MicroMed has the smallest LVAD on the market (outside of the US), which makes it suitable for the sought-after destination therapy market. The MicroMed LVAD has been implanted in more then 450 patients, which makes it second only to Thoratec in terms of the number of implants. But it hasn't been easy. To get to this point, MicroMed chewed through large helpings of money-seed funding, four rounds of venture capital, and a bank financing, before going public in 2005 through a reverse merger with a shell company. By the end of 2007, MicroMed needed to raise money on top of a large accumulated deficit. Rescue came from private equity group E-Wilson, which took the company private.

After cutting his teeth on heart pump technology at re-start Impella, Rolf Kaese thought he had found the perfect vehicle to build a ventricular assist device business at Berlin Heart. But now Kaese is starting over and so is Berlin Heart after a falling out between the two, in a tale that's an object lesson to anyone who's ever had to begin again.

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.