The road to success often seems nicely paved when young medtech entrepreneurs look at the success of companies that have thrived before them. However, not very often do you get to hear an innovator’s retrospective look on the real challenges they faced as they took their company from ideation to exit. Stanford Biodesign alumni and current fellows recently attended a panel session hosted by Hank Plain (Lightstone Ventures) where they had the opportunity to hear from three panelists: Andrew Cleeland (CEO, Twelve), Alexei Marko (CEO, Neovasc) and Matt McLean (Director R&D, Twelve). In August 2015, Medtronic acquired Twelve, the transcatheter mitral valve replacement (TMVR) company which was also the 12th company to emerge from medtech incubator The Foundry. While it was not the first TMVR acquisition announced that summer (Edwards acquired CardiAQ for ~$400 million and Abbott acquired Tendyne for ~$250 million), it was the largest: $408 million at closing plus $50 million upon achievement of CE Mark. The panelists shared their stories on how the Twelve team worked fiercely to bring forward a concept from paper to first-in-man to acquisition in four years while working in collaboration with a direct competitor to make such magic happen.