Boston buys Symetis and accelerates in aortic – but ditches mitral

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So much for going public. The Swiss transcatheter aortic valve developer Symetis, which filed for a €55m ($59m) float on Euronext Paris, has just been bought by Boston Scientific for $435m in cash.

This is a clear win for Symetis, which appears to have pulled off the time-honoured trick of announcing IPO plans to make a vacillating buyer sign on the line. But with Boston having pulled its own Lotus valve from sale in Europe last month, leaving a $50m hole in its finances, this is a welcome move from the larger group too.

Even before the Lotus market withdrawal Boston’s commercial reach in transcatheter aortic valve replacement (TAVR) was badly out of proportion to its size. Boston is around 80 times larger than the minnow it has just bought – but the acquisition of Symetis will nearly double its share of the European transcatheter aortic valve market.

While only two products are available in the US for TAVR, the European market is more crowded. The number one and two positions are held by Edwards Lifesciences and Medtronic with their Sapien and CoreValve franchises – also the two sold in the US.

Symetis is fourth placed, with a 7% share of the market, its chief executive Jacques Essinger told EP Vantage last month – and Boston, despite its huge size, has just 8% (Symetis follows its fellows into mitral valve technology, February 20, 2017).

No mitral no more

That was before last month’s recall of the Lotus franchise (No Lotus élan for Boston, February 24, 2017). On a conference call today Boston’s chief executive, Michael Mahoney, denied that the Symetis acquisition had anything to do with the Lotus withdrawal – or that it boded ill for the upcoming results of Reprise III, a rare head-to-head study of Lotus versus Medtronic’s CoreValve. “We’ve looked at Symetis – and they would confirm that – for the last two years,” he said.

Adding Symetis’s Acurate aortic valves to its own – once they are back on sale at the end of this year – will not enable Boston to leapfrog Medtronic to reach second place in the European TAVR rankings, but it will make a meaningful difference to its sales.

While Boston sees synergistic advantages in combining the aortic ranges it does not feel the same way about the mitral valves the two companies are developing. Symetis recently bought a mitral technology specialist, Middle Peak Medical, to diversify its product range into the new hot technology. Boston is not interested, and the Middle Peak technology will be spun out before the close of the Boston-Symetis deal.

“We currently have other investments in the mitral field,” said Kevin Ballinger, president of Boston’s interventional cardiology, on the call. “We’re comfortable with other investment areas we have and Middle Peak won’t be part of the process here.”

At this point Boston almost seems to be going out of its way to avoid owning a mitral valve. Last year it bought Neovasc’s biologic tissue capabilities and made a 15% equity investment in the company for a total of $75m in cash – but did not obtain any rights to Neovasc’s mitral valve, Tiara (Neovasc soars as mitral valves head to Europe, December 7, 2016). And it has previously invested in an Israeli mitral valve firm, Mvalve, but again does not have direct rights.

Amidst all this excitement, spare a thought for the also-rans. Jenavalve Technology has had a CE marked TAVR product since 2011 and has sucked in a whopping $143m in venture funding with no deal to show for it. And Direct Flow Medical, which got its CE mark in 2013, went into liquidation late last year, having failed to put a financing deal together.

The TAVR space is a powerful exemplar of just how closely the medtech sector relies on corporate activity from the big companies.

To contact the writer of this story email Elizabeth Cairns in London at elizabethc@epvantage.com or follow @LizEPVantage on Twitter

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