CMS pays 33% of its budget for patients with end stage kidney disease, a group that, in terms of patient numbers, accounts for less than 1% of the Medicare population. For all this money spent, mortality rates remain high--the one year mortality rate for patients on hemodialysis stands at 24%, a survival rate that's worse than that of metastatic cancer. In an industry traditionally resistant to change, however, changes are coming, brought about by reimbursement changes and a delivery model that can't scale-up to meet a growing population, making room for new start-ups in the space.

Brief summaries of recent advances in device research and clinical trials, including a new study sugesting that treating post-PCI patients with vascular closure devices in combination with bivalirudin have substantially reduced bleeding rates, and a large study of postmeenopausal women indicated that tracking CA-125 may be an effective way to detect early-stage ovarian cancer.

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.

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.