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.

The whole area of congestive heart failure (CHF) is hot right now, particularly for medical device firms who can offer an alternative to drug therapies, which seem to have hit a wall in advancing treatment options. But Acorn Cardiovasculaar, whose device represents a surgery-based approach to reducing the size of enlarged hearts, faces a crowded device field: not only are left ventricular assist device (LVAD) manufacturers seeking to expand beyond their historic bridge-to-transplant niche, but cardiac rhythm management companies are aggressively promoting their new cardiac resynchronization therapy. Adding to Acorn's challenge: the company has had to extend its commercialization timelines as enrollment in its clinical trial took longer than company officials thought it would and it has spent considerable time building the clinical rationale for its approach. As it prepares to launch its device in the next year or so, Acorn is counting on one edge over other CHF device companies: the growing enthusiasm of surgeons for new procedures, as interventional cardiology takes over more and more of their traditional CABGs.

David Melvin, MD, a cardiovascular surgeon turned biomedical engineer has created a large patent portfolio of cardiac devices and components covering novel solutions to sticky problems. CardioEnergetics was founded to commercialize his current and future inventions. The company's lead product is a ventricular assist device that lies outside the blood path to avoid clotting and stroke.

Looking for larger patient populations, the newer CHF device companies position their products as early intervention tools that can perhaps delay or halt the progression of the disease.