Ramji Iyer - Laplace Interventional

[00:00:00] Ramji: But in general, all investors like to see different time points so that they can see your progress. So, I started talking to a lot of people very early. Even when all I had was a napkin sketch or basically, just a concept.

[00:00:20] And I said, this is what I'm trying. But then when you go back to the same investor, in a fairly short amount of time with a less amount of capital, and you have shown progress, then they see the potential in terms of okay. Definitely that's a good delta that they see. And then that gives confidence.

[00:00:35] ​

[00:00:35] Giovanni Lauricella: Hi, everyone. We are here today in St. Paul with Ramji Iyer, the founder and CEO of Laplace Interventional.

[00:00:47] And this is the Medtech Startup Podcast, where we are about to get inside the head, the hearts and the guts of this medtech entrepreneur. And I'm very fortunate. I have known Ramji for a long time.

[00:00:58] That's right. Back when you were over at St. Jude Medical. So I think the best way we could first start this whole interview and discussion is figuring out who you are and how you've built your entire life, academic, your professional career leading up to the time that you had the guts to go out and start a company yourself.

[00:01:15] So Ramji, where are you from? How'd you get here? How'd you start Laplace that entire life spectrum? Who are you?

[00:01:21] Ramji: First of all, thanks for having me. And it's a pleasure to be here and talking to you. And yes, we have known each other for a very long time. Yeah. So I was born and raised in India until my undergrad.

[00:01:33] I did seriously consider going into medicine for my undergrad. Butended up picking up engineering for two reasons. One I got into a really good school and two, a lot of my friends also got into the same school, so I said, okay, I'm taking up engineering, and so mechanical engineering it was.

[00:01:50] Came here to Minnesota for my graduate studies did my master's and PhD and my first job out of grad school was at St. Jude Medical. Where, interestingly, I took up a role in operations. Partly because I thought moving to an R&D type of environment would be easier, given my let's say, Ph. D. And anyway spent five years there, worked on several things, primarily structural heart or cardiovascular slash structural heart space. Worked on the baby mechanical heart valve, worked on the surgical tissue heart valve, worked on the TAVR device. Briefly worked on renal denervation and then after that, there was always a desire to understand startup and be part of a startup with the goal of ultimately starting sometime. I don't know how and but I thought the best way to do that would be to go work in a startup. And that's exactly what I told when I was interviewing for Caisson as well.

[00:02:47] Anyway, so I met Todd and CJ over the founders of Caisson Interventional. Actually in an even before they had office space in a hotel room. It was very exciting. And started as an engineer, did a lot of different things at Caisson I was the second engineer who was hired and ended up leading the R&D there.

[00:03:07] Spent seven years there. Along the way saw a Caisson being acquired by Livanova as well. And then in 2020 I decided to start Laplace. So I was also consulting a little bit but was figuring out what space to look into and then ended up picking up Laplace.

[00:03:23] And I started Laplace in August of 2020. And Here we are have an exciting team, exciting technology i it's been a phenomenal journey, to be honest. I am extremely happy and extremely pleased,

[00:03:35] Giovanni Lauricella: So now here we are. You founded and now we're leading as CEO for Laplace Interventional. Tell us what the technology is and then tell us. Where the company is to date.

[00:03:45] Ramji: Yeah. Yeah. Laplace is a transcatheter, tricuspid valve replacement company. And, like I said, it started the company in, august, 2020. And at that time it was just me.

[00:03:56] I was,

[00:03:56] It was self-funded,

[00:03:58] Partly by,

[00:03:58] some friends and family and then also,

[00:04:00] A small grant from the Minnesota State.

[00:04:02] It's the LaunchMN grant. It's relatively small,

[00:04:06] But,

[00:04:06] At that time, it was extremely crucial,

[00:04:08] And I have everything put together. It was,

[00:04:11] A little less than 150, 000,

[00:04:13] Enough to do,

[00:04:14] Let's say one animal study enough to file a provisional patent enough to,

[00:04:18] Do all the bench,

[00:04:19] Testing,

[00:04:20] Do some early prototyping.

[00:04:21] But I think that's where,

[00:04:22] Minnesota overall,

[00:04:24] Has been extremely helpful as an ecosystem.

[00:04:27] Given that I've spent a lot of time in the space in general, Transcharacter heart valve space in general,

[00:04:32] I knew what I wanted,

[00:04:34] To basically go,

[00:04:36] Convince,

[00:04:36] The initial investor.

[00:04:37] At that point, I was, to be honest, I was looking at,

[00:04:40] It could be a Seed it could be a series A.

[00:04:42] I was open. I wasn't necessarily looking for something.

[00:04:45] But I knew what Had to be raised to get to where I need to get to.

[00:04:49] At least that was. Fairly clear in my head.

[00:04:53] Anyway,

[00:04:53] So series A was raised only in,

[00:04:55] September of 21.

[00:04:57] That was,

[00:04:57] 7. 9 million.

[00:04:59] And then,

[00:05:00] After that,

[00:05:01] We,

[00:05:02] Now we have 13 full time employees.

[00:05:05] We have,

[00:05:05] Approximately I would 25 26 FT lease

[00:05:08] you

[00:05:09] We have a 5, 000 square foot office space. We built an R&D lab, built a clean room, most importantly, have shown great feasibility data in bench and animals,

[00:05:19] And making good progress overall,

[00:05:21] Working towards our,

[00:05:22] clinical feasibility.

[00:05:23] And recently we also closed our series B round,

[00:05:26] Which you know how difficult the climate is.

[00:05:29] So yeah,

[00:05:30] Extremely proud of our team's accomplishments here.

[00:05:32] Giovanni Lauricella: So

[00:05:33] I was thinking about asking it later on, but I want to get right off of it because of everything you just shared.

[00:05:38] In the grand scheme of things, it's a transcatheter bicuspid valve replacement technology. We all know, I shouldn't say we all know, but anyone who's privy to the space, this is not a chip shot where you're going to get in and get out in a couple of years.

[00:05:51] This is a long haul. And I know that one of the proudful things that you are about your company is how fast you've made it, how far you've made it, how quickly you've done it.

[00:06:03] How, what do you attribute that to?

[00:06:05] Ramji: I think it's, it's the team.

[00:06:08] We do have a rockstar team and I'm extremely proud that I was able to, bring it together, played my role in bringing it together. And, but, although it's a small team,

[00:06:18] it's really, very, if you count the number of years in terms of total experience that the team has. There's plenty, and everyone plays that role and everyone, comes together and, we argue, debate, in a healthy way. One of the things that I always tell, my team and,

[00:06:35] we, it's about optimally balancing data with, good judgment and good, analytical skill sets and able to, get to a conclusion quicker. Sometimes, we make bad decisions, too. But, I would say for us to be here, we should have made a lot more good decisions than bad.

[00:06:52] Giovanni Lauricella: In the spirit of the entrepreneurial spirit. You went from white sheet of paper, right? So this quick consulting phase, you're like, okay, I'm going to go start this company once again, not in the easiest space to innovate. And then three years. Now, here you are.

[00:07:07] So I want to get into. The fact of. You going from a big corporation like St. Jude, getting that very early on experience within Caisson but still not leading that helm, right? So you've had both startup experience and corporate experience. Do you attribute that to having a nice recipe to give you that success and confidence to go do your own thing?

[00:07:33] Ramji: I think so. I think the St. Jude experience was a good way to come from academia to, corporate environment where you could understand the building blocks of why certain things exist. You have to live that to experience all of that.So I think, the first five years, i was, yes, working on certain projects and certain technologies that i'm extremely proud of, but at the same time, it gave me a good, exposure to how things need to be done. Why are certain processes and structures in place to, develop a product, all of that. So definitely that was a good Foundational experience. And then, Caisson was, I think i was a sponge, in terms of just, whatever any, scenario or, any person or a, I had terrific people to work alongside. I had terrific, mentors there, in terms of, the two founders and it was just such a great environment to learn about so many things, product technology.

[00:08:31] Things are obviously, in some sense, chaotic in a startup. There's too many things going on and you're always. But despite that, it's important to just, have a structure and, have a systematic process that you can work through and that discipline, all of that existed. And I learned a ton there. So yeah, I'm trying to, apply all of that in Laplace. And I think we've done good so far.

[00:08:55] Giovanni Lauricella: So you mentioned the word mentor and sorry for throwing you on the spot, but you know where you are in your life, the big corporates having the startup experience and now running your own thing. any mentor you want to give a shout out to?

[00:09:06] Ramji: Yeah, absolutely. I think Todd Mortier, whom I reported to all at Caisson and CJ Schweich. They are the two founders off Caisson. They founded, Myocor as well, and they are, serial entrepreneurs, and, I have a extreme amount of respect for them. And, everything that I've learned from them, and, again, continue to be, great mentors,

[00:09:28] Giovanni Lauricella: The one entrepreneur lesson, one of many, that I want to learn from you today is,If you could speak to a room of entrepreneurs who are engineers at Abbott, Medtronic, or at some other startup right now who are just salivating on one day starting their own idea.

[00:09:44] What don't they know about being a CEO?

[00:09:47] What was that transition from, okay fine, it was nitty gritty and very different at Caisson from the big resourceful corporate giant that you were at St. Jude. But there is a difference of starting and leading and running your own company. What is those? What's the role of a CEO in your opinion, in your learned opinion and what are those learning lessons you had to go through?

[00:10:07] Ramji: I think, given the space or, area that we are in, which is med tech, which is, it's tech. It is extremely technical. So I maybe I'm biased, but I do think engineers make a great CEOs and which might be a little contrary to some of the other opinions that I've at least heard. But,

[00:10:26] I, similar to let's say software, similar to I do think medtech needs a lot more engineers, to become more CEO. So I think, as engineers, there's generally a lot of questioning, and, you generally want to generate a lot of data to drive through certain aspects of it.

[00:10:45] In terms of what, I think, is a CEO's role, I think it's primarily to set vision, and also direction for the company.

[00:10:55] And where that becomes important is basically when, when things are not clear, right?

[00:11:00] The obvious ones, everyone knows, especially in a small team, you know what needs to get done. It's in, it's during times of uncertainties, that, you as a CEO can actually provide clarity by providing a certain direction. So that was something that, I thought was very important and I continue to think that.

[00:11:24] I think that's, in my opinion, one of the biggest role of, of a CEO. And then, a lot of times, essentially, i, there are so many things that need to be done. So I'm almost essentially, fluidic enough that I fill the gap, so to speak. Obviously, I need to make sure that,

[00:11:41] Need to have more and more people build out the team in a Structured way so that we don't get constrained from a lack of Resource standpoint. But i think i look at my role as Almost fluid to bring everything together and just Filling the gaps, so to speak.

[00:11:57] Yeah. Is it challenging for you, now that you've built out The team and you still have more room to grow, i'm sure, is it challenging for you to be that fluid?

[00:12:06] Profile that brings everything together rather than being that Awesome design, hands on engineer that you

[00:12:11] loved? I, to be honest, i enjoy both the roles, and i like to Be focused at times, and i like to have that broad perspective Also. It is challenging, but in a Good way, in a healthy way, right? I enjoy having you,

[00:12:30] it's working out is not easy, but when you finish that, you feel good running a marathon.

[00:12:35] It's not easy when you finish it. You feel good, similar to that. It's hard, but in a healthy way, I think it, it does stimulate me. And, yeah, I find it very satisfying.

[00:12:47] Giovanni Lauricella: So first time CEO first time fundraiser. You talked about having friends and family and a grant from Minnesota that was slightly less than 150, 000.

[00:13:01] And then all of a sudden this press release comes out and you've raised 7. 9 million in a Series A. From being the engineer and reiterating everything that we've already talked about, where did you even learn and what did you even start as your first step in learning how to raise capital?

[00:13:19] Ramji: Yeah. I think, you've built a network, right?

[00:13:21] Throughout the years, I talked about the mentors and I did have a good amount of people to start with. Probably because I was first time CEO. I didn't know I had a goal in mind. And, essentially a lot of discussions, a lot of talking to different people.

[00:13:35] It was multiple meetings, and, through that I navigated through the space. There was a little bit of strategy, obviously, in terms of, how do you, I spend the time. I would also say that I did spend good amount of time initially, at least talking to a lot of investors where now I probably wouldn't, just trying to be mindful of, which investors target which therapeutic areas and whatnot.

[00:14:00] And, even medtech is fairly broad.

[00:14:02] Cardiovascular specific PMA versus 510ks different. All these different, things mean certain things to investors, and, you can get these answers fairly quick. You don't have to go through a full blown pitch and, do all that. I think it took me a little bit time to figure that out. But, but it was also, a good time to, keep pitching and keep improving your pitch. So so there's always some positive. So it's all of that. Yeah,

[00:14:30] Giovanni Lauricella: I deal with a lot of startups and I deal with a lot of first time founders and it's been a tough year and a half of hearing people trying to raise capital, especially after this big boom of 2021 and even early 2022. But a lot of the times, even in class three devices,

[00:14:45] I'm hearing these founders who they scraped together that 100 or 200, 000 or maybe even 50, 000 up front. They did what they could with it, but now they're raising the seed round and it's, 500, 000 or 2, 000, 000 or 850, 000, whatever it may be.

[00:15:02] You're an engineer and you mentioned engineers should and do make good CEOs. Yeah.

[00:15:07] How did you engineer in your head in that learning process of just saying, okay, I have a little bit less than 150, 000. Yeah. Screw it. I'm going right for my series A and I'm bypassing the seed round.

[00:15:17] What was that?

[00:15:18] Ramji: Yeah. So there was not, it was less of, Seed was a series A versus, all the different nomenclature. It was more about what do I need to go from where I am to basically, to next meaningful milestone, right? And I initially, I did consider raising maybe a little less, maybe somewhere in that four to five million, but I don't think I could have gone that far with a million dollar or 2 million. So I would have called it a series A no matter what, whether it was four or five versus eight million. That's basically, can be debated.

[00:15:53] But I was, I wanted that much so that, then I can show some meaningful progress. So that because I think that is something that, every, CEO, should be looking for.

[00:16:06] I think what is that next uptick, in terms of building the company. And for us, it was showing pretty clinical feasibility. Sufficient so that there is, now we feel that there can be more funds being raised to go on to the clinical feasibility. So that was really the key factor that played a role on how much to raise and again, it wasn't easy.

[00:16:28] But a lot of times that's where all this filtering that I mentioned in terms of, if you look at how many, investors are there who, do that, 7, 8 million, after, let's say a 150k raise. PMA type, company. Not that many. You can really narrow it down to a few.

[00:16:45] Giovanni Lauricella: So out of the styles of investors that you have successfully raised from both even in your series A and series B. Yeah. So we have, objectively speaking, we have angels and angel groups and family offices and corporate venture and we have foundations and we have healthcare system venture arms.

[00:17:03] There's a lot of different styles of investors. What types of investors have you raised from?

[00:17:09] Ramji: Yeah. For Series A, that was led by a strategic, and then, ShangBay capital, participated as well. We also, had Mayo Clinic participating in that round. So those were the, I would say the major investors. And then, after that, in Series B, we had, Features Capital. And,

[00:17:26] ShangBay was,

[00:17:28] Was the lead,

[00:17:29] ShangBay along with Features,

[00:17:30] Co led the Series B round,

[00:17:32] And then we had,

[00:17:33] Engaged Venture Partners,

[00:17:34] Saw that you met Kelly recently,

[00:17:36] And then we had a few others as well,

[00:17:38] Yeah.

[00:17:39] Giovanni Lauricella: We like to talk about this just because it's the psychology of capital.

[00:17:42] Sure. When You're putting your first time pitch decks together, and I'm sure you in a Caisson you've seen some of the pitch decks because you were part of at least the awareness of Caisson having to raise, but now in your own company when you are going and talking to a strategic big multinational or you're talking to a institutional investor or Mayo Clinic a hospital health care venture arm Do they all have different motivations and different needs and wants, and then the story that you're pitching your same technology, does it have to change?

[00:18:15] Ramji: Yeah,

[00:18:15] I think the pitch, to some extent, yes. But, I'll tell you the things that I, gave importance to. So I, I think given the space that, we are in, by that, transcatheter, let's say, and, so I wanted to reach out to strategics right from the beginning, where the general,

[00:18:36] i wouldn't say all the advice, but general,

[00:18:38] I was getting some, advice that, it's too early for strategics, why don't you go in after some time, et Cetera, but I decided to. Partly because I think, they, the strategics have spent the time, developing a TAVR device, or acquiring a TAVR, technology or technologies, acquiring mitral technologies, and digesting it and still digesting it, and probably have some internal, tricuspid programs or have invested in some other tricuspid.

[00:19:05] So that's, we all know that.

[00:19:07] And given that I, I thought they would understand the space really well, right?

[00:19:12] So they've really spent a lot of time dealing with the,

[00:19:16] what works, what doesn't.

[00:19:18] I thought I should definitely talk to them at least see, so that was one approach that I took.

[00:19:23] So

[00:19:23] I would say,

[00:19:24] that it is important to,

[00:19:25] pay importance,

[00:19:27] to whom you need to talk to based on what space you're working in. So

[00:19:32] so second, I think,

[00:19:33] coming to hospitals, I think,

[00:19:35] again,

[00:19:35] primary customers are interventional cardiologists, cardiac surgeons, given the type of technology that we are working on.

[00:19:41] I looked at all the key interventional cardiologists,

[00:19:44] in this space and how closely do they work with their venture arm.

[00:19:49] I was trying to gather that,

[00:19:52] information and I would just ask some of the physicians and

[00:19:55] based on that I,

[00:19:56] talked to certain ventures,

[00:19:58] in the hospital.

[00:19:59] So that was something that,

[00:20:00] I used to get into,

[00:20:03] some venture arms and certain. So I, and I thought that was, at least that was successful for Laplace.

[00:20:08] On the corporate side Sure. They're big behemoths.

[00:20:12] Giovanni Lauricella: Time is not really Yeah. That much of an issue because

[00:20:14] They're at the end of the food chain.

[00:20:16] Yeah. When you start dealing with Institutional investors that have time horizons and they're having to return their money back to their own LPs, etc.

[00:20:26] What were some of the processes that you had to learn or just go out and find the right partners? But how do you convince institutional investors to get on board so early for such a intense technology?

[00:20:40] Ramji: Yeah, I think the,

[00:20:41] a lot of times,

[00:20:42] there is going to be I would say most institutional VCs would fall and

[00:20:49] they've already made up their mind in terms of, are they going to go for a PMA longterm play or not? I think,

[00:20:56] that kind of initial filter, I think you can find out even in the initial discussions.

[00:21:01] I think,

[00:21:02] just by asking, I think so, so you, so that was the first filter. Then after that, I think there might be few that may do it, may not do it. But there's a little bit of.

[00:21:11] It depends to them. I think,

[00:21:13] you have to,

[00:21:14] present the technology and the opportunity that it,

[00:21:18] it really presents.

[00:21:19] And,

[00:21:20] a lot of the

[00:21:23] this applies to strategic as well. But in general, all investors like to see different time points,

[00:21:29] so that they can see your progress. So I started talking to a lot of people very early.

[00:21:35] Even when I had all I had was,

[00:21:37] a napkin sketch or basically,

[00:21:39] just a concept.

[00:21:41] And I said, This is what I'm trying to. But then when you go back to the same investor,

[00:21:46] in a fairly short amount of time with a less amount of capital and you have shown progress, then they see the potential in terms of okay.

[00:21:53] Definitely

[00:21:53] that's a good delta that they see. And then that gives confidence.

[00:21:57] And that's applies to any investor. And that's so we all think about investing in general.

[00:22:03] So we want to see growth.

[00:22:05] So trying to talk to them, I would say,

[00:22:08] talk more

[00:22:09] early as possible in some sense, so that you can show that growth.

[00:22:12] Giovanni Lauricella: and when you have, like you mentioned, ShangBay came in on the series A how does that relationship develop? We're like, you what does it mean when they continue on to the next round and not only that, but lead it like what signal does that send when you're raising,

[00:22:31] Ramji: Clearly, I think

[00:22:32] they,

[00:22:32] see the,

[00:22:33] the,

[00:22:34] all the positives of the company and they continue to see the growth of the company.

[00:22:39] And I think,

[00:22:40] it's a reflection of that.

[00:22:42] So I think it's definitely a very strong signal.

[00:22:44] And,

[00:22:45] I'm hopeful that they'll participate in the future rounds as well. And,

[00:22:48] yeah,

[00:22:50] Giovanni Lauricella: And then going back to

[00:22:51] the educational mechanics of it.

[00:22:54] Never having raised capital before, like the lexicon safes, equity priced rounds, convertible notes, preferred versus common. Did you read books and did you have to just ask, did you have all these mentors?

[00:23:06] How you make it sound so easy, but I'm sure there was a really good learning

[00:23:09] process.

[00:23:10] Ramji: There was see, so

[00:23:12] there's the math and the finance behind it.

[00:23:15] And then there is the art of fundraising, right?

[00:23:18] The negotiations. So I'm pretty sure all engineers who is the math part of it.

[00:23:23] Yes, there is nuances to it, and you have to spend the time. But,

[00:23:27] again, these are all engineers who have solved much more complex problems.

[00:23:31] So that's why I feel like,

[00:23:32] so that the math part of it, yes,

[00:23:34] I learned about safe,

[00:23:35] some of the And,

[00:23:37] and then I learned about,

[00:23:39] the,

[00:23:39] equity,

[00:23:40] all the price based equity rounds, all of these.

[00:23:43] But those are the, those are things that can be learned. It's the language that you have to learn and,

[00:23:49] how everything works out.

[00:23:50] The nuances of,

[00:23:52] or the art of fundraising, so to speak,

[00:23:54] that's the part that,

[00:23:55] again comes by doing it multiple times, talking to more people and then building that relationship. And then,

[00:24:02] like I said, you're showing that growth, so to speak, all of that. So I think that's what it takes to convince someone.

[00:24:08] Giovanni Lauricella: Closing up on the actual raising piece in your opinion, and maybe even some of the nuances. Yeah. Which was harder, Series A or Series B?

[00:24:18] Ramji: I was told that Series B would be easier than Series A.

[00:24:22] I don't know if it was because of the climate or, I think both were hard.

[00:24:27] And,

[00:24:27] it took time.

[00:24:28] It does take time. And I think it never,

[00:24:31] I think one of,

[00:24:32] multiple people have told me that,

[00:24:34] fundraising never really stops. You just keep going. You have to just keep at it because it's never easy. And,

[00:24:41] again, I think the focus ultimately comes down to if you're building a good technology, good company,

[00:24:48] and I do, I think,

[00:24:49] it may take time.

[00:24:50] It may take slightly longer than what you desire,

[00:24:54] but it'll happen. So that's what I continue to believe in.

[00:24:58] Giovanni Lauricella: You came all the way to Minnesota from India, you were educated here, you've spent and built your career here. So you have both the corporate and the startup again from here. Yeah.

[00:25:08] What's so great about the Twin Cities? Like where does this fall in the ecosystem of medical device and why is it a fertile ground for

[00:25:17] entrepreneurship.

[00:25:17] Ramji: Yeah, I think

[00:25:19] Minnesota's great.

[00:25:20] Just from,

[00:25:21] the talent,

[00:25:22] that Minnesota presents,

[00:25:24] great schools,

[00:25:25] great engineers,

[00:25:26] great,

[00:25:27] corporates,

[00:25:27] Medtronic, Boston Scientific, Abbott,

[00:25:31] great hospitals, Mayo Clinic, Abbott Northwestern,

[00:25:34] the V. A. and then the startup ecosystem. I think there are so many,

[00:25:41] manufacturer contract manufacturers design prototyping house that you can tap into irrespective of the stage of the company.

[00:25:49] If you're in very early stage, still trying to get some,

[00:25:51] prototyping going, there are places that you can go to if you are,

[00:25:55] early to mid,

[00:25:56] stage company.

[00:25:58] There are places that you can go to or if you're like,

[00:26:00] if you're commercial and you're basically, and there's still multiple places that you can go to. So I think that,

[00:26:07] offering,

[00:26:07] is great and,

[00:26:09] that's what makes Minnesota special.

[00:26:10] Giovanni Lauricella: How's the ecosystem of the investor climate around here? Yeah. Does it force you to have to go to the coast?

[00:26:16] Ramji: So we do go to the coast. I would say rather than course,

[00:26:19] basically go global at this point.

[00:26:21] And,

[00:26:22] I know of several companies that have You know, brought in funds from,

[00:26:26] from Asia, from Europe, from South America.

[00:26:29] You name it, there are,

[00:26:30] there are always instances.

[00:26:31] I think,

[00:26:32] I would say from an investment standpoint, yes, there are a few,

[00:26:35] large VCs as well here that invest in MedTech space.

[00:26:38] But there are a few other, you, if you have to go larger, you do that.

[00:26:44] Giovanni Lauricella: And then in the space that you're actually innovating in.

[00:26:47] It's 2023, 10 years ago was 2013. CoreValve was already acquired. PVT was already acquired in the TAVR space. Evalve was already acquired in the mitral repair space, but fast forwarding all these years, here we are in 2023.

[00:27:03] You just got back from TCT. Where are we in terms of when you think about the four heart valves and innovation from trans catheter perspective, like where's the industry today?

[00:27:14] Ramji: I think,

[00:27:14] TCT was great. First of all, I think this was

[00:27:17] the, maybe the second TCT after,

[00:27:20] let's say,

[00:27:21] post COVID.

[00:27:22] So it was nice to see everyone. And,

[00:27:24] it was huge, but it's still such a close knit,

[00:27:27] group.

[00:27:28] In terms of TAVR, I think,

[00:27:30] the,

[00:27:30] it started off with prohibitive or inoperable,

[00:27:33] risk patients and then,

[00:27:34] moved on to high risk, then moved on to,

[00:27:37] moderate. Now we are in low risk.

[00:27:38] So I think the field has come long ways,

[00:27:41] and,

[00:27:42] both,

[00:27:42] Sapien and,

[00:27:43] Corwell presented that data,

[00:27:45] seemed very positive. In terms of mitral repair, I think,

[00:27:49] again,

[00:27:50] what CLIP has done to the overall field,

[00:27:52] both,

[00:27:53] CLIP and PASCAL,

[00:27:54] the tier,

[00:27:55] basically,

[00:27:56] has moved the field so much forward,

[00:27:58] so mitral replacement is still,

[00:28:01] early,

[00:28:01] I think there is still,

[00:28:03] no one or two or three,

[00:28:05] solutions,

[00:28:05] but everyone is fighting for its spot, which is great to see. Tricuspid has come along in a long ways too.

[00:28:12] It's no longer the forgotten valve.

[00:28:14] People have,

[00:28:15] triclip data was shown earlier, but then,

[00:28:17] evolve six months. Data was shown at TCT

[00:28:20] the,

[00:28:20] the fact that patients do well when you treat T. R. It's important for the field and,

[00:28:26] it's important for Laplace, but it's important for everyone in this field.

[00:28:30] And you and I were talking about this. You mentioned that, especially when it comes either building a business or certainly raising capital. You mentioned the space that you works in matters a lot. Yeah,

[00:28:42] Giovanni Lauricella: what do you mean by that?

[00:28:43] Ramji: I think that the technology that you're developing, that's what I meant by space.

[00:28:48] But basically,

[00:28:49] I think,

[00:28:49] and throughout this conversation, we have touched on that,

[00:28:52] here and there,

[00:28:53] the complex technology like a transcatheter heart valve replacement.

[00:28:59] You're developing a valve, you're developing

[00:29:01] usually a set of catheters, not just one catheter.

[00:29:04] It's simple to say delivery system, but that's a combination of three or four catheters.

[00:29:09] And then you're also developing a procedure.

[00:29:11] So it's,

[00:29:11] it's complex.

[00:29:12] So based on that,

[00:29:13] the capital required is,

[00:29:14] substantial. It takes long term,

[00:29:17] long duration before,

[00:29:19] the investors get their return on the investment. So all things considered, I think you have to make sure that.

[00:29:25] When I say space, it's the technology that you're really developing. You have to consider all these factors and then decide on whom to talk, when to talk,

[00:29:34] how frequently to talk, all of those.

[00:29:35] Giovanni Lauricella: And then going back to

[00:29:37] the fundraising itself, coming out of this challenging year, how do you handle the no's and how do you handle the challenges when you have like the naysayers and the disbelievers and, but you still have a great track record and you're still making great progress.

[00:29:50] How do you handle that own psychology when you're out there raising capital

[00:29:54] with all these notes?

[00:29:54] Ramji: Yeah,

[00:29:54] again,

[00:29:55] let's face it. No one likes being told no. And,

[00:29:59] and I'm no different.

[00:30:00] But having said that, they usually have,

[00:30:02] the good investors usually have a reason.

[00:30:05] And,

[00:30:05] I try to.

[00:30:06] Understand what that is and then try to basically work on it and then go back and show that,

[00:30:12] A lot of times, like I said,

[00:30:13] it takes time before they get comfortable,

[00:30:17] with,

[00:30:18] with investing and you just have to keep at it and then show progress and,

[00:30:23] and then go back to them.

[00:30:24] And a lot of times where,

[00:30:27] when I have that relationship or,

[00:30:28] reasonable amount of time and shown progress that actually has worked out well.

[00:30:33] Yeah,

[00:30:33] Giovanni Lauricella: A lot of investors called medtech hard tech, and that's objectively speaking, you're in a

[00:30:39] really hard portion of hard tech medtech.

[00:30:43] And innovation is not going to stop.

[00:30:45] So once again, having known you for all these years, and now you've taken on all this experience, and you've now built a team and built a company and raised all this money. If you have to speak to a room of entrepreneurs who, once again, are going to be in your shoes one day, they want to go out and start a company.

[00:31:02] They want to start building their own technology and turn it into a company. Knowing what you've learned and what you've known about entrepreneurship, what would you tell yourself 12 years ago, 10 years ago, what would you tell all these entrepreneurs about what to expect being in your shoes now?

[00:31:18] Ramji: Yeah,

[00:31:18] I think a couple of things.

[00:31:20] I think one is,

[00:31:21] I think,

[00:31:21] you should,

[00:31:22] or one should,

[00:31:23] try to learn the operational aspect of it. I think,

[00:31:27] once you,

[00:31:28] have raised funds, how to run a company is best learned by working in a startup. So I think if you can, I think that's something that,

[00:31:36] I think it teaches you how,

[00:31:39] cost efficient you can be, how lean you can be and still make a lot of progress.

[00:31:43] In some sense, I think,

[00:31:44] that,

[00:31:45] lean or lack of resources,

[00:31:47] fosters creativity in some sense. It forces you to be creative. And that's a great way to,

[00:31:53] learn how to run a startup. So I think so that is one. Why that is important is then you will be able to communicate to your potential investors that you, especially when you are a first time,

[00:32:06] CEO.

[00:32:07] The only thing you have is a track record because you haven't done that. So I think,

[00:32:12] showing some experience of ability to

[00:32:15] execute when funded, I think will give the investor some confidence.

[00:32:19] So I think that's something that,

[00:32:20] I would say is valuable. The other part is,

[00:32:25] again, look,

[00:32:27] yes, I've raised some fun,

[00:32:28] some funds and I'm extremely happy, but it's still the beginning.

[00:32:31] If you look at all everyone else in the field, how much they have,

[00:32:35] still long ways to go.

[00:32:36] So all I would say is,

[00:32:37] just start once you feel,

[00:32:38] everyone has this,

[00:32:40] internal scale where they feel,

[00:32:42] they're ready to start. Or,

[00:32:44] I think sometimes it's just good to start,

[00:32:46] start doing it and,

[00:32:48] a lot of things will,

[00:32:49] fall in place if you're disciplined and if you keep doing in a systematic fashion, it might, you will run into some roadblocks, which is fine.

[00:32:56] Which,

[00:32:56] but you should be able to overcome it. If you have a good system and a good practice and if you're disciplined.

[00:33:03] So yeah,

[00:33:04] Giovanni Lauricella: My last fun question for you is the name. So interventional certainly speaks for itself, but Laplace Interventional, how'd you come up with the name and decided to

[00:33:12] run with that?

[00:33:13] Ramji: Yeah.

[00:33:13] The. The stress in your heart wall is governed by Laplace's law.

[00:33:18] So it's,

[00:33:19] it's the name of the scientist,

[00:33:21] who came up with that equation, so to speak. And

[00:33:24] I do,

[00:33:25] believe people make big impact. And

[00:33:28] yeah, that's why Laplace Interventional.

[00:33:31] Giovanni Lauricella: Ramji, I'd like to say thank you very much for being here with us today.

[00:33:34] Thank you. And for all those watching and listening in today, This is the MedTech Startup Podcast where we just got inside the head, the heart, no pun intended, and the guts of this medical device entrepreneur, Ramji Iyer founder and CEO of Laplace Interventional. Thank you so much for being here today.

[00:33:54] I really appreciate it. Thank you.

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