Carmat: the French artificial heart stopped beating 💔

In December 2013, a significant medical achievement occurred when surgeons successfully implanted an artificial heart manufactured by the French company, Carmat, into Claude Danis. This device, developed by world-renowned surgeon Alain Carpentier, was hailed as a national triumph, attracting substantial media attention and securing approximately 500 million euros in total funding. However, thirteen years later, enthusiasm waned as only 122 patients had received the implant. The 'made in France' heart failed to meet expectations, culminating in the company declaring cessation of payment in June 2025.

I had the impression of arriving at the end of a marathon, and very quickly I understood that it was the beginning of another marathon.

The genesis of Carmat dates back to the early 1990s when Alain Carpentier partnered with Jean-Luc Lagardère, then head of the industrial group Matra. Lagardère heavily backed Carpentier's research, establishing a small, highly secretive engineering team at Matra's Compiègne site. This project remained confidential, even after Matra was absorbed by Airbus in 2000. Patrick Colombier, who joined the project later, noted that this secrecy, referred to as a "black program," was necessary to allow sufficient research time without attracting premature competition, especially from transatlantic rivals.

Carmat was officially unveiled in 2008, financed by Airbus (then EADS), Alain Carpentier's foundation, and the French fund Truffle Capital. The French State also provided significant support; Oseo (the precursor to BPI) granted 33 million euros in public aid, marking the largest advance ever given by the organization to an SME at that time. To raise further capital necessary for clinical progression, the company opted to enter the stock market in 2010.

The extensive development timeline was justified by the project's gigantic ambitions, aiming to surpass existing medical solutions. At the time, the only artificial heart on the market was the Syncardia device from the American company, which operated pneumatically using compressed air, making it cumbersome and typically a temporary measure awaiting a human graft. Carmat sought to completely replace the human organ by mimicking its biological pulse, adapting automatically to patient effort, and reducing clotting risks through the use of a natural bovine pericardium envelope.

After this first success, the public and the media became passionate about the company.

Following the successful 2013 operation, Patrick Colombier projected an extremely rapid scaling trajectory. These initial forecasts suggested selling 50 prostheses in 2013, 100 in 2014, with plans to double the volume annually thereafter. However, the subsequent path proved significantly more challenging than these early, optimistic scheduling assumptions suggested.

The momentum stalled when the second patient, implanted in August 2014 during a clinical study, died nine months later due to a defect in the apparatus. This tragedy immediately shifted the primary objective: the goal of implanting permanent artificial hearts receded, and the device was repurposed mainly as a bridge to transplantation, supporting the patient's circulatory system until a donor graft became available.

The third, fourth, and fifth patients experienced outcomes similar to the first two. Although the prosthesis was not implicated in every fatality, and some patients survived beyond the critical 180-day threshold, the clinical trial was suspended briefly. This suspension created severe medical and commercial difficulties, as Carmat required the CE marking to sell the heart within the European Union—a milestone promised to shareholders back in 2010. The CE marking was finally obtained in 2020, yet it represented only a partial victory, as authorization was restricted to temporary use.

It was necessary for the product to become totally mature. It is a bit like the first car; people needed to have steering problems, problems with their wheels, and so on, for those problems to be remedied.

During these years of development, the company's workforce grew to 200 employees, yet Carmat constantly struggled for financing, stabilizing its needs around 20 million euros per year, often refinancing in emergencies with diminishing returns. Over 17 years of existence, the firm consumed 550 million euros. A brief ray of hope appeared in July 2021 when the first sale outside clinical trials occurred, priced around 150,000 €. This was followed by six further commercial implantations in Germany and Italy, but this momentum quickly vanished due to quality issues stemming from suppliers who delivered imperfect components late.

Activity accelerated starting in 2024, with approximately 50 patients treated that year alone, bringing the total to 122 implants since inception. However, the company's financial health deteriorated severely. In 2024, Carmat recorded revenue of only 7.5 million euros—half of its projection—while annual losses amounted to 51.4 million euros, rendering profitability distant.

The dire financial situation led to the withdrawal of crucial investors: Truffle Capital departed in 2020, followed by Airbus in 2024. In 2025, the BPI ceased funding and publicly expressed regret over its past support, stating its role is often to reject projects, even appealing ones. This abandonment created a crisis, as the company desperately needed 3.5 million euros by the end of June to survive, but only managed to raise 19,000 €.

Unprecedented criticism emerged against Carmat, citing an initially overestimated market and a prosthesis deemed too large, potentially excluding female patients. Furthermore, internal management was accused of opportunism, prioritizing short-term financial gains over the core medical mission.

I came to Carmat for the medical promise, but I found there was greed and too strong a preoccupation with short-term financial gains.

The prevailing financial climate, which favored web and AI investments over medical devices, did not help Carmat's plight. The company officially declared cessation of payment on June 30, 2025, leading to the suspension of its stock market listing. The share price collapsed from nearly 180 € in 2011 to less than 0.10 €.