1. Confidential

2. needs associated with surgical sealing and adhesion prevention
Company Overview
Platform technology of “in situ polymerized” biomaterials and delivery devices
Targeting large potential markets in biosurgery, specifically:
Adhesion Barriers and Sealants
First to market products
Products commercially available
Initial targets in Neuro/Spine and broad applicability beyond initial targets
Confluent’s vision is to be the leading developer of products for unmet
needs associated with surgical sealing and adhesion prevention

3. Confluent Hydrogel Technology
Proprietary "Reversible" Hydrogel Technology

4. Confluent’s Differentiation
Technology
Synthetic origin, very biocompatible
Strong tissue adherence
Products stored at room temperature
Quick polymerization
Ideal for minimally invasive surgery applications
Strong IP and barrier to entry
Business Model
No separate reimbursement typically needed for products
Leverages outsourcing
High margins
Minimal capital investment
Easily scaled

5. The Need for Surgical Sealing
Neuro and Spine Surgery
CSF leaks can lead to neural compression, postural headaches, infection, meningitis, and death
Vascular, Cardiac, and Orthopedic Surgery
Bleeding can prolong surgery, transfusions create risk of disease transmission
Thoracic and General Surgery
Prolonged hospital stays, risk of infection, and morbidity

6. The Need for Adhesion Prevention
Gynecological
Infertility and pelvic pain due to adhesions
General Surgery
Bowel obstruction, pain, complicated re-operations
Spine Surgery
Failed back syndrome, re-do surgery may result in dural tears
Cardiac Surgery
Complicated re-do surgery, danger of myocardial incision

7. Confluent Hydrogel Products
DuraSealTM – Achieve watertight dural closure, prevent CSF leakage following cranial surgery
Commercially available in U.S. and select international markets
In pivotal clinical trial in U.S. for spinal sealing
SprayGel® – Reduce the formation of post-surgical abdominopelvic adhesions
Commercially available in select international markets, under clinical trials in U.S.

8. DuraSeal Surgical Sealant Target Market
Cardiac $$
Large need for surgical sealants (neuro, spine, general, vascular, thoracic, and plastic)
$$ initial target opportunity for Confluent
DuraSeal will be first dural sealant in U.S.
Additional markets can be accessed with technology platform
Neuro $$
Vascular $$
Thoracic $$

9. DuraSeal – Mechanism of Action
Intended Use:
Duraseal is intended for use as an adjunct to sutured cranial dural repair to provide watertight closure.
When applied, DuraSeal:
Rapidly diffuses into tissue crevices and crosslinks
Interlocks within tissue crevices resulting in excellent tissue adherence
Blue colorant allows for visualization of gel coverage and thickness

10. DuraSeal – Mechanism of Action
DuraSeal can withstand elevated CSF pressures due to:
Strong tissue adherence
High cohesive strength
Biomimetic elasticity

11. DuraSeal – Mechanism of Action
Post operative attributes:
Separates dura from the bone flap preserving the tissue plane
May facilitate subsequent re-operation

12. DuraSeal – Mechanism of Action
Biocompatible absorption:
Water soluble linkages hydrolyze over # weeks
Water soluble PEG molecules are liberated and cleared via the kidneys

13. DuraSeal – Mechanism of Action
DuraSeal Benefits for cranial surgeries:
Creates an immediate watertight seal
Blue colorant allows for visualization of gel coverage and thickness
Reduces postoperative CSF leaks
Safely absorbs after the body has naturally healed
Easily prepared in # minutes

14. DuraSeal - Clinical Data*
Pilot Study (Reference)
Single arm study in patients for intradural cranial and spinal procedures
100% intraoperative sealing of the dura was observed
##% post-operative leak rate and ##% pseudomeningocele rate observed
Pivotal Study (Reference)
Single arm study in ## patients for intradural cranial procedures
##% intraoperative sealing of the dura was observed
#% post-operative leak rate and #% pseudomeningocele rate observed
*Expected rate of postoperative CSF leakage is about ##% and cost of a single CSF leak is estimated to be around $$$

15. DuraSeal - MicroMyst Applicator
Cleared in U.S.
CE Mark in EU
For use in Spine and transsphenoidal procedures

16. DuraSeal Spine Sealing
“Zero Swelling” Version of DuraSeal
Durotomy
Sealant application

17. SprayGel Adhesion Barrier
Status
OUS: CE Mark
US: Clinical trials
Large clinical need for post- surgical adhesion prevention (gynecological, abdominal and pelvic surgery)
Initial target opportunity for Confluent
SprayGel is the world’s first sprayable local adhesion barrier
Pilot trial in Gynecology has shown 70% reduction in incidence and extent of adhesions
Trial in General Surgery underway and pivotal trial in Laparoscopy planned
Worldwide Adhesion Barrier Market
Abdominal $
Gynecologic
SprayGel Air-assisted Applicator

18. Product Pipeline

19. Product Roadmap and Strategy
Overall Market Opportunity Size
Time

20. DuraSeal - Drug Delivery
% Analgesic Released
% Antibiotic Released
Days at 37°C
Days at 37°C
Controlled release demonstrated with:
Antibiotics
Analgesics
Antiproliferatives
Anti-inflammatories

21. Intellectual Property Position
13 issued patents
Additional 12 patents pending
Broad coverage of fundamentals
Creates substantial barrier-to-entry
Composition of matter, method of use, delivery device technology

22. Competitive Environment
DuraSeal – None for craniotomy. Other indications include: Cryolife and Baxter
Strength
Preparation Time
CoSeal DuraSeal HemaSeel
Burst (amount / amount)
HemaSeel
CoSeal
DuraSeal
Time

23. Financial Overview Products commercially available
Year
(Expected)
Planned / Actual
Revenue
Products commercially available
Exceeded forecast this past year 25%
Profitability expected by late year

24. 2005 Revenue by Month Year End Totals DuraSeal US Launch Total Sales

25. Management Team Amar Sawhney (Co-founder and CEO)
Jim Fortune (COO) 24 years experience (17 with JNJ in orthopedic, neurosurgical businesses)
Eric Ankerud (VP Clinical, Regulatory, Quality) 23 years experience
Headed regulatory at Boston Scientific, Summit, CR Bard
Patrick Campbell (VP R&D) 22 years experience (ACS, Focal)

26. Board of Directors
Fred Khosravi (Co-founder and Chairman) Co-Founder and President, Access Closure (current), Embolic Protection, Inc., EndoTex, Inc.
Sandra Panem Partner, Cross Atlantic Partners
Mark Wan Founding Partner, Three Arch Partners
Martin Sutter Managing Director, Essex Woodlands
William Tidmore Former President, Chairman Acromed
Charles Warden Versant Ventures

27. DuraSeal : Broad applicability and dual benefit
Sealant > Cranial, Spine, Vascular, Thoracic
Adhesion Barrier > Cranial, Spine, Cardiac
Significant revenue opportunity
Market Opportunity
Neuro $$
Spine $$
Thoracic $$
Cardiac $$
Vascular $$

28. Confluent’s Products: Addressing Emerging Trends in Surgery
Enable Minimally Invasive Surgery
Provide multiple benefits: sealing, faster surgery, easier re-operations, decreased pain etc…
Favorable Healthcare Economics
Decrease LOS
Improve Outcomes by reducing post-op complications
Significant new products in emerging fields of “Biosurgery” and “Orthobiologics”
Ideally suited for “combination products” that include added bioactive agents