During the London investor meeting, LivaNova outlined three strategic portfolio initiatives that are expected to drive growth in the longer term:

VNS for treatment-resistant depression: TRD is a bit of sensitive area as Cyberonics had unsuccessfully sought US reimbursement for this indication not just once but twice, in 2007, then in 2013. LivaNova is still betting on the TRD market for VNS, but it is now focusing its efforts in the EU. It has started a pilot trial in Germany, where there is a favorable reimbursement environment for VNS-TRD, and LivaNova is planning a scaled launch in other European countries where the company already has approval and reimbursement for this indication. It is still in dialogue with the CMS with the hope of getting that all-important thumbs up for the US market.
Transcatheter mitral valve replacement: LivaNova first invested in Caisson International in 2012 and in May this year, it bought the company outright, thus bringing in-house the Caisson TMVR technology. Currently, only Abbott's MitraClip is available on the market for TMVR, but other cardiology giants – Medtronic, Abbott, Edwards Lifesciences – are racing to bring to market their respective technologies. Caisson's TMVR is said to be the only TMVR system designed to be delivered through a single venous access, and implanted using a trans-septal approach. The system comprises a proprietary delivery system as well two-part, anchor-and-valve implant. LivaNova just initiated the INTERLUDE study and enrolled its first patient in Canada in August. The results from this study will be used to support CE-marking, which the company expects to obtain in 2019.
VNS for heart failure: Probably the longest shot out of the three strategic portfolio initiatives. The company would not be the first to explore the use of VNS for this indication, and clinical evidence of its effectiveness has been mixed. However, CEO Damien McDonald said the company "knows it works" and that LivaNova – with its combined expertise in both vagus nerve stimulation and cardiology – has the advantage of "a real understanding of the clinical pathway" involved. Having looked at other VNS-HF studies that have failed, the CEO said at the London investor meeting that he believes LivaNova can overcome the issues that led to those studies' failure. In its ongoing trial of VNS for heart failure, the firm already has "very powerful" results from the first 60 patients. "We're in a really good spot here," McDonald assured.

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