Malek Nasr - High Life Medical

[00:00:00] Malek Nasr: To lead, you need to create a connection. You need a connection. And this connection can only happen if you are genuine to the other.

[00:00:14] ​

[00:00:14] Giovanni Lauricella: We're going to start with a hug though first, uhgg Malek I brought this beautiful champagne and I know it would be silly if you said French champagne.

[00:00:25] Malek Nasr: Yes, because you can't, it's only French.

[00:00:29] Giovanni Lauricella: It can't be champagne. If it's not

[00:00:30] Malek Nasr: Blanc de Blanc the Blanc my favorite. Perfect. You bring me something. I brought you chocolates.

[00:00:35] Giovanni Lauricella: Oh, thank you. Yeah. Can you open this?

[00:00:36] Malek Nasr: I always have chocolates with me.

[00:00:38] Giovanni Lauricella: Yeah. Let me see here.

[00:00:45] ​

[00:00:45] Giovanni Lauricella: Malek you and I have known each other forever. It started with me reaching out to you on a LinkedIn message that I was super fortunate that you accepted. I hunted you down in Paris. The one thing that I want is the world to know who you are as the entrepreneur that you are. And it's always best to start with, who are you?

[00:01:05] So where have you built your life from? through academia leading all the way up to this day where you are an executive and the VP of High Life Medical.

[00:01:15] Malek Nasr: Let's start from the beginning. I would say as a kid, I was someone that would be always dreaming, I would say. I was like this person, this kid that dreams about the future and has a lot of imagination, draws, writes.

[00:01:26] I was this kind of person, very much interested in science. And I used to dream and hope that one day I would invent something. And I was interested in biology. As I was growing up, and so I did my studies in biomedical engineering. I never felt that I wasn't aware of what I wanted in terms of a career. I always knew I wanted to be in biology.

[00:01:48] Biology first. So I first, actually I first studied biology, then biomedical engineering. And as I was doing my internship, actually, in the engineering school, I was fortunate to meet Georg Börtlein, who actually back then was in CoreValve. So I did an internship and on a project around the mitral valve, which was a kind of a little project, part of CoreValve.

[00:02:12] And eventually after the internship ended, CoreValve got sold to Medtronic.

[00:02:16] Giovanni Lauricella: It's a very famous acquisition.

[00:02:17] Malek Nasr: It's a very famous acquisition. And I must say it actually changed the face of cardiology and Georg has had a huge impact on structural heart. By allowing technologies like CoveValve to exist and to be used today worldwide.

[00:02:29] So it was a huge deal. It was that this product becomes a reality. And at this point, I was just starting my career. anD so I remember going to Georg simply saying, Hey, I like it here. Can we work together on a new project? It was that as simple as that. I just asked.

[00:02:44] And for and I was lucky because he said, Yes, let's work on something. So maybe for about a year, I think we brainstormed around different projects, and then he met with he knew him already, but he met again with Rüdiger Lange, who was a heart surgeon in Munich. who also was working back then with Nicolo Piazza, a cardiologist that is now in Montreal.

[00:03:07] And the four of us, we started High Life with this idea of having a valve, a mitral valve implant that is delivered through catheters, and a ring implant that helps this valve to stay in place in the heart. So this is how it started. At the beginning, I was really doing Engineering work like really pure engineering work from the conception of the valve of the ring that is in the ventricle that we also use.

[00:03:32] We have a two component system. So purely engineering then that led to prototyping, of course, animal work, animal studies. So this is preclinical then production then after production first in man, then then clinical studies that which we are now running in three continents. So this is in a nutshell how the, how I evolved and it's been 13 years actually in High Life.

[00:03:53] I would say 13 great and fun years, so I'm very happy about it and things are going well now, so I'm happy to keep moving this project forward.

[00:03:59] Giovanni Lauricella: And you have also been around the world because of High Life Medical, right? So based in Paris.

[00:04:08] Malek Nasr: Yeah, my, my house is in Paris but I'm almost never there. You know that. Today we are running a clinical study, clinical studies worldwide. On three continents. So this is the USA, of course, all around the USA France, Germany, Poland UK Belgium Australia. We also help a little bit in China with Peijia. We have a deal with Peijia. They are doing their study.

[00:04:29] We're not running the study, but we help them a little bit with some aspects. Very much of an international role also leading people all around the, these countries. All around the globe actually. And I must say that this is how the things have evolved and it wasn't something that I expected originally.

[00:04:44] I'm very happy about it and I acted proactively for it to be this way, but it wasn't something that I had imagined early on. But it's something that makes me very happy, that's for sure.

[00:04:53] Giovanni Lauricella: You're an accomplished entrepreneur. It's a very hard technology that you've been building alongside a great team.

[00:05:00] How much has luck played into this whole story?

[00:05:02] Malek Nasr: Look, some people call it luck, some people call it randomness, some people call it hard work. It's probably a mix of all. Of course, luck is not enough. If you're not a hard worker, you get nowhere. But the opposite is true also. You could be a very hard worker and you have no luck.

[00:05:17] I would say, of course, I like to think about luck. It's a voluntary process in my mind. I like to think about it. I like to think that one could be lucky. Because, first, it removes the pressure off of your shoulder sometimes. You say, okay, I did my best, and then things are what they are. But also, it avoids you from being overconfident.

[00:05:37] If things are going well for you, and you only attribute it to your efforts and to your hard work, Then this is a very dangerous bias, I think, in my perspective.

[00:05:45] Giovanni Lauricella: When you started this transcatheter mitral valve replacement journey, that whole space was still the wild west. Tricuspid hasn't really come out yet.

[00:05:55] Repair of tricuspid or even mitral, for example, to be seen at that time, but Mitraclip is now Mitraclip. It's been a long time in the market and still one of the only. And very successful.

[00:06:07] Malek Nasr: It's very successful and it does definitely change cardiology also. It's a very successful product.

[00:06:11] Giovanni Lauricella: Here in the United States for a long time, at least over in Europe, you had several CE Mark transcatheter mitral valve repair technologies for the longest time. And I think Pascal maybe from Edwards was the second one that came through. But MitraClip was dominant here for a very long time.

[00:06:24] So it's a very challenging space. And going back 13 years ago, you start this napkin, white sheet of paper idea. Yep. But, just for me to set the stage, you were an intern, one of three. Georg selected you. We'll call it luck and hard work and just being at the right place.

[00:06:44] Malek Nasr: Yeah, it was probably luck at that time.

[00:06:45] Giovanni Lauricella: But you asked.

[00:06:46] Malek Nasr: I did, yeah.

[00:06:46] Giovanni Lauricella: You literally asked him, hey, is there something that we

[00:06:49] Malek Nasr: Can we work together, yeah.

[00:06:50] Giovanni Lauricella: And maybe you know, a closed mouth goes unfed, right? So you have to ask. That's a huge learning lesson.

[00:06:55] Malek Nasr: Yeah, for sure. I think this is one I apply this in many, I would say situations in my life.

[00:07:00] When I, when you want something, just ask and it doesn't have to be aggressive or anything, but very often people say yes. It's surprising if, again, going back to what we said about being genuine, when it comes from a genuine place, people recognize it and very often you get it, yeah.

[00:07:14] Giovanni Lauricella: Then you said there was a year of you ideating.

[00:07:17] Malek Nasr: Yeah different ideas, not necessarily heart valves, really very different, I don't remember now, but very different implants, cranial implants, just ideation, yeah.

[00:07:26] Giovanni Lauricella: You found the idea that you guys wanted to run with, and for lack of a better phrase, you were the first engineer. on this technology.

[00:07:35] Malek Nasr: Absolutely. It was it was really a fun time. I would say. It's still fun today, but in a very different way, meaning that at that time, I would say anything was possible, especially for young engineer who really wants to start from white paper and draw something and make it a reality.

[00:07:50] So This is really how it worked. It was a drawing on a paper, and then we would go to the supplier, we would do a few prototypes with them. It was really completely from scratch. It was extremely fun, and of course at this point you don't have yet all the, I would say, the quality checks, etc. that you get afterwards.

[00:08:06] Like any startup that is starting, you have, you're limited in resources. So you don't have a lot of money to spend on engineering. I definitely think that this is a blessing that prevents you from over engineering things. And from ending up with devices with 300 buttons and four knobs on them and nobody knows how to use it.

[00:08:25] Because we didn't have so much money actually, we had to make things in the simple way. And today High Life is a device that's very simple to use. You basically have just one knob on it and that's it. And partly it's because, of course, the technology allows it. It allows you to have a simple procedure.

[00:08:42] But also it's because we didn't have a choice back then. We had to make it simple. If someone is starting a project now I would even advise to restrict resources on purpose and see what you can do with the minimum. And this is where you get to the core idea and to the simple idea. I think this is what I would do.

[00:09:00] Giovanni Lauricella: So then I want to frame it out. And this is where we're going to talk about how you built your career. But once again, focusing on entrepreneurship and entrepreneurship is building businesses, raising capital for the business, your part in all of this, or at least either your perspective, your peripheral awareness, or your actual execution.

[00:09:19] Frame it out. Like, how long were you this R& D engineer before things started to change? Because that's new to you. You came out of academia into this. You went from doing what you normally do, thinking about ideas and being creative, and all of a sudden you latched on to an idea, and then all of a sudden that idea started turning into a business.

[00:09:38] I want to learn about that.

[00:09:41] Malek Nasr: It's, yeah, I need to resituate this in my head. I think we, so the first in man was in 2016, so pretty much everything before 2016 was pretty heavy on R& D. And then as we were preparing for the first in man, it started to switch towards clinical. And this is where my role also started to change little by little to head more towards clinical, which is the only thing I do today.

[00:10:03] Giovanni Lauricella: You only do clinical today?

[00:10:04] Malek Nasr: I don't do R& D anymore, yeah. It's only, I would say, clinical, meaning clinical, meaning therapy development. Which is procedures training physicians communicating, marketing. It's everything around the procedure, but not doing the devices themselves.

[00:10:16] So this is, this was the next evolution. I would say first it was really R& D work. Then when we did our first demand, it started to switch towards the clinical side. And then we had to hire people to run the clinical studies. All around the world, and this is where I would say leadership skills.

[00:10:31] Malek Nasr: I had to learn them and this is when they came in.

[00:10:33] Giovanni Lauricella: So at the clinical stages when you became a leader?

[00:10:35] Malek Nasr: Yeah, exactly. It's because you had to not exactly because I also had an R& D team right before, but I would say the true challenge My experience is that it was, it took me a lot of, a lot more effort, I would say, to manage a worldwide team of clinical specialists compared to managing a local team in the office of engineers.

[00:10:55] Giovanni Lauricella: Well, that's a huge concept. Yes. You go from being a leader of where you can see people in an office every day.

[00:10:59] Malek Nasr: And you know what they're doing and you're very familiar with how, what they do because you're an engineer yourself, to actually managing people who have a very different background and also that have very different cultures.

[00:11:09] We're talking about Australia, Europe, USA.

[00:11:11] Giovanni Lauricella: And time zones.

[00:11:11] Malek Nasr: And time zones. So I think this was a big learning point. And at that, I remember there was a time where I was very much hesitating. Can I should I continue? Should I choose R and D or should I choose this clinical aspect of things? And and the chairman of our board, Pepe, who is actually also a mentor.

[00:11:28] He also always give me good advice. He actually told me that it's better for me to actually choose this, the path that I'm on right now. And I think it's true.

[00:11:37] Giovanni Lauricella: Quick background on Pepe. Who's Pepe? .

[00:11:38] Malek Nasr: He's the chairman of our board, a very successful entrepreneur in medtech devices was a biosensor before

[00:11:43] Giovanni Lauricella: he was with biosensors, that's how he got his big.

[00:11:45] Malek Nasr: Yes, yeah, this was his, yeah.

[00:11:46] Giovanni Lauricella: And he's been also a mentor for you in this whole thing.

[00:11:48] Malek Nasr: Absolutely, yeah. He was, he's not the only one, but he's definitely a part of the people I trust and that I can speak to openly. And just as Georg I think you always need to find around you the people that, that you can trust and that are going to give you good advice.

[00:12:02] And I trust them. So far, what they have recommended to me have always turned out to be the good thing.

[00:12:07] Giovanni Lauricella: I want to go back to that transition, because I remember you and I talking about that. When you were going from R& D into clinical.

[00:12:13] Malek Nasr: Wondering, is this the right thing to do? Yeah.

[00:12:14] Giovanni Lauricella: Watching your technology go from napkin sketch, prototype, preclinical testing, into clinicals. I want you to frame this out as these engineers who are still in maybe either very early phases of their development or they're still an engineer at Medtronic or Boston Scientific and they're just dreaming about becoming this entrepreneur one day and taking their shower idea and turning it into a company.

[00:12:40] That's what you've done, right? With the team, obviously, and a great, very credible co founder.

[00:12:44] Malek Nasr: Absolutely. Yeah.

[00:12:45] Giovanni Lauricella: But you have that story to tell. So what was that like watching your technology grow? Actually go into humans.

[00:12:53] Malek Nasr: Look, when you're doing it, you don't really think about it. Meaning for me, this evolution felt very natural because I think I was always very curious and like hungry to make progress for myself, for my career.

[00:13:06] So I I was always on the, asking myself, what's next? Okay, I've done the R& D part, what's next? First in man, what's next? Clinicals. And I still ask myself the question today. So this is how things have evolved. It's, I would say It stems from curiosity and personally, I know one of my drivers is the need and to learn the need I want to learn.

[00:13:25] I want to go. So this is one of my drivers. So things have evolved naturally. But now when I look at it, 13 years later, I think it's absolutely crazy. I think it's absolutely magic. And I don't know if I Had ever imagined that at this point when I started to do the project that I would be one day seeing it implanted in patients and even patients living with it and and being in good health with and a good shape with it so I think you just need to be curious and you want you need to be willing to learn and to do the to go the extra mile.

[00:13:56] You need to be able to give yourself. I would say a hard time Yeah, you need to accept them to be happy about it because giving yourself a hard time also is a chance that means you can do it. You have the capacity to do it. It's a chance.

[00:14:10] Giovanni Lauricella: You went from owning a lot of this responsibility and designing creativity.

[00:14:16] Talk about growing pains of a business.

[00:14:18] What was it like when you went from 2 to 3 to 4 to 10?

[00:14:22] Malek Nasr: I think I wasn't aware of the impact human factor can have. And when you start having a team and different point of views and different cultures, I wasn't aware of this impact. So now I'm very well aware about it.

[00:14:35] And I think it's something that is manageable and that we need to take care of. And this is where people like you, Giovanni, are also very good advice to find the right people for a team. So I'm very well aware about it now. But at the beginning, I think this is what surprised me. When the teams are growing and then you start to see structure first from your perspective, people you were very close to maybe in your team when you were two or three people, maybe you're, you can't be as close to them anymore because now it's getting structured and also their attitude changes.

[00:15:02] I think this is this would be the growing pain Going from an area where you're more like really like almost I would not say friends, but also this kind of the sense of friendship in a little team to a team where now you need structure because there's so much to do. And otherwise things will not need structure.

[00:15:19] Otherwise you won't move forward. So I guess this to me, this would be the learning point here or the thing that was a bit difficult. It's not something you can deal with. Of course, we dealt with it and it's going well, but You have to be aware about it and be ready to treat it. If I may say it this way.

[00:15:36] Giovanni Lauricella: Going now from R&D into clinicals again. And through these growing pains of growing teams, et cetera.

[00:15:41] Malek Nasr: Also, when I say one, one more thing, Giovanni, when you go from R&D to clinical, you need to be, it wasn't easy because you had to let go. of your baby in one way, if you're the engineer behind it, et cetera. I think this was also a learning point of kind of okay, now I'm not taking care of this product anymore, someone else is and I'm doing something else.

[00:16:00] Giovanni Lauricella: Was that painful?

[00:16:01] Malek Nasr: It was heartbreaking. Absolutely. Yeah. I'm not gonna lie. It's true. It was very difficult. I had to take a lot of advice from Georg, from Pepe, from you. It was very painful, but it's one of these pains that are actually good for you, that teach you something.

[00:16:15] And there's a hidden gift in it, if you want. So I'm very happy about it now. I'm very happy that I was able to go through it because it teaches you a lot. Yeah? It teaches you to, it teaches you basically, to understand what's important and what's not.

[00:16:28] Yeah.

[00:16:30] Giovanni Lauricella: High Life Medical is developing a transcatheter, now transeptal, mitral valve replacement technology.

[00:16:36] It is arguably one of the hardest styles of technologies for the human body.

[00:16:41] Malek Nasr: It's the frontier in cardiology today. Yes. And, you were saying, you were talking a bit earlier about the field, how there were so many companies trying to do the mitral replacement, et cetera. And 13 years later, there's only Highlife and a few others because it's a very difficult field.

[00:16:55] A lot of these companies turned to tricosporid or stopped existing.

[00:16:58] Giovanni Lauricella: You brought up a really good point. There's only a few left. If you talk to. For example, MedTech Strategist, which is an amazing publication that I love, and they host great conferences as well. You, if you read some of their literature, or some of the other articles that are published, you hear about wild west of heart valves.

[00:17:17] But then there was many years and we, you probably know much better than I in this moment in time, there was so many people and companies being developing or developed to go after these technologies, whether it was repair for the left or the right side of the heart replacement for the right or the left side of the heart.

[00:17:33] But you're now saying that you're only one of the very few. Yeah. It's not for lack of trying or a lot of other companies still trying. It's you're one of the few who have made it as far as you've gone.

[00:17:43] Malek Nasr: Yeah, absolutely. It's a very difficult field. Technologically, it's difficult to get a device that would work on the left side of the heart.

[00:17:50] It's, I think, maybe in some aspects a bit easier on the right side because pressures are lower, etc. And I think this explains why there's not so many left. 13 years later, it's actually great that that we are here 13 years later, because that means the concept is proven. The product is working. Now we're doing the studies.

[00:18:06] So there's so much, actually the bar is very high.

[00:18:10] Giovanni Lauricella: Is it fair to say High Life today at this point in time is the mitral valve replacement technology, transcatheter, that has the most clinical validation?

[00:18:24] Malek Nasr: From the, from amongst private companies. Correct. Yes, amongst privately held companies, this is what we know.

[00:18:29] At least no one has announced more data than us so far. And it's been like this for a while, so I'm very happy about it.

[00:18:35] Giovanni Lauricella: Can we have a chocolate? I think that deserves a chocolate.

[00:18:37] Malek Nasr: I think this deserves a chocolate. Yeah, I think that deserves a chocolate. This is pistachio.

[00:18:39] Giovanni Lauricella: This is, it's one of my favorites. Thank you.

[00:18:41] Malek Nasr: Yeah, I'm going to have the vanilla one.

[00:18:44] Giovanni Lauricella: When you think about now with all your experience and starting your career in one of the hardest styles of technology, not, a wearable, for example, really

[00:18:53] Malek Nasr: implantable devices,

[00:18:54] Giovanni Lauricella: Exactly. How hard is medical device development and where in your experience are some of the most challenging pain points of developing a business in medical device?

[00:19:04] Malek Nasr: In terms of device, I don't think it's hard. I think you need to have an idea and you just don't need to overthink it and think it's going to be hard. Just do it. No, I don't have, I don't recollect that I felt at any moment that it was hard to develop as a technique. And I think it was easy and I think it's easy to use today.

[00:19:23] Giovanni Lauricella: A technique meaning procedural?

[00:19:24] Malek Nasr: A procedure and the devices themselves, like designing them, etc. I don't remember that this felt like a hard function or a hard or a difficult thing to do. I think. Maybe the scaling up to a company and hiring people and having a team leading all these projects. This is the difficult part.

[00:19:41] And as you were saying in the beginning, it's a bit fuzzy. It's because you are in a very free environment at the beginning. So it depends how much your ideas are clear about your project, but you can go in different directions. But eventually it becomes linear because you have a lot of regulatory and quality restrictions.

[00:19:58] So this is why it becomes linear, it doesn't mean you have the right idea, you could have the wrong idea, but you're stuck with one thing over the, on the long run. You also have restrictions in terms of the money you raise, what it is raised for, so you can't do everything you want in regards to what your investors are asking from you.

[00:20:11] So this is how it evolves. But I don't think that people or engineers that are starting startups, I don't think they should start thinking it's going to be difficult to develop. Sometimes you're very surprised. I remember very well the stent we have in High Life, which is the frame of the valve has a specific shape.

[00:20:26] It's an hourglass shape if you want, and back then it wasn't very common to have these kind of stents. Not today. It's more common. We're talking 2009, 2010. And I remember that our supplier was telling me it's impossible to do this stent. You're not gonna, we're not gonna do it. It's impossible.

[00:20:43] And I said, okay try it and with a, and actually they tried and they succeeded. And now we're producing this stent. And many companies have more complex stent frames than we have. So don't think it's gonna be difficult. Just go and do it candidly. This would be my advice.

[00:20:57] Sometimes things are easier than you think.

[00:20:59] Giovanni Lauricella: Going back to that wild west of when you started High Life in the transcatheter heart valve space. And then the summer of 2015 comes along. Hopefully I get all my

[00:21:06] names correctly. Twelve was acquired by Medtronic.

[00:21:10] You had CardiaQ acquired by Edwards. You had Tendyne acquired by Abbott. Yeah. That was the summer of love of 2015. And then later on we have Cephea. We have Livanova buying Caisson Interventional. We have Cardiovalve being acquired by Venus Med Tech, right? So there's been others after that, but so from an entrepreneur's perspective, who's developing in this hard space and now fast forward, you're still one of the last men standing.

[00:21:44] How does developing a business in this crowded, challenging space work setbacks?

[00:21:50] Malek Nasr: At that time in 2015, I think that we had we really speeding up and trying to get to first demand as soon as possible. We knew something was coming We knew the acquisitions were coming. So if you remember originally Highlife was more was a trans apical device So basically for people listening to us, it's actually a catheter that goes directly through the heart It's like a little hole in the heart and we were financed for this, so this was originally what the technology was and at some point we were saying We like we're saying we noticed with Georg that the market Or the potential market is going to be shifting completely to trans femoral, which is basically valves that are inserted through the groin and not anymore through the heart, into the heart directly.

[00:22:29] And this was this turning point where we switched. Now these other companies, maybe they had they didn't have a lot of data, but, sometimes there's there's this kind of momentum. One strategic company buys another one and then everybody wants his own device. They had probably good reasons to do the deal.

[00:22:43] But these are not things you control. So as an entrepreneur, you just give it your best. And our best at that time was to say, okay, we are doing the first in man for the transsepical and we are preparing the transfemoral solution, which we now apply. And we stopped doing transsepical completely. So we just gave it our best.

[00:23:00] It wasn't at any point, anything that I would say discouraged us in any way. No, it actually validates the fact that there's a market.

[00:23:10] Giovanni Lauricella: Good point on validating the market, and you mentioned earlier that you were even financed for that trans apical approach. I want to go to that topic.

[00:23:21] And you also mentioned Peijia over in China, so I want to start pulling some of these things about, and this is all public information. Going from that intern to that R& D engineer to that leader as the company was transitioning into first in man, What was it like to be aware of what it meant to raise capital for your company based on what you had to execute on?

[00:23:44] Malek Nasr: It was extremely important because basically it allows you to understand what How much are you going to push, for example, for a feature on your device and what, how important it is. So as an engineer, you could be stuck in this idea, I can always do better, right? But then if you know that you have just enough money to do this thing, then you're not going to focus on improving this one aspect of this device, you're going to focus on something else.

[00:24:06] So it really steers your choices. For example, sometimes it doesn't make sense to make a few improvements. Because maybe you're not going to run out of money before this comes to the clinical study. Clinical studies take a long time before, before you can actually get new devices on them if you can at all.

[00:24:22] Giovanni Lauricella: What has been your learning curve of raising capital from the position that you've been in the company?

[00:24:27] Malek Nasr: Oh it's about the story. I would say this definitely not that the story has to be real. It has to be genuine. I think everyone in this field is you only have smart people around you and they can tell if you are, telling fake things or not.

[00:24:39] But it's how you present it, so they have to like the story, they have to like the team, they also have to like you as a person. There's some aspect of personal relationships that count just as much as I would say hard arguments when you are raising money. They need to bet on someone that they can connect to.

[00:24:55] Giovanni Lauricella: Is raising capital a much more human game than you expected?

[00:25:01] Malek Nasr: Yes, I would say it's, I would say it's mostly a human game. , like really sometimes, Sometimes I meet people, in conferences and we're not even talking about raising money and they're like, Oh, but we actually are interested, like I'm not even asking them for anything.

[00:25:14] And they say they're interested so that I connect them with the team, et cetera. So it's very organic. Yeah. You need to create the connections, you need to network. I think it's a very human thing. Yeah.

[00:25:22] Giovanni Lauricella: You've been to a lot of conferences and you just brought it up an exceptional point. You've seen startups take the stand and pitch their 10, 15, 20 slides slide deck. Is that the way to raise money or is it the off, whatever happens off the court, these relationships?

[00:25:36] Malek Nasr: I tend to think it's a relationship. The real deal happens like behind the scenes.

[00:25:40] Giovanni Lauricella: Have you been a part of investor discussions and things like that?

[00:25:44] Malek Nasr: Yeah. Yeah. Yeah. I have not all the time, but I've been many times a part of it.

[00:25:47] Yeah. And it's really for my part, it was really talking about the technology. Very recently we did this with Georg talking about the technology, also finding new contacts, maybe we have very often maybe I have a few aspects from my personality that are different from other people talking to investors.

[00:26:04] So they. They might connect more with me than with others. So it depends. I think there's a human factor to it. Yeah, for sure.

[00:26:10] Giovanni Lauricella: That's what I, from your position, right? You're, you are the VP of the company. We know that the CEOs are technically the ones that are out there knocking on doors and having these conversations.

[00:26:20] And those are the ones that are responsible for raising the cash. But from that co founder perspective,

[00:26:26] Malek Nasr: you can help for sure. Meaning I've been in touch with with with VCs because sometimes my relationships bring me to them. , and maybe in the, in this case, Georg doesn't have a relationship with this person, so I bring him to the table.

[00:26:37] No, you can definitely help, but you need to be, but here, basically I completely take off my engineering hat, right? I'm really now talking as I, as. as a leader in the company and creating a network and creating relationships, and yes, I bring them down to the table when we're talking about financing.

[00:26:53] But this is a total shift from I would say my previous engineering responsibility.

[00:26:58] Giovanni Lauricella: So that shift. That's what I want to know, right? So we talked. We've beat it up. You are the intern. That was the hour. Did you read books? Did you have mentors? How did you learn how to take that hat off?

[00:27:09] Malek Nasr: Mentoring and books.

[00:27:10] I find that Maybe this connects me to the, I always have this will to learn and to, so I like to actually get information from books. Yeah. It doesn't mean that they're always good by the way, but at least you get something.

[00:27:22] Giovanni Lauricella: I remember we were in London and you were telling me that you were reading this book about the hiring process, et cetera.

[00:27:27] So I want to come back to this whole hiring and how you learn how to become a leader. I think that's very important, but I want to close this chapter of understanding about your experience of raising capital from your perspective. with a fairly unique story. Not every company has been able to be through this.

[00:27:44] Malek Nasr: Maybe one thing is that You as an engineer that's also co founder, etc. You can bring also the whole story to the table Which is something that in many companies you don't have many people that can do that So really the whole story from A to Z and I find that people, every time I talk to investors about the story of how we developed the product, what it does, where we are, et cetera.

[00:28:05] I find that they are very they pay attention to this. So I think it brings something. Yeah. You actually showed the team, you said the team, right? So it's part of it.

[00:28:15] Giovanni Lauricella: Did that lead into this whole idea of this other very big topic, which is a big country, China, right? So I know that you've done tech transfers to China.

[00:28:25] And that was also part of some of the funding that High Life has received over the years. You've had this really unique. And I think from the perspective that you come from, you've covered it really well of what it actually means to be a co founder or part of the executive team. From the very beginning as well on being able to sell the company and how you can help fund raise and raise capital alongside or with or tee up and support the CEO to close the deal. But you also raised capital from China.

[00:28:51] Malek Nasr: So with Peijia, we have a licensure agreement, meaning they are allowed to basically produce and use our technology in China. So they're doing their own clinical trial at the moment. And I would qualify this experience with them as very surprising. Surprising because maybe I expected it to be to have some difficulties.

[00:29:10] It's a tech transfer, right? You're transferring everything from how to suture the valves, how to make the stance, how to make the casters, really everything, things that we spent years doing, right? I need to transfer it to this company. And this was during COVID. We couldn't travel. We don't know them personally all through video.

[00:29:28] So this was the challenge. And and it was very it was a fun thing to do. Very very it was a learning point for sure. And I would say surprising because it was much easier than I thought.

[00:29:39] Giovanni Lauricella: What was much easier than you thought?

[00:29:40] Malek Nasr: The technology transfer. It was really seamless. Now, they have a great team at Peijia.

[00:29:45] And I can tell you, one year after the deal, exactly one year after the deal, They made their first man, which we supported via video from Paris myself and one of the engineers in the team.

[00:29:56] Giovanni Lauricella: Have you had to go to China once yet?

[00:29:57] Malek Nasr: Not once, even once. Wow. So in one year, they were able to actually learn everything about the devices, the valve, learn how to produce the valve, suture it I found really lovely people to work with.

[00:30:08] Very easy access to them. Of course we couldn't travel, but they were always available. I was always available with the team to support them. A very good experience, honestly and very profitable for High Life also. So I think it was the right thing to do at this point. Yeah.

[00:30:20] Giovanni Lauricella: Is Peijia part of High Life?

[00:30:22] Are they two separate companies? Do you give up licensing agreements? What does it truly mean to do what High Life has done and then in exchange for what?

[00:30:32] Malek Nasr: Yeah,

[00:30:32] no, in our case it's really a pure licensing agreement, meaning that they don't have they don't own High Life. They just have the right to use High Life devices and to produce them in China.

[00:30:42] And this is limited to China mainland. As a startup, of course, it and even if you're not a startup, it's extremely difficult to get into the Chinese market. You have to have a joint venture, etc. So for us, it was the right thing to do. They have their own structure already in place.

[00:30:56] They have their engineers, they have their clinical team. So they just needed the recipe. And basically, we allow them to use this recipe in China limited to China. So everywhere else in the world, it's High Life. And in China, Peijia can use High Life.

[00:31:08] Giovanni Lauricella: So then that's now given you more international experience and you had to do that tech transfer over there like you mentioned. But those teams that are being led over there. You're not leading those teams, right?

[00:31:20] Malek Nasr: No, we're supporting them, especially in the beginning meaning how to everything how to prepare the patients how to prepare the devices how to proctor the cases how to train the physicians? We really supported them on every single aspect as much as we could via video calls, right?

[00:31:36] Mind you this is what we did also in Australia the first cases in Australia not the first cases But amongst the first cases were done only by video because it was in the middle of Covid pandemic. So we were already we knew we could manage cases from abroad thanks to the australian experience.

[00:31:52] And so we just applied it to Peijia. So to china.

[00:31:55] Giovanni Lauricella: So having this international leadership experience now. I want to come back to you becoming a leader you talked about you've read books, you have your own process, your own hiring process. You've led teams now internationally. Let's focus on, and if you can rewind the story back to when you first started becoming a leader and then talk about how you've learned to become a leader in your own company that you started with.

[00:32:19] Malek Nasr: Yeah. Of course, reading books and understanding things from a technical perspective is always useful. Also doing some coaching. It's all useful. I find today that the most important thing. is that you are genuine. And I think people follow you for who you are. Really, I think this is the main part of it.

[00:32:35] It's for who you are. If you are starting to you need to be authentic with them, you need to tell them things the way they are, and I think this is what creates the strongest bond with the team. Whenever I hire, I do this all the time, I tell, from the beginning, you need to establish the trust from really the beginning, from the interview.

[00:32:50] And I tell to the candidate, this job at High Life offers you this, and it doesn't offer you that. Because I understand what they want, right? I ask them and I say, okay, from what you want, this is how it fits and this is how it doesn't fit. Is that okay for you? This is why this is good for you.

[00:33:05] This is why you're not getting this. Maybe you'll get it later, but not now. Is this clear, so I don't oversell. I think this is one of the biggest at least I don't do it. I, but I think it's one of the biggest problems is when things are oversold to people and you give, you, you make promises that you cannot deliver on.

[00:33:23] I'm extremely careful with this because this really breaks the team. So being genuine, saying things the way they are, I think is the biggest and not being afraid of being who you are with them, right? This is, for me, the biggest lesson. Of course, you can learn about how to manage people, cultural differences, etc.

[00:33:41] I would call it more technical. But in reality, it's really being who you are. People are smart. People recognize it. And to lead, you need to create a connection. You need a connection. And this connection can only happen if you are genuine to the other.

[00:33:57] Giovanni Lauricella: You mentioned that you designed your own interview process. What is that?

[00:34:01] Malek Nasr: So it's a I care a lot about the culture and the cultural fit, I would say. My very first interview is a phone interview, which is like a screening call, which I try to understand who is this person I'm talking to. And I'm not talking specifically about the skills, but who is he or she as a person.

[00:34:17] What does he or she aspire to? I don't go into personal details, but it's really understanding how they think. What motivates them. So this is the very first thing. And of course, I have against this what I call a scorecard, which is I understand for each position what's important for me and what's important for the position.

[00:34:33] And I keep it in front of me. When I'm talking to them, it's in front of me. And I personally do this because I'm aware of how biased I can be when talking to people because I have oh, I have a good connection with someone, then this is the right person. No, maybe not. Maybe it's wrong. So I'm aware of my bias, which you can never do without anyway, but you try to limit it.

[00:34:50] So this is the first interview. Then I do a second interview, which is an in person interview, where we really go into details about their previous experience. It's very researched, and maybe it could last up to two hours. They always do this joke. I get this often that they feel like they went through a therapy after speaking.

[00:35:08] But it's actually fun because I find that it also gives them the opportunity first to tell the whole story. And I find candidates very often reflecting themselves on their story for the first time. Which is crazy and I discover things with them, they tell me things and they realize it as they're saying it to me.

[00:35:27] This is very nice and it gives me

[00:35:28] Giovanni Lauricella: I'm going to call you out for something real quick and I want you to keep on going with your thought. But, I think maybe that's part of life when people have to self reflect and rarely people stop long enough to do a lot of self reflection, especially these days.

[00:35:42] But this is your first podcast, right?

[00:35:44] Malek Nasr: Yeah, this is why I'm nervous. That's why I need champagne and chocolate.

[00:35:47] Giovanni Lauricella: Exactly. And even when we were talking about this was what are you going to talk about? How do I tell these stories? So that's that natural ability to have to self reflect. We've now been sitting here for however long and you have a lot of story to tell.

[00:36:02] Just like these candidates that go through your interview process.

[00:36:05] Malek Nasr: And by the way, one thing about interviewing, you have to like it. It's time consuming. It's difficult. You have to try to identify the right candidate while being clueless. So it's it's difficult. You have to love it. If you don't like it, it's not for you.

[00:36:22] But I think it's part of the things that you have to do if you're leading a company or a team, for sure. And then just to finish, the third process is we actually go into, it's more like a case study where we ask the candidate to present something. About a subject that is of interest for us and we reflect with him or her about one of these subjects and see how he reacts on he positions himself This is maybe one hour and a half once I'm done with these three And I take notes, of course of everything once I'm done with these three interviews I do a reference check which is very common in the USA not so much in Europe, but I still do it.

[00:36:55] Giovanni Lauricella: You're this engineer you've come up with this beautiful device that has lasted this whole war zone of the transcatheter heart valve.

[00:37:03] Malek Nasr: It's the right way to call it, by the way. It's a war zone.

[00:37:05] Giovanni Lauricella: Absolutely. And you're one of these last men standing, right? With all this clinical data to be able to show. For all those people listening and watching, and forget transcatheter heart valves or not, just objectively the medical device industry, or maybe life in general, creating a device for the benefit of patients, to help save patients, that kind idea of creating this heart valve device that's going to save all these patients versus wrapping around a business, around a product.

[00:37:41] Is it the way the world really works, meaning challenging of building a business and are there technologies that should have succeeded that didn't? Are there technologies that shouldn't succeed and they did? Is this game of building medical device companies what it seems?

[00:38:01] Malek Nasr: Look, at the end of the day, it's a business.

[00:38:06] Of course you are doing something that's beneficial for the world and for patients. This is true, absolutely true. And it's something that one can be proud of if you actually I have a successful product that is saving lives. Of course, this is true, but there's a business aspect to it. And very often, if not always med techs are financed by VCs, right?

[00:38:23] And the VCs, their job is to make money with the money they invest. So one, one also has to understand this, and this is part of also the switch and mindset from an engineer to a leader in a company. You have to understand that some people invested in your company and they deserve a fair return. Not only by the way, the investors deserve a fair return, also all the employees that have stock options, et cetera, everyone deserves a fair return.

[00:38:45] So you cannot dissociate the humanitarian aspect. from the business aspect. They are really intertwined. And yes, for sure. Sometimes you have companies that failed that should have succeeded, maybe because it's they just run out of funds and the market is not favorable for them, right? Sometimes it's external to the company and we get back to the idea of luck and bad luck.

[00:39:06] Sometimes you can do all the efforts you want, but it's just not the right context. Markets are not helping, whatever. It could be also sometimes a question of management. It's not the right people in the right place. So many factors get into the way of companies and some of them don't succeed while they should have.

[00:39:21] And many succeed or depends what success means, right? For some, it's an acquisition. For some, it's actually treating patients and becoming the gold standard in treatment. But let's put it simply, many succeed that maybe were not the best solution when they were on the table, yeah.

[00:39:34] Giovanni Lauricella: At times, and it doesn't always have to look like this, but this is a business at the end of the day, and not everything is what it seems, but the intention of helping patients is noble, but when you wrap around a business for that concept,

[00:39:48] Malek Nasr: it gets yeah, you add the nuance to it, I would say, which is you have to understand the business and eventually, if you took at all med techs financed by VCs, it's going in the right direction if you look at the sum of these companies.

[00:40:00] But yeah, if you look at individual companies, sometimes some have bad luck and it could be anything but luck in human resources, bad luck in financing.

[00:40:09] Giovanni Lauricella: I want to end with going back to this core of entrepreneurship and I'll ask you again and cheers by the way, I want to give you a cheers knowing what you know now versus 13 year ago, Malek, would you do it all again?

[00:40:29] And also what would you do differently?

[00:40:34] Malek Nasr: Would I do it all again? Yes. Yes. A hundred percent. 100%. I feel very happy with the experience, very happy with where we are now. Honestly, in that sense, yes, it's a blessing where High Life is today and what I'm able to do in this company. What would I do differently?

[00:40:52] I would say maybe a few things. Sometimes you need to choose your battles. Sometimes you take things too much to I would say you feel that certain subjects are too close to your heart, but you don't, it's not necessary. So I would say, yeah, I would be maybe more in hindsight, I would say maybe a few subjects I could have been less emotional about.

[00:41:10] For sure, yeah. But at the same time, this is the beauty of it, right? You maybe at this, maybe at that time, it was necessary to be emotional, but yeah, in hindsight, this is what I would say. I would say being more cold headed on some things. Yeah. Yeah. This is but would I ever do it?

[00:41:24] Yes, absolutely. Absolutely. Like even after High Life, I think I would do it again and again. Yeah.

[00:41:29] Giovanni Lauricella: And my final question for you is speak to all these engineers, whether they're in Medtronic or Boston Scientific or DePuy Synthes or still studying their engineering degree. Yeah. And they have these visions of grandeur of one day starting their own medical device. What would you tell them?

[00:41:49] Malek Nasr: I would say have your ideas clear. Don't always listen to people that have much more experience and tell you this is how things should be done. Do no, do it the way you think is right. Be prepared to wear many hats. Be prepared to do many things, really. And be prepared at some point to let it go. This is important. To let it go because other people will take care of it and then your role will also evolve. And be prepared to to work on leading people. This is really I would say a job by its own. Yeah, maybe this would be my but I would definitely recommend doing it.

[00:42:21] Yeah, for sure. Yeah.

[00:42:23] That's how I want to end this, where I believe we fully just got inside the head, the heart and the guts of this medtech entrepreneur, Malek. I love you. I'm so grateful for knowing for you all these years. Thank you for doing this with me today. And hopefully our story and your story will affect all these engineers who can go off and do amazing things.

[00:42:48] Thank you.

[00:42:49] ​

[00:42:49] Malek Nasr: I'm going to steal one more of these chocolates.

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