Gerardo Noriega, Presiden & CEO at PercAssist, Inc

Jesus Moreno (00:02.348)
Hey Rdo, welcome back to the show. It's really a privilege to have you with us again.

Gerardo (00:10.57)
Thank you, Jesus. Thank you so much.

Gerardo (00:26.193)
special friend to me and wonderful person. So, let's take it away Jesus.

Jesus Moreno (00:34.58)
Absolutely, thank you, Gerardo, and I would like to start from the beginning. You made the move from Lima to San Francisco in the nineteen seventies. A pretty different shift both personally and professionally. what did that transition look like for you and how did that ultimately lead you into MedTech?

Gerardo (00:59.713)
Thank you Jesus for that wonderful question. My journey started in July 7, 1977 when I landed in San Francisco and I was fortunate enough to be welcomed by my uncle Victor in San Francisco in his house and by the avenues. So upon arrival, my English was zero pretty much, nothing.

close the window because it was so cold. Summer in San Francisco, you know, it's very, very cold. So, you know, he said, you need, let's go and register, you know, at the university to learn English. So it was the first step, like pretty much upon arrival. And the university was about 10 blocks from the house. So, but I was so afraid to take the bus because I said, what happened if I get lost? I be able to talk to anybody.

Not knowing that San Francisco is a very diverse city in which you have multiple people from multiple nations. So I think I would have been okay taking the bus, but I was afraid. So I just walked to school both ways and I didn't have any friends, anybody. So it was good, you know, anyway. So learning very quickly, I mean, get going.

After that, you know, my journey expanded. By then I have more friends and, you know, able to communicate, which is so important. Shaping my, a little bit my life as an immigrant. Honestly, my intent was always to stay for six months. And I've been here for 50 years now.

So that's kind of the beginning of the journey in the United States. Obviously, the situation was quite different at the time. I don't see how now, looking back, I think it was a pretty daring move on my part, at such a young age, to take this big journey. Probably I wouldn't do it again. It's just my thinking now, obviously. It's easy to look back, right?

Jesus Moreno (03:11.722)
Yeah.

Mm-hmm. Mm-hmm.

Gerardo (03:17.002)
That was the time, the opportunity was there and I was welcomed by my uncle Victor, who was wonderful gentleman, very successful, so he me through good things.

Jesus Moreno (03:31.051)
Wonderful. And how did you get involved in in MedTech?

Gerardo (03:36.023)
Well, you know, after learning English, obviously, I needed to further my education, which was the intent all along anyway. So I went to the engineering school at San Jose State University, where most of my teachers were from industry. would say all my classes were early in the morning, like, you know, seven, eight o'clock in the morning, and then after four o'clock work.

the professors were available after work. So all my training has been the latest in technology from these professors. And also very hands-on. Silicon Valley is always innovating, always moving forward, not only in the United States, but worldwide. I travel throughout the world trying to find a place like Silicon Valley. And honestly, I haven't found one that has these dynamics.

And it changes with the years, you know what mean? So that's what happened. And it started in telecommunications, fiber optics. And a company hired me to work on that. Three months into my first job, my boss told me that he was being laid off. And he said, now you are the head of engineering. And here I am, young engineer with three, four months of training. And he said, no, don't worry. I train you well.

So I took the opportunity and move forward. I realized that the company was counting on me to advance the technology. So I hired an engineer to help me. And because at the end of the day, it's a group effort, right? One individual cannot take it on his own. then an opportunity came. A company recruited me.

to work in neurology in coils for the brain, for aneurysms in the brain. So I told them that I was not familiar with medical field. I'm a technology type of person. They told me, no, you have the right skills for us. So it will train you. So it's fantastic. I started to work on it and pretty soon I realized that this was the thing that I wanted to do.

Gerardo (05:54.923)
going forward, but I wanted to add technology to the device. I always wanted to add more in the electromechanical communication type of thing. Even if he's looking for opportunities to advance the technology by adding electronics software, even though I'm not a software engineer, but I know enough to add technology to whatever I worked on. And I realized that just at every single invention that I

Jesus Moreno (05:57.022)
Yeah.

Gerardo (06:24.32)
created or I worked on, there is some level of software hardware electronic communication type of thing. It's very much Silicon Valley like.

Jesus Moreno (06:37.822)
Yes, infused with the sorry, I I was gonna say infused with the DNA of of San Francisco Silicon Valley technology entrepreneurship.

Gerardo (06:37.918)
After that.

Gerardo (06:50.806)
That's exactly what this was about.

So I joined this small company and I was very happy there and the company eventually went public or I didn't acquire it. I said, well, know, I did okay. So I was able to purchase my first condominium.

And said, well, it's not too bad. Then other companies, now my name was out in the market. So other smaller companies reached out to me and expanded my offerings again into the ultrasound imaging, stenting.

So now you have a electromechanical, you know, into the pool of things. So again, that company also was acquired by a larger company. Once the companies get acquired by a larger organization, then it's not my thing. It's not, you know, I don't mind, but it becomes too, too bulky, too slow. And I like speed execution. That's my thing. It's called vision and execution. That is my.

by driving force behind whatever I do. Dream about it, but make it happen. Because there is lots of dreamers, you know, but not everybody is able to execute. I do. I execute well, good or bad. Because you don't know what you don't know, so I just put it to practice whatever I have in mind.

Jesus Moreno (08:28.555)
Of course.

Gerardo (08:28.81)
That happens about four or five times in which I joined companies and they all have been acquired or gone public in the same mode. You know, they acquire by bigger companies and I lose my driving forces, which is a smaller startups, you know, get going.

Gerardo (08:52.438)
Do you want me to continue in the journey a little bit more?

Jesus Moreno (08:57.47)
we I think I think we we get the big picture of of how that transition unfolded for you and and how you were presented with the right opportunities and the right people along the way to to steer you into med tech and and you added that flavor of technical technology into whatever product the company was was

Gerardo (09:13.236)
Yeah.

Jesus Moreno (09:26.686)
developing at the time. But you you mentioned a couple of times that need to adquire a language, a second language, English in this particular case. But I know that you your career is accentuated by working across multiple cultures, multiple countries, even even within the same week. And you're very hands-on as you've already shared.

you talk about being in the operating room across different countries and working with side by side with the medical staff, even speaking their language. And I want to contrast that with what the industry is going for or it's been pushed into with today's innovation, AI specifically, and how that

In addition to remote monitoring monitoring and automated data capture, algorithm decision making, all those elements that are separating the human presence from the execution of the study, it is it's posing a a necessary question, which is where does being physically in the room give you an edge?

That technology can really replicate.

Gerardo (10:58.898)
It's a great question. It's very important to feel the connection with the people in the room, the physician, the nurses, assistant, whoever is in the room, you need to connect. And the best way that I found is to greet them in their own language, try to learn their own language. I was in Czech Republic, you know, for the first time in my life.

Czech sounds like Polish and I speak some Polish. So some of the words were similar and I was able to communicate and humor the people in the room when I spoke and they tried to sound like they do. I tried to mimic their movements and I greet them like they do. then all of a sudden you become part of their team and then the transition is seamless. I don't.

get all the comments. Obviously the languages are more romantic like French, Italian or Portuguese. You know, I'm more engaged. But on the other ones, I'm just as engaged. In fact, I speak some Japanese too. I have many Japanese colleagues and they cannot believe it that you know I speak Japanese. I sound like Japanese too. I make it sound like it.

So make the effort to do that. It is extremely, extremely important to connect, especially nowadays in which you need the diversity of languages and cultures to succeed.

throughout and that has been great for me, honestly. When we develop clinical protocols, for instance, I remind the person writing the protocol that this is for a foreign reader. know, when we apply for clinical studies approvals outside of the United States. So the sentences should be short. So when the translator translates,

Gerardo (13:07.606)
is a lot easier for him. If you go into a long run sentence, even though it's correct, grammatically correct, it is harder to translate and harder for the reader to communicate. So being mindful that the reader is a foreign person is important. So in every aspect, even the name of the product is important to make sure that everybody, or as much as possible, can

say it, can pronounce it. So I'm mindful of those little details.

That's, know, in our company, have multi-cultures, multi-nations. And what is beautiful behind that is that we all, you know, push in the same direction, which is the success of the product. I mean, we have worked internally with people from China, Korea, South Africa, Czech Republic.

Americans obviously, because we're in the United States, Mexico. Now we're working with Brazil. I worked with folk from Venezuela, Colombia, and multiple countries, Iran.

It's just fantastic to feel that everybody's helping for the success of the project. At the end of the day, pain and suffering doesn't discriminate. A heart attack here in the Silicon Valley, that pain and fear is exactly the same fear and pain that you have in Africa or in China. So.

Gerardo (15:00.798)
It's an important aspect of the development of a problem. This is for everybody. That's basically what I'm trying to say. It's a worldwide effort to bring relief to people that are suffering.

Jesus Moreno (15:15.296)
And making it universally accessible it's it's something that I would I would suggest makes makes it more prone to success.

Gerardo (15:29.48)
Indeed, fact, the communication with the doctors overseas, even here, know, in rural areas where there is no, you know, maybe there's no floral machines or more technology. The doctors, you know, are limited in resources. And this is here in the U.S. too. mean, certain places in Texas where there is no, you know, advancement equipment.

or they don't have the funds, you know, now that they're trimming a lot of the medical care. It is important to have products that are accessible to everyone, as much as possible. Obviously, we're in a business in which we have to operate, you have to have profit, otherwise you will make it. Even non-profit organizations have to be profitable, otherwise they wouldn't be able to function. That's just the most basic.

of operational organizations have to be profitable. So we also have to be profitable to succeed. Obviously, right now we're not in the commercial. We are operating at business with expenses only. There is no income. So we have to do with what we have. And I have to balance that.

I developed the skill to be able to advance companies with limited resources and funding. The funding is what I have and you have to move forward with what you have. That is the bottom line.

Jesus Moreno (17:07.158)
And that's exactly where I I wanna take the conversation. You you've built several ventures, and I'm curious to learn if there was ever a step back or a turning point that really reshaped the way you think about risk.

Gerardo (17:08.002)
So.

Gerardo (17:23.753)
away.

Gerardo (17:28.278)
I do. After, you know, on the first half of my career working for companies and other companies, I told my wife, you know, I've been doing this for a while now and I noticed that we have done great. I enjoy what I do, but now it's time for me to move on on my own. Unfortunately, it was in the year 2000, which was the worst year to start in a company because it was a collapse of, you know, dot com.

People were telling me, well, you labeled your company dot com and you'll be fine. And then luckily I got funded before the bubble burst. So I had a little bit of money. But three, four months into it, the incubator told me that they were folding because they didn't have money. So I asked him, so what is going to happen to me? said, well, you can buy the company back from us.

make us an offer so I made a really nominal offer because you have a lot of money so and they accepted. So I talked to my friend and mentor Mr Simpson and said you know Carl Simpson and said Carl what do we do? Well you know let's keep going so we bought the company and eventually the company was acquired by Bustle Scientific.

Pretty good feeling. But that's when I realized that this is really, really, really what I want to do. I finally found my driving force. This doesn't come. Entrepreneurship is something that is in you. It's not something that you can learn. Because there is a lot of ups and downs, more downs than ups. But it really doesn't matter. You have to believe in what you're doing and change.

You have to change. You cannot continue in the same mode if things are not going your way. You need to be mindful and humble enough to say, you know, this cannot work in, but there are alternatives. It's not like, it's not working, therefore it's dead. That's not the point. It's not working, change. That's that, that is the message, right? This come from, you know, my grandfather came from England and recently I learned that he went through Ellis Island.

Gerardo (19:51.475)
and then from there to South America. So he was an immigrant in South America and he was also an entrepreneur. So some of these come from my family. Eventually my grandfather passed away and my grandma was a mother uneducated with five children with a business to run that she has absolutely no clue what to do. But there she was, you know? So all of this.

teachings are ingrained in me, meaning obstacles and downfalls doesn't mean the end. That means you need to reroute and re-focus and you'll be fine. That's the message. And I do that to all my engineers and when they get nervous about joining a company that's starting, what happened? You run out of money. Even if you work for a larger company.

The company comes and you know, today is your last day. Nobody gets offended. They might give you little severance and then you keep going. Obviously, it's not pleasant. likes that, but it happens even with big companies. mean, Microsoft, they lay off 10,000 people, but nothing. Well, these big companies lay off thousands and thousands of workers all the time.

And people find their ways in smaller companies or medium sized companies. Or maybe people just decide to venture on their own. I decided to venture on my own. And I'm totally happy with that. And so this comes from seeing my grandpa, my grandmother.

entrepreneurs is in me. So that's what the driving force behind what I do. On top I love the medicine. I'm not a physician but I learn, I study a lot the problems and trying to gain from that to develop what I'm looking. My inspiration typically come from gardening. I love gardening and flowers.

Gerardo (22:09.493)
I learned a lot from.

see the little bugs, how they fly and how, and I try to convert that into mechanical actions that can benefit when I'm working on.

Gerardo (22:29.859)
A while ago, no I don't remember when, but I saw this person walking along the fence and they have this very weird...

Gerardo (22:42.593)
shape on their face, they grab worms, that's how they feed themselves. And so said, wow, that's very interesting. So I looked into the anatomy of the possum and I found that I could use some of that to create a device. And I did that, I prototyped it with my technicians. And it was brilliant, it was very fulfilling. So nature is a big inspiration.

Gerardo (23:11.884)
bitch.

Jesus Moreno (23:12.042)
And I would like to build from that into how you operate today because one thing that you s that you use a lot in your startups, and correct me if I'm wrong, is the idea that execution only works if the environment supports it. Specifically the clinical, operational, and regulatory environments. And based off of that,

you designed and executed the prog strategy, which for those who know it, it's considered one one of the textbook examples of how to run a multi-site study in parallel and therefore be able to get approval in record time and at a dramatically shorter you know time window compared to the US.

But beyond the speed, beyond the speed, what is the philosophy behind it? What are you really optimizing for? And how is your evaluation process for the geography and those other non-negotiables that create that environment that allows you to find the correct clinical, operational and regulatory environment?

Gerardo (24:11.063)
day.

Gerardo (24:14.551)
Thank

Gerardo (24:40.503)
You know, before you go into a clinic, you need to do your mechanical testing. One thing that I promised the doctor when I showed up at their site, I said, I cannot guarantee that what I'm bringing you will be effective. But when you push a button, the device will do what it's supposed to do. Because I've done all the testing on site, animal study, preclinical work before I venture into humans.

The objective is to bring relief, not to hurt the person. So I'm mindful that the person on the other end needs the help. And my job is to bring a tool, a technology that will enable them to do that. Will they get better? Obviously, I hope so. And I've seen some of the preclinical results. But on preclinical work, it's not the real goal.

even though it's in a real subject, he's not an ill patient. So a lot of the work is done behind, but very quickly. And we do not develop technology for veterinarians. We develop technology for physicians. So.

Some companies tend to spend too much time on the preclinical side. Therefore, you start making changes to accommodate the model. And I don't. I do enough, but I like to move quickly to the clinic. And I bring the doctor that I'm working with to the preclinical work with me. Once I do that, maybe once or twice, maybe three times.

That's it. Then we were ready for human studies. all these data is collected properly. Because all this information has to be gathered properly. That's the value of the company, the quality of your data. So when you have that information, you can share with the ethics committee. You can share with the competent authorities. And again, if you write the protocol,

Gerardo (26:59.733)
you know, thinking that the reader is a foreign person, they are more, they have less questions. In fact, in the Czech Republic, we had one question, we responded, and the approval happened in one day.

So the whole process was 90 days from beginning until I was ready to start the study. 90 days with one comment from the reviewer. And after that, it took us one day to get it approved. I just was like, incredible. So with that, we began the process. I was a little bit nervous because it was the first case, but I was confident because the doctor trained with us and he was very familiar.

That's the strategy. And I always like to do preclinical work, but not forever. Always we start changing the design to accommodate the model. That is totally in my mind not the way to do it.

Jesus Moreno (28:06.132)
So move fast from preclinicals into clinicals and make sure that the philosophy between the one set of let's say professionals that are involved aligns with the ones in the clinical study, mediating that with with you being physically present in the room.

Gerardo (28:24.469)
Okay, yeah.

Gerardo (28:31.017)
Indeed, always, in every case. The last two cases in was really interesting because I remember from here, from Silicon Valley to Prague, it 14 hours. So I used to get the call like 11 p.m., send a message to my team, said, meet me at the airport. The next day we were flying to Prague. And then, you know, basically 24 hours later, we were implanting the device in the patient.

I mean, we couldn't wait. From the airport, we went straight to the hospital. Not even checking in in the hotel. And then two hours later, the device was implanted and the patient is starting to recover. That is how we operate. And we did that five times. The last two times, wanted to, you know, the patient couldn't wait for us to arrive.

So I said, well, don't we do it via Zoom? So I set up the call and my team was, everybody in their home guiding the doctors in pride. And it was a very successful study, both of them. And so we did a remote. That was kind of scary because you will not be there, you know, it was physically possible. So that was the best outcome. Showing the simplicity of the approach too, right? It was kind of.

beneficial, but I really wanted to be there.

Jesus Moreno (30:03.871)
And how does that kind of velocity affect the burn rate, the quality of data, and the ability to make confident decisions early on?

Gerardo (30:17.025)
Well, again, the clinical protocol is very specific. What kind of data do

Gerardo (30:24.073)
things and they have to check all the boxes otherwise to include the patient you know so it's very very well scripted what how you include the patient into the study so and we review that with the doctor and say yeah he's a good patient but quickly right you need to move fast they they know the the anatomy and the symptoms a lot better than I do

Gerardo (30:56.001)
pretty much it, you move fast. That allows you also, like you said, to put your money, your investment, whatever money you have, into areas that will increase the value of the company, which is clinical results. We have electronic data systems, know, collecting the data. So on top of paper, paper is the first one, it's really...

But also we have electronics, so we have access to the result pretty much right away. So our clinical team is reviewing the data and flagging, talking to the doctor. Is there something that's in town?

Gerardo (31:42.078)
if you don't align or something. Also sharing the result with the team because you have to convince also your audience on the other side, the nurses, the physicians, the radiologists, whoever is involved, that we're doing good. So it's a constant reinforcement to the team where you're doing the clinical studies that you know what you're.

doing is good, you're not putting anybody at risk, nobody can hurt, that adds value to. And if that is not the case, then you need to also say, what are you doing about it, right? That's also another way, because not always things go your way. So you need to inform them how you're to resolve some of the issues that they're seeing.

So in a way, your funds go towards the right direction. Also, you're getting feedback. Let's say your capital is too rigid, like it's a more flexible. So you convey that information very quickly to the engineers. The engineers start working on it while we're doing more cases. We're getting more feedback. Obviously, we do not change everything because otherwise,

You don't know what change, you know, cause the benefit. So you need to change a few things. I'm inclined to make one change at a time because then you know if it's beneficial or not. If you do two changes, you don't know which one is the benefit or causing the trouble.

Anyway, that's kind of philosophically how I feel and I've been able to successfully control the burn rate in the company and add value at the same time.

Gerardo (33:49.215)
And we don't resolve to present that meanings. Last year we were in Frankfurt, Germany, before we were at TCT in San Francisco. And this year we were in Boston, in Washington DC. In May we were in Europe at the EuroPCR presenting two big auditoriums. And also...

we joined a competition on innovation, medical devices in which any company participated and we were selected at the top three in Europe. And this is huge for such a small company, know, with a novel approach. we're just...

Jesus Moreno (34:36.802)
This was at the Paris Cardiology Conference. That's right.

Gerardo (34:40.736)
Yeah, there is going to be. Yeah, in May, a few weeks ago. So doctors come and says that's truly unique and out of the box. There was a comment throughout, this is an out of the box approach, very unique, very clever. And they want to see more. So they want to see more. That means I have to work harder to provide more.

feedback or results and not lose the momentum. Because once you lose the momentum, you have to climb harder, you know? But always innovate, vision and execution all along, vision and execution is the driving.

Jesus Moreno (35:32.001)
And I definitely want to explore that that topic further, the Purcosist. but before moving on to that, I wanted to mention something that you do differently. And it has to do with the capital strategy. which is where you've done something unique, really. taking the traditional regulatory requirement of a clinical evaluation report and turning it into

Part of your financial strategy. How did that idea come together and how does it actually work in practice?

Gerardo (36:11.702)
Well, you know, when you get engaged into a project right from the get-go, you need to know what are the regulatory hurdles in the US. First of all, are you a PMA or you 510k? If you are a 510k, well, some people like that, investors, you know, like it. But the challenge is that you have to prove adoption in the market for a 510k device. So you need to have some level of sales that requires, you know...

investment and it might slow down some of your innovation depending on how much money they have in the bank but to bring a product to market is very expensive in the US. I mean the Bay Area I think you have like 10 hospitals at least and how can you serve with one or two salesmen? would be impossible. That means you need more and more means

expensive. So you need to prove probably best to go overseas, gather more clinical data, show good results, engage FDA.

Gerardo (37:31.48)
None. And so this is our intent. Don't be shy about talking to FDA. There is nothing wrong to talk to them early on. They are not going to punish you for talking to them. In fact, it's best to share your story with them. So you go in the right path. They get to know you when you go to meetings. They will be there. Trust me, I've seen them. They're listening to your presentations. So.

to hide or to try to pretend that you don't exist or you have done something. So, if you want do something that is ethical and legal, it's fine. It doesn't have to be in the US. So, get data early on outside of the US in countries in which FDA has no issues, Because if you're going to go to a country in which they don't believe the data, then that's a big problem. So, you know.

That's kind of the story. Early on engaged with FDA. with that philosophy you can go into other countries. Granted, other countries the hurdles are bigger. It's mostly administrative. has nothing to with the technology. It's just a nightmare in paperwork.

Sometimes you need to find countries that are more amicable to advancements in medicine. Which are those? The ones that get ethics committee approval first. And then with that you apply to the government. Other countries, say, you have to have approval by the country and then ethics committee. That is not beneficial because that doesn't help.

So it's better to have ethics committee approval first. With that information, you go to the competent authority and say, look, the doctor's already liked it, already approved it. They think this is safe.

Gerardo (39:42.781)
It's a good way to position the product.

Jesus Moreno (39:50.275)
I see. Okay. Stepping back to the broader market. having considered all this strategic decisions early on, when do you start thinking about a merger or or an acquisition and and what does it mean in today today's environment for a founder to to really know that they're ready for that step?

What does it actually mean or or what do they need to be? where do they need to be in order to be ready beyond having promising data?

Gerardo (40:38.347)
Well, obviously, you have to be in a market that there is a need, And fulfilling it. Everybody, obviously, rightly so, thinks that they have developed something that is fulfilling that market need. But you have to gauge how you compete against existing established technologies. Like one of the companies that can't quite direct to compete, they have been in business for

25 years and $1 billion in sales and they were acquired for a huge amount of money. That's a competitor, that's tough. But that doesn't mean they own the market. That doesn't mean that you cannot bring new things. That just means actually it's good that they're in the market because that shows that there is a need, right? And so competition is good.

by all means. In fact, since we're ahead of all the companies that work in the extravascular space, they're cheering for us. They say, keep going. It's good what you're doing. These are my near competitors. Send me messages. Keep at it, because it's good for all of us at IMB. I don't mind sharing some of it.

What you see on the screen is we're able to disclose to the public. There's nothing too high. So working with them, competition is good. I'm not gonna give them all the secrets obviously, but they can read, they can see the results. So.

Competition is good. That's about all I'm saying. And that's Silicon Valley mentality. Otherwise, there will be no innovation.

Gerardo (42:35.605)
And also, you know, talking about the speed, here you have, you know, laser people, machinists, you have...

software, hardware engineers that, you know, now with the AIs, many of them are available to work, actually a lot more than before. mean, material science is, we're very close to Nvidia. So there's a lot of engineers available now to join companies like us.

And we can share our vision. People get excited when they see what we're working on. That's what you need. People that are excited, coming to work every day. Hey, I was thinking about this. What do you think? And I encourage them to do an execute and come back with, you And then I give them my ideas. Hey, guys, what do you think? This is what I'm thinking. I couldn't stop thinking about it. Can we prototype it or something?

And see, sometimes it's pretty cool that people get more engaged and more enthusiastic about what we do. Regarding, at what point do you start talking to a strategic when you have enough evidence that you have something that is repeatable?

And he doesn't take a lot of cases to do that.

Gerardo (44:16.159)
And it's not automatic either. It might invest first, good. Allows you to move forward with the technology, innovate more. And then second step, say well, then we would like to move forward with something more meaningful, maybe stage the acquisition or something. Meet these objectives and then we'll do first payment and so on. There many ways to.

In between, know, as you say, you need to stay alive so the investment that you work with

I need to support you.

And that's, you give them updates and resolve. Not all the time, but maybe twice a year, it's good.

Otherwise you'll be spending hours and hours trying to update everybody and you'll be, you'll have calls all day long. But it hasn't been that way yet. Everything is moving forward the way I envision and it just don't stop. Conditions change. For instance, the grants.

Jesus Moreno (45:22.318)
Mm-hmm.

Gerardo (45:39.317)
are obviously gone. The warm and gratin many companies used to get no longer available. But now I think it's starting to surface again.

But they are all organizations like the American Heart Association. They also have grants.

And I learned this recently, so I'm gonna apply for that. And give you exposure to their meetings and other entities that are interested in what you're working on. We are a worldwide company, that's a fact. I'm telling you, that is the case. We are a company for the world, we are not for one.

Jesus Moreno (46:28.896)
And I would like to bring it back precisely to Percosist and ultimately how how this product works with one of the maximums of cardiology, which is time is muscle. Every delay has a real consequence into the outcome of the patient. So how does the EVAT system fit into that timeline and how does it change the equation compared to

existing options like Impala or ECMO.

Gerardo (47:04.599)
First of all, the little E from E-vegeties because we're extravascular. That alone removes a lot of the issues that we have seen in current technologies. Bleeding, sepsis, hemolysis, infections, vascular damage because we do not enter the vasculature. Peripheral artery disease because when you put a catheter to your groin, you're

potentially blocking flow to the limbs. And you know, that's not ideal. But we access the heart via subcyphoid, which is below the sternum, straight into the left ventricle, deploy the device between underneath the rib cage, but on top of the heart.

in the space called the pericardium.

Then we synchronize our device with the patient's cardiac rhythm. So, and our balloon technology inflates only in systole. That's what the patient needs the most. While we're different, again, we're extravascular. What we have discovered is that even though we don't press on the right ventricle, we do produce a right ventricular effect.

So our technology is for producing a biventricular effect on the person helping the left and the right ventricle at the same time. And that's a big thing because for right ventricular failure, there is no much.

Gerardo (48:58.123)
people can do. The options are limited. So the fact that we're extravascular have opened doors and the fact that we are biventricular is becoming extremely interesting in the interventional cardiology and heart failure space. So we are very unique in that sense.

Jesus Moreno (49:27.474)
And was this part of what you shared at the cardiol cardiology conference in in Paris? can you tell us a bit about the experience and what does that recognition mean for your team and the position of Purcaset?

Gerardo (49:28.215)
And if we can just go ahead and the video.

Yes

Gerardo (49:45.271)
Well, there were 22,000 attendees at the EuroPCR, even more than the TCT.

in the US. Probably American Heart is maybe a little bigger than that, but the beauty about the Europe PCR is the exposure from the entire European community, but also worldwide. were a lot of people from the Middle East and from Asian countries too. So it's a moral exposure is fantastic because you're more broader range.

It was, I think there was a cardiology meeting in Abu Dhabi. I missed it because I was planning on preparing for our next.

human trials, so I couldn't go. But just to show you, in the Middle East, there is a huge need for technology in the heart failure space. Who would think, right? They do. As I said, this problem, the more I look into it, I oh my god, it's getting bigger and bigger. Southeast Asia has the highest level of heart failure, like 7.5 % of the population.

compared to US or Europe, which is three and a half percent. And South America, about the same too. A lot of smokers, a lot of fried food, delicious obviously, but it's not the healthiest.

Gerardo (51:28.371)
Neither is eating bacon.

Jesus Moreno (51:30.722)
Yes. Well you're gonna have to die somehow.

Gerardo (51:32.28)
But we all like it. So, know, might as well be eating bacon to be happy.

Jesus Moreno (51:38.818)
Yeah.

Gerardo (51:41.849)
So, you know, the exposure in the European Union, the reception, making it to the top three was fantastic. It was so fulfilling. And Dr. Krucov did a fantastic presentation. And then the viventricular effect was presented by Dr. Van Meehan, Nicholas Van Meehan, the up-and-coming researcher in the European Union.

extremely wonderful guy to work with. And we love when he comes, his excitement. And it's very contagious to work with people like that. So, Nicholas, I've become a great friend and I love working with him and my team likes him a lot too.

Jesus Moreno (52:33.27)
Well, Gerardo, this has been a fantastic conversation. And as we mentioned before, there's this saying that time is muscle, but it applies just as much in innovation as it does in cardiology. And everything that you've shared with our audience today, every Yeah, strategy or or perspective philosophy adds to that.

so that very, very practical blueprint for navigating the challenges of med tech and innovation in the spaces has been of great value to us. So thank you and thank you for the work you're doing. As you say it's a Percasist is is a company that solves a worldwide problem that I know it's gonna

impact the lives of many many people around the world. And for listening listeners, until next time and keep accelerating. Thank you, Gerardo.

Gerardo (53:48.139)
It's pleasure to share the journey and for whatever it's worth, if somebody wants to follow the path. You know, worked for me. Find your, maybe some of these hints and tips will help for a small startup companies. All the best to all of you. And thank you, Jesus and Julio. All the best for including me in your podcast.

Jesus Moreno (54:16.654)
Thank you. Thank you for sharing with us. Okay. Until next time.

Gerardo (54:19.193)
Cool.