The success of transcatheter aortic valve replacement has generated optimism that the much larger pool of mitral regurgitation patients can be similarly served. While big strategics bet on replacement, however, other companies are betting on repair, developing less invasive devices inspired by an array of established mitral valve surgical repair techniques.

Amid the success of transcatheter aortic valve replacement (TAVR), strategic acquisitions of transcatheter mitral valve replacement (TMVR) companies and the success of mitral valve repair device MitraClip, a group of companies are developing a number of minimally invasive options to repair mitral valves. Whether minimally invasive repair, replacement, or some combination will emerge as the best option for patients with mitral regurgitation remains unclear, and insiders say this road will be rockier than it was for TAVR.

Start-Up interviews the inventors behind Ardian, the object of one of the highest priced venture capital-backed medical device acquisitions, and between them, five other medical device companies. The team uniquely brings a perspective of applied physiology, and the integration of systems, to the goal of device innovation. In CHF Solutions, they've addressed heart failure with a device from nephrology, in Cardiac Conetps, heart failure by way of a neurological approach to sleep apnea, and in Ardian, hypertension, by studying the functioning of the kidney.

A roundup of recent medtech strategic alliances, mergers & acquisitions and financings.