (NASDAQ: MDCO).
The companies market products aimed at addressing at least part of the problem with heart disease. An estimated 6.5 million diagnostic and therapeutic interventional cardiology procedures were performed in the U.S. in 2008, which added up to a $4.7 billion market for corresponding products, according to Huntington Beach, CA-based market research firm LSI.
I won’t be on site this year, so I sought out the view of an expert observer will be there, Steve Salmon of San Francisco-based Latterell Venture Partners. Here are four big trends Salmon says will be watched at this year’s TCT conference.
—Percutaneous valve replacement. This is a hot field in which interventional cardiologists seek to thread a catheter through the femoral artery of the leg, up into the chest to repair the heart’s aortic valve without cracking open the chest and doing surgery. Medtronic agreed to pay $700 million upfront, plus milestones, in February 2009 to acquire Irvine, CA-based CoreValve to get its technology in this field, in which Edwards is also a significant player. The technology is attractive because it’s a new market, in which elderly people generally considered too frail for heart surgery can become candidates for a minimally invasive valve repair procedure.
Santa Rosa, CA-based Direct Flow Medical and Los Gatos, CA-based Sadra Medical are a couple of interesting Bay Area companies focused on percutaneous aortic valve repair that will be closely watched at the TCT conference, Salmon says. There are other “skunk works” ideas out there, but new technologies still face a lot of science and technical risk, as well as risk of being turned down by regulators. These companies are seeking to repair beating hearts, with squishy tissue, in frail patients, without causing more harm than good. Many companies also have to follow the expensive and arduous pathway through FDA known as the PMA route. “We’ve looked at doing deals in the space, and there are significant barriers to entry,” Salmon says.
—Ancillary products for percutaneous aortic valve repair. Some of the newer cardiovascular procedures, while still not as invasive as surgery, are creating larger puncture wounds into the femoral artery that physicians need to deal with. The traditional ancillary hardware used to insert cardiac stents that prop open clogged arteries, or tools to perform angioplasty, don’t really represent a growing market anymore, Salmon says. There are various ideas for closing up puncture wounds, like mechanical devices, stitches, and clips mounted at the end of catheters. Someone who comes along with an effective new device could have a hit, Salmon says, because it would provide peace of mind to physicians who worry about a puncture wound for a minimally invasive procedure that could go wrong and create a life-threatening situation.
“It can be a very stressful situation, when you put a big hole in the vessel,” Salmon says. “They (vascular surgeons) need to see it close. Otherwise, you can bleed someone out real fast.”
—Peripheral artery disease. While interventional cardiology has traditionally focused, just like the name sounds, on the heart, many of these same patients have other problems with clogged blood vessels causing problems in their legs. This condition has caused 2 million Americans to seek treatment, complaining of pain when they walk. Most people go undiagnosed now, partly because there aren’t many good options for treatment.
Healthcare giant Covidien (NYSE: COV) completed a $2.6 billion acquisition in July to get one of the leaders in this field of peripheral artery disease, ev3. This company has a technology, marketed as the SilverHawk and RockHawk, that is designed to cut through the various clots and plaque buildups that cause peripheral artery disease in the legs. Kirkland, WA-based Pathway Medical Technologies (a member of Latterell’s portfolio) has another approach, with a high-speed drill that breaks and vacuums out the blockages in the legs. Santa Clara, CA-based Bacchus Vascular is another player in the field to watch, Salmon says. C.R. Bard (NYSE: BCR) has invested in the field, Salmon says. “There’s a lot of movement,” Salmon says. “People are wondering about how much activity is here, how much growth potential.”
—Lastly, Salmon says he’s going to pay attention to what’s new in the field of neurovascular treatment. This includes big established markets, in which Boston Scientific and Johnson & Johnson are major players in sealing off aneurysms without requiring brain surgery that drills through the skull. Covidien’s acquisition of ev3 was equally focused on the smaller company’s capability in treating neurovascular diseases, Salmon says.
That’s partly why he’s attending the meeting—to learn more about it. But he did mention a couple stroke device companies to watch—Mountain View, CA-based Concentric Medical, and Alameda, CA-based Penumbra.
“There are companies coming up that seem to be dramatically improving technologies physicians have for acute ischemic stroke,” Salmon says. He hesitated to make firm predictions on who the winners will be, saying “I’m just starting to get my feet wet.” Of course, that’s partly what meetings like TCT are for, to learn more.