von Segesser, Ludwig K.

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EditorialNEXT = new events in xurgical technology§www.elsevier.com/locate/ejctsEuropean Journal of Cardio-thoracic Surgery 38 (2010) 239—240The 23rd Annual Meeting of the European Association forCardio-Thoracic Surgery to be held in Geneva, September11—14, 2010 (www.eacts.org) is the event to find out allabout what is NEXT, i.e. New Events in Xurgical Technology. Aseveryone knows surgery has its origin in the Greek termxeiroyrgikZ (cheirourgike¯) which means ‘hand work’.Further enhancement of what can be done manually requiresinstruments or, in other words, technology. In addition,problems with technology are usually approached with moretechnology. As a matter of fact, cardiac, thoracic andvascular surgeries are very technology driven fields and thereare a numerous examples in this volume of the EuropeanJournal of Cardio-Thoracic Journal [1—7], etc.).One key issue is of course how to get from a good idea for anew surgical device [6] to an approved implant or instrumentwhich can be used in routine fashion for the clinical practice?There have been two interesting papers in the recent issuesof the European Journal for Cardio-Thoracic Surgery by Vechtet al. showing first, how to protect one’s assets by securingthe intellectual property [8], and second how typicalpathways for prototyping, certification, manufacturing,marketing, and financing [9] can look like.Basically, there are two concepts for financial engineeringaround the creation of a start-up company for the NEXTproduct. Either the ‘self-financed’ route which may involvethe family and friends versus the totally ‘venture capitalfinanced’ route.The venture capital financed route requires a good storyand a lot of effort to convince the fund managers. It mayallow for attracting big investments, which in conjunctionwith a brilliant team can shorten the time to market byparallel processing, and a global roll-out. It can potentiallygenerate huge returns. The main price for this strategy is,that the inventor is usually removed from the commandsearly on, his holdings are diluted accordingly or vice versa,and the initial spirit of the invention may be completely lost.Hence, it is of prime importance for the inventor to negotiateadequate rewards for his contributions from the verybeginning.In contrast, the self-financed route is an extremelytedious one. Most of the problems occurring at the variouslevels of development, certification, production, marketingand sales have to be solved typically by the few persons in§ Conflict of interest: LKvS is founder and shareholder of Smartcanula LLC,Lausanne, Switzerland.1010-7940/$ — see front matter # 2010 European Association for Cardio-Thoracicdoi:10.1016/j.ejcts.2010.06.033the team. This is due to the fact that such small operationsare usually short of cash, which provides the necessarypressure to find efficient solutions (positive), but big jumpsare just out of question (negative). Potential suppliers aswell as customers have to be convinced almost one by one,which in turn slows down the penetration of the marketseven if an innovative well functioning product can be madeavailable readily. Hence, the financial compensations earlyon are none or insignificant as compared to a well negotiateddeal for the scenario outlined above, but, it is possibleto stay in control of the entire operation for the time ittakes, and thus after all the final reward may turn out to besuperior.Of course there are all sorts of combinations in-betweenthese two scenarios, but not all products are suitable forboth. Typically, the development, production, and marketingof an artificial heart [10] or even a prosthetic heart valve [11]can rarely be financed out of one single pocket, and in orderto get somewhere, multiple rounds of investments byorganizations willing to take some risks are unavoidable. Incontrast, it is still possible for relatively simple devices [12],to evolve under the inventor’s direction at a much smallerscale, and of course, slower pace. In the latter case limitedfunding from start-up friendly foundations and governmentagencies which do not have too many strings attached can beof major help for scientific proof of principle (e.g. SwissNational Science Foundation: www.snf.ch, and the equiva-lents in other countries) or processing clearly defined workpackages for industrialization (e.g. Swiss confederationinnovation promotion agency: www.CTIstartup.ch, and theequivalents in other countries).The emerging discipline of Venture Philanthropy providesa promising third option along with self-funding andtraditional venture capital investment. Not-for-profit orga-nizations can put their considerable resources into play, inways consistent with their mission, at a time in productdevelopment that is too early for traditional ventureinvestment and too late for academic funding. While suchorganizations invest instead of giving grants, they do so withan eye toward re-distributing profits to evergreen funds touse for future investments always within their philanthropicgoals. In this way they help to bridge the so-called translationgap, the transition in product development between benchand bedside where financing is known to be difficult. Incardio-vascular disease, Broadview Ventures (www.broad-viewventures.org) has been established by the trust thatSurgery. Published by Elsevier B.V. All rights reserved.Editorial / European Journal of Cardio-thoracic Surgery 38 (2010) 239—240240funds the Fondation Leducq (www.flcq.org) to address justthis problem. With a mission to accelerate the developmentof technology in diagnosis and treatment of cardio-vascularand neuro-vascular diseases through targeted investments,Broadview aims to make resources available to inventors andearly stage companies to help to insure that promisingtechnology can move forward. Ultimately, this is in every-one’s interest.References[1] Kuratani T, Kato M, Shirakawa Y, Shimamura K, Sawa Y. Long-term resultsof hybrid endovascular repair for thoraco-abdominal aortic aneurysms.Eur J Cardiothorac Surg 2010;37:299—304.[2] Wheatley GH, Koullias GJ, Rodriguez-Lopez JA, Ramaiah VG, DiethrichEB. Is endovascular repair the new gold standard for primary adultcoarctation? Eur J Cardiothorac Surg 2010;37:305—10.[3] Marty B. Endovascular repair for adult coarctation: stating the obvious.Eur J Cardiothorac Surg 2010;37:310.[4] Fiore A, Ruzmetov M, Huynh D, Hanley S, Rodefeld MD, Turrentine MW,Brown JW. Comparison of bovine jugular vein with pulmonary homograftconduits in children less than two years of age. Eur J Cardiothorac Surg2010;37:318—25.[5] Bothe W, Escobar Kvitting JP, Swanson JC, Go¨ktepe S, Vo KN, Ingels NB,Miller DC. How do annuloplasty rings affect mitral leaflet dynamicmotion? Eur J Cardiothorac Surg 2010;37:340—9.[6] Lutter G, Quaden R, Iino K, Hagemann A, Renner J, Hu¨mme T, Cremer J,Lozonschi L. Mitral valved stent implantation. Eur J Cardiothorac Surg2010;37:350—5.[7] Yilmaz A, Geuzebroek GSC, Van Putte BP, Boersma LVA, Sonker U, DeBakker JMT, Van Boven WJ. Completely thoracoscopic pulmonary veinisolation with ganglionic plexus ablation and left atrial appendix amputa-tion for treatment of atrial fibrillation. Eur J Cardiothorac Surg 2010;37:356—60.[8] Vecht JA, Athanasiou T, Ashrafian H, Mayer E, Darzi A, von Segesser LK.Surgeons produce innovative ideas which are frequently lost in thelabyrinth of patents. Eur J Cardiothorac Surg 2009;35:480—8.[9] Vecht JA, von Segesser LK, Ashrafian H, Rao C, Skapinakis P, Saso S, DarziA, Athanasiou T. Translation to success of surgical innovation. Eur JCardiothorac Surg 2010;37:613—25.[10] Liden H, Haraldsson A, Ricksten SE, Kjellman U, Wiklund L. Does pre-transplant left ventricular assist device therapy improve results afterheart transplantation in patients with elevated pulmonary vascularresistance? Eur J Cardiothorac Surg 2009;35:1029—35.[11] Vergnat M, Henaine R, Kalejs M, Bommeli S, Ferrari E, Obadia JF, vonSegesser LK. A new self-expanding aortic stent-valve with annular fixa-tion: in vitro haemodynamic assessment. Eur J Cardiothorac Surg 2009;35:970—6.[12] von Segesser LK, Kalejs M, Ferrari E, Bommeli S, Maunz O, Horisberger J,Tozzi P. Superior flow for bridge to life with self-expanding venouscannulas. Eur J Cardiothorac Surg 2009;36:665—9.Ludwig K. von Segesser*Department of Cardio-Vascular Surgery, CHUV,Rue du Bugnon 46, 1011, Switzerland*Corresponding author. Tel.: +41 21 3142279/3142280;fax: +41 21 3142278E-mail address: Ludwig.von-segesser@chuv.ch

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