UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
_________________________
Form 10-Q
(Mark One)
þ

QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
 For the quarterly period ended SeptemberJune 30, 20172018
 or
¨
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
 For the transition period from _______________ to _______________
Commission file number: 001-37599
lnlogomain280x72.jpg
LivaNova PLC
(Exact name of registrant as specified in its charter)
England and Wales98-1268150
(State or other jurisdiction of
incorporation or organization)
(I.R.S. Employer
Identification No.)
20 Eastbourne Terrace
London, United Kingdom
W2 6LG
(Address of principal executive offices)

(Zip Code)

(44) (0) 20 3325 0660 
Registrant’s telephone number, including area code:

 

Securities registered pursuant to Section 12(b) of the Act:
Ordinary Shares — £1.00 par value per shareThe NASDAQ Stock Market LLC
Title of Each Class of StockName of Each Exchange on Which Registered

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.  Yes þ     No ¨
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).  Yes þ    No ¨
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”filer,” “smaller reporting company” and “smaller reporting“emerging growth company” in Rule 12b-2 of the Exchange Act.
 
Large accelerated filer
þ

Accelerated filer¨
Non-accelerated filer
¨ (Do not check if a smaller reporting company)
Smaller reporting company¨
Emerging growth company¨  
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act

¨
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).  Yes ¨     No þ
ClassOutstanding at October 27, 2017July 26, 2018
Ordinary Shares - £1.00 par value per share48,211,55948,591,937


LIVANOVA PLC
TABLE OF CONTENTS
  PART I. FINANCIAL INFORMATION PAGE NO.
   
  
   
   
   
   
   
  
  
  
  PART II. OTHER INFORMATION  
  
  
 

 
  
  
  
  
In this Quarterly Report on Form 10-Q, “LivaNova,” “the Company,” “we,” “us” and “our” refer to LivaNova PLC and its consolidated subsidiaries.
This report may contain references to our proprietary intellectual property, including among others:
Trademarks for our VNS therapy systems, the VNS Therapy® System, the VITARIA® System and our proprietary pulse generator products: Model 102 (Pulse®), Model 102R (Pulse Duo®), Model 103 (Demipulse®), Model 104 (Demipulse Duo®), Model 105 (AspireHC®), Model 106 (AspireSR®) and Model 1000 (SenTiva™).
Trademarks for our oxygenator product systems: Inspire™, Heartlink™ and Connect™.
Trademarks for our line of surgical tissue and mechanical valve replacements and repair products: Mitroflow™, Crown PRT™, Solo Smart™, Perceval™, Top Hat™, Reduced Series Aortic Valves™, Carbomedics Carbo-Seal™, Carbo-Seal Valsalva™, Carbomedics Standard™, Orbis™ and Optiform™, and Mitral valve repair products: Memo 3D™, Memo 3D ReChord™, AnnuloFlo™ and AnnuloFlex™.
Trademarks for our implantable cardiac pacemakersperfusion systems and associated services: REPLY 200™, ESPRIT™, KORA 100™, KORA 250™, SafeR™, the REPLY CRT-P™, the remedéproducts: Inspire® System., Heartlink®, Connect™, XTRA®, S5® and Revolution®
Trademarks for our Implantable Cardioverter Defibrillatorsline of surgical tissue and associated technologies: the INTENSIA™, PLATINIUM™,mechanical valve replacements and PARADYM®product families.
Trademarks for our cardiac resynchronization therapy devices, technologies services: SonRrepair products: Mitroflow®, SonRtip™Crown PRT®, Solo Smart™, Perceval®, Top Hat®, Reduced Series Aortic Valves™, Carbomedics® SonR CRT™, the INTENSIA™, PARADYM RF™, PARADYM 2™Carbo-Seal®, Carbo-Seal Valsalva®, Carbomedics®Standard™, Orbis™ and PLATINIUM™ product familiesOptiform®, MEMO 3D®, MEMO 3D® Rechord™, MEMO 4D®, MEMO 4D® ReChord™, AnnuloFlo®, AnnuloFlex®, Bicarbon Slimline™, Bicarbon Filtline™ and the Respond CRT™ clinical trial.
Trademarks for heart failure treatment product: EquiliaBicarbon Overline®.
Trademarks for our bradycardia leads: BEFLEX™ (active fixation) and XFINE™ (passive fixation).
These trademarks and tradenamestrade names are the property of LivaNova or the property of our consolidated subsidiaries and are protected under applicable intellectual property laws. Solely for convenience, our trademarks and tradenames referred to in this Quarterly Report on Form 10-Q may appear without the ® or ™ symbols, but such references are not intended to indicate in any way that we will not assert, to the fullest extent under applicable law, our rights to these trademarks and tradenames.



NOTE ABOUT FORWARD LOOKING STATEMENTS
Certain statements in this Quarterly Report on Form 10-Q, other than purely historical information, are “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933 (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). These statements include, but are not limited to, LivaNova’s plans, objectives, strategies, financial performance and outlook, trends, the amount and timing of future cash distributions, prospects or future events and involve known and unknown risks that are difficult to predict. As a result, our actual financial results, performance, achievements or prospects may differ materially from those expressed or implied by these forward-looking statements. In some cases, you can identify forward-looking statements by the use of words such as “may,” “could,” “seek,” “guidance,” “predict,” “potential,” “likely,” “believe,” “will,” “should,” “expect,” “anticipate,” “estimate,” “plan,” “intend,” “forecast,” “foresee” or variations of these terms and similar expressions, or the negative of these terms or similar expressions. Such forward-looking statements are necessarily based on estimates and assumptions that, while considered reasonable by LivaNova and its management based on their knowledge and understanding of the business and industry, are inherently uncertain. These statements are not guarantees of future performance, and stockholders should not place undue reliance on forward-looking statements. There are a number of risks, uncertainties and other important factors, many of which are beyond our control, that could cause our actual results to differ materially from the forward-looking statements contained in this Quarterly Report on Form 10-Q, and include but are not limited to the risks and uncertainties summarized below:
Risks related to our business:
changes in our common stock price;
changes in our profitability;
regulatory activities and announcements, including the failure to obtain regulatory approvals for our new products;
effectiveness of our internal controls over financial reporting;
fluctuations in future quarterly operating results;
failure to comply with, or changes in, laws, regulations or administrative practices affecting government regulation of our products, including, but not limited to, U.S. Food and Drug Administration (“FDA”) laws and regulations;
failure to establish, expand or maintain market acceptance of our products for the treatment of our approved indications;
any legislative or administrative reform to the healthcare system, including the U.S. Medicare or Medicaid systems or international reimbursement systems, that significantly reduces reimbursement for our products or procedures or denies coverage for such products or procedures or enhances coverage for competitive products or procedures, as well as adverse decisions by administrators of such systems on coverage or reimbursement issues relating to our products;
failure to maintain the current regulatory approvals for our products’ approved indications;
failure to obtain or maintain coverage and reimbursement for our products’ approved indications;
unfavorable results from clinical studies;
variations in sales and operating expenses relative to estimates;
our dependence on certain suppliers and manufacturers to provide certain materials, components and contract services necessary for the production of our products;
product liability, intellectual property, shareholder-related, environmental-related, income tax and other litigation, disputes, losses and costs;
protection, expiration and validity of our intellectual property;
changes in technology, including the development of superior or alternative technology or devices by competitors;
competition from providers of alternative medical therapies, such as pharmaceutical companies and providers of cannabis;
failure to comply with applicable U.S. domestic laws and regulations, including federal and state privacy and security laws and regulations;
failure to comply with non-U.S. law and regulations;
non-U.S. operational and economic risks and concerns;
failure to attract or retain key personnel;


failure of new acquisitions to further our strategic objectives or strengthen our existing businesses;
losses or costs from pending or future lawsuits and governmental investigations;
changes in accounting rules that adversely affect the characterization of our consolidated financial position, results of operations or cash flows;
changes in customer spending patterns;
continued volatility in the global market and worldwide economic conditions, including volatility caused by the implementation of Brexit;Brexit and/or changes to existing trade agreements and relationships between the U.S. and other countries;
changes in tax laws, including changes related to Brexit, or exposure to additional income tax liabilities;
harsh weather or natural disasters that interrupt our business operations or the business operations of our hospital-customers; and
failure of the market to adopt new therapies or to adopt new therapies quickly.
Other factors that could cause our actual results to differ from our projected results are described in (1) “Part II, Item 1A. Risk Factors” and elsewhere in this Quarterly Report on Form 10-Q, (2) our Annual Report on Form 10-K for the fiscal year ended December 31, 20162017 (“20162017 Form 10-K”), (3) our reports and registration statements filed and furnished from time to time with the SECSecurities and Exchange Commission (“SEC”) and (4) other announcements we make from time to time.
Readers are cautioned not to place undue reliance on forward-looking statements, which speak only as of the date hereof. We undertake no obligation to update or revise any forward-looking statements after the date they are made, whether as a result of new information, future events or otherwise. You should read the following discussion and analysis in conjunction with our unaudited condensed consolidated financial statements and related notes included elsewhere in this report. Operating results for the three and ninesix months ended SeptemberJune 30, 20172018 are not necessarily indicative of future results, including the full fiscal year. You should also refer to our “Annual Consolidated Financial Statements,” “Notes” thereto, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” and “Risk Factors” contained in our 20162017 Form 10-K.
Financial Information and Currency of Financial Statements
All of the financial information included in this quarterly report has been prepared in accordance with generally accepted accounting principles generally accepted in the United States or of America (“U.S. GAAP.” and such principles, “U.S. GAAP”). The reporting currency of our consolidated financial statements is U.S. dollars.




PART I. FINANCIAL INFORMATION
Item 1. Financial Statements
LIVANOVA PLC AND SUBSIDIARIES’SUBSIDIARIES
CONDENSED CONSOLIDATEDSTATEMENTS OF INCOME (LOSS)
(UNAUDITED)
(In thousands, except per share amounts)
 Three Months Ended September 30, Nine Months Ended September 30, Three Months Ended June 30, Six Months Ended June 30,
 2017 2016 2017 2016 2018 2017 2018 2017
Net sales $309,664
 $295,268
 $916,156
 $903,284
 $287,498
 $255,843
 $537,896
 $482,668
Cost of sales 108,233
 106,454
 318,584
 360,675
 91,993
 84,023
 176,591
 163,991
Product remediation 1,642
 689
 2,573
 2,243
 1,542
 1,723
 5,257
 931
Gross profit 199,789
 188,125
 594,999
 540,366
 193,963
 170,097
 356,048
 317,746
Operating expenses:                
Selling, general and administrative 121,177
 109,233
 353,943
 345,744
 123,439
 94,264
 227,600
 181,604
Research and development 31,393
 32,175
 104,051
 94,076
 34,215
 33,833
 65,967
 54,219
Merger and integration expenses 2,013
 7,576
 7,743
 20,537
 4,409
 3,512
 7,369
 5,698
Restructuring expenses 792
 4,381
 12,060
 37,219
 476
 2,597
 2,357
 12,627
Amortization of intangibles 12,350
 11,775
 35,445
 33,959
 9,817
 8,116
 18,618
 16,076
Total operating expenses 167,725
 165,140
 513,242
 531,535
 172,356
 142,322
 321,911
 270,224
Income from operations 32,064
 22,985
 81,757
 8,831
Operating income from continuing operations 21,607
 27,775
 34,137
 47,522
Interest income 199
 585
 724
 1,119
 232
 252
 679
 525
Interest expense (1,421) (3,495) (5,314) (6,665) (3,006) (1,578) (5,117) (3,893)
Gain on acquisition of Caisson Interventional, LLC 
 
 39,428
 
Foreign exchange and other gains (losses) 491
 1,216
 957
 (2)
Income before income taxes 31,333
 21,291
 117,552
 3,283
Income tax expense 1,913
 9,731
 10,881
 16,891
Gain on acquisitions 
 39,428
 11,484
 39,428
Foreign exchange and other (losses) gains (70) (2,837) (343) 336
Income from continuing operations before tax 18,763
 63,040
 40,840
 83,918
Income tax (benefit) expense (1,030) 3,259
 2,863
 8,914
Losses from equity method investments (1,590) (13,129) (20,072) (19,382) (265) (14,102) (627) (16,098)
Net income (loss) $27,830
 $(1,569) $86,599
 $(32,990)
Net income from continuing operations 19,528
 45,679
 37,350
 58,906
Net (loss) income from discontinued operations (4,462) 1,819
 (9,011) (137)
Net income $15,066
 $47,498
 $28,339
 $58,769
                
Basic income (loss) per share $0.58
 $(0.03) $1.80
 $(0.67)
Diluted income (loss) per share $0.57
 $(0.03) $1.79
 $(0.67)
Basic income (loss) per share:        
Continuing operations $0.40
 $0.95
 $0.77
 $1.22
Discontinued operations (0.09) 0.04
 (0.18) 
 $0.31
 $0.99
 $0.59
 $1.22
        
Diluted income (loss) per share:        
Continuing operations $0.40
 $0.95
 $0.76
 $1.22
Discontinued operations (0.09) 0.03
 (0.18) 
 $0.31
 $0.98
 $0.58
 $1.22
        
Shares used in computing basic income (loss) per share 48,181
 49,075
 48,130
 49,016
 48,487
 48,140
 48,406
 48,104
Shares used in computing diluted income (loss) per share 48,534
 49,075
 48,339
 49,016
 49,338
 48,303
 49,263
 48,241


LIVANOVA PLC AND SUBSIDIARIES’SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
(UNAUDITED)
(In thousands)
  Three Months Ended September 30, Nine Months Ended September 30,
  2017 2016 2017 2016
Net income (loss) $27,830
 $(1,569) $86,599
 $(32,990)
Other comprehensive income (loss):        
Net change in unrealized gain (loss) on derivatives (1,980) 2,042
 (5,923) (5,224)
Tax effect 473
 (673) 1,756
 1,513
Net of tax (1,507) 1,369
 (4,167) (3,711)
Foreign currency translation adjustment, net of tax 39,106
 (1,805) 111,123
 32,598
Total other comprehensive income (loss) 37,599
 (436) 106,956
 28,887
Total comprehensive income (loss) $65,429
 $(2,005) $193,555
 $(4,103)
  Three Months Ended June 30, Six Months Ended June 30,
  2018 2017 2018 2017
Net income $15,066
 $47,498
 $28,339
 $58,769
Other comprehensive (loss) income:        
Net change in unrealized gains (losses) on derivatives 801
 (1,310) (456) (3,943)
Tax effect (192) 559
 111
 1,283
Net of tax 609
 (751) (345) (2,660)
Foreign currency translation adjustment, net of tax (58,154) 56,587
 (47,601) 72,017
Total other comprehensive (loss) income (57,545) 55,836
 (47,946) 69,357
Total comprehensive (loss) income $(42,479) $103,334
 $(19,607) $128,126



LIVANOVA PLC AND SUBSIDIARIES’SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(In thousands, except share amounts)
(UNAUDITED)
 September 30, 2017 December 31, 2016
 (Unaudited)   June 30, 2018 December 31, 2017
ASSETS        
Current Assets:        
Cash and cash equivalents $65,158
 $39,789
 $47,380
 $93,615
Accounts receivable, net 314,041
 275,730
Accounts receivable, net of allowance of $9,561 at June 30, 2018 and $9,418 at December 31, 2017 261,915
 282,145
Inventories 214,593
 183,489
 157,831
 144,470
Prepaid and refundable taxes 58,969
 60,615
 51,944
 46,274
Assets held for sale 14,117
 4,477
 
 13,628
Assets of discontinued operations 
 250,689
Prepaid expenses and other current assets 55,176
 55,973
 35,621
 39,037
Total Current Assets 722,054
 620,073
 554,691
 869,858
Property, plant and equipment, net 213,769
 223,842
 186,156
 192,359
Goodwill 781,070
 691,712
 965,697
 784,242
Intangible assets, net 717,646
 609,197
 798,434
 535,397
Investments 46,380
 61,092
 21,130
 34,492
Deferred tax assets, net 4,356
 6,017
 65,539
 11,559
Other assets 117,855
 130,698
 5,489
 75,984
Total Assets $2,603,130
 $2,342,631
 $2,597,136
 $2,503,891
LIABILITIES AND STOCKHOLDERS' EQUITY        
Current Liabilities:        
Current debt obligations $52,074
 $47,650
 $110,588
 $84,034
Accounts payable 102,651
 92,952
 86,914
 85,915
Accrued liabilities and other 92,212
 75,567
 86,153
 78,942
Taxes payable 28,954
 22,340
 23,089
 12,826
Accrued employee compensation and related benefits 80,466
 78,302
 61,276
 66,224
Liabilities of discontinued operations 
 78,075
Total Current Liabilities 356,357
 316,811
 368,020
 406,016
Long-term debt obligations 71,853
 75,215
 50,413
 61,958
Contingent consideration 178,449
 33,973
Deferred income taxes liability 152,133
 172,541
 154,404
 123,342
Long-term employee compensation and related benefits 33,957
 31,668
 29,328
 28,177
Other long-term liabilities 74,404
 39,487
 33,488
 35,111
Total Liabilities 688,704
 635,722
 814,102
 688,577
Commitments and contingencies (Note 9) 
 
Commitments and contingencies (Note 11) 
 
Stockholders’ Equity:        
Ordinary Shares, £1.00 par value: unlimited shares authorized; 48,250,361 shares issued and 48,200,257 shares outstanding at September 30, 2017; 48,156,690 shares issued and 48,028,413 shares outstanding at December 31, 2016 74,697
 74,578
Ordinary Shares, £1.00 par value: unlimited shares authorized; 48,661,493 shares issued and 48,584,123 shares outstanding at June 30, 2018; 48,290,276 shares issued and 48,287,346 shares outstanding at December 31, 2017 75,269
 74,750
Additional paid-in capital 1,731,565
 1,719,893
 1,744,262
 1,735,048
Accumulated other comprehensive income (loss) 38,469
 (68,487)
Retained earnings (deficit) 72,024
 (14,575)
Treasury stock at cost, 50,104 shares at September 30, 2017 and 128,277 shares at December 31, 2016 (2,329) (4,500)
Accumulated other comprehensive (loss) income (2,633) 45,313
Accumulated deficit (33,755) (39,664)
Treasury stock at cost, 77,370 shares at June 30, 2018 and 2,930 shares at December 31, 2017 (109) (133)
Total Stockholders’ Equity 1,914,426
 1,706,909
 1,783,034
 1,815,314
Total Liabilities and Stockholders’ Equity $2,603,130
 $2,342,631
 $2,597,136
 $2,503,891


LIVANOVA PLC AND SUBSIDIARIES’SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)
(In thousands)
 Nine Months Ended September 30, Six Months Ended June 30,
 2017 2016 2018 2017
Operating Activities:  
  
    
Net income (loss) $86,599
 $(32,990)
Non-cash items included in net income (loss):    
Net income $28,339
 $58,769
Non-cash items included in net income:    
Depreciation 27,880
 30,193
 16,624
 17,998
Amortization 35,445
 33,959
 18,609
 23,095
Stock-based compensation 14,261
 15,575
 14,220
 8,564
Deferred income tax benefit (27,270) (10,224) (9,909) (19,791)
Losses from equity method investments 20,072
 19,382
 1,838
 18,482
Gain on acquisition of Caisson Interventional, LLC (39,428) 
Gain on acquisitions (11,484) (39,428)
Impairment of property, plant and equipment 4,581
 
 480
 4,581
Amortization of income taxes payable on inter-company transfers of property 23,831
 17,114
 5,166
 17,770
Remeasurement of contingent consideration to fair value (5,546) 155
Other 3,364
 8,765
 (943) 1,675
Changes in operating assets and liabilities:       ��
Accounts receivable, net (19,107) (11,040) 21,799
 (15,912)
Inventories (11,006) 20,607
 (11,285) (6,927)
Other current and non-current assets (17,846) (25,845) (15,786) (13,904)
Accounts payable and accrued current and non-current liabilities (3,870) (12,438)
Restructuring reserve (12,753) 14,961
 284
 (11,129)
Accounts payable and accrued current and non-current liabilities (14,958) (31,109)
Net cash provided by operating activities 73,665
 49,348
 48,536
 31,560
Investing Activities:  
  
 

 

Acquisitions, net of cash acquired (279,863) (14,194)
Purchases of property, plant and equipment and other (24,004) (28,928) (13,231) (14,923)
Acquisition of Caisson Interventional, LLC, net of cash acquired (14,194) 
Proceeds from sale of cost method investment 3,192
 
Proceeds from the sale of CRM business franchise 186,682
 
Proceeds from sale of cost-method investment 
 3,192
Loans to equity method investees 
 (6,834)
Proceeds from asset sales 5,346
 222
 13,222
 5,170
Purchases of cost and equity method investments (5,209) (8,059)
Loans to cost and equity method investees (6,928) (6,595)
Purchases of short-term investments 
 (7,054)
Maturities of short-term investments 
 14,051
Other 
 (145)
Net cash used in investing activities (41,797) (36,363) (93,190) (27,734)
Financing Activities:        
Change in short-term borrowing, net (18,054) (33,831) (17,971) (12,812)
Proceeds from short-term borrowing (maturities greater than 90 days) 20,000
 
 240,000
 20,000
Repayment of short-term borrowing (maturities greater than 90 days) (190,000) 
Repayment of long-term debt obligations (11,615) (11,354) (12,240) (11,306)
Proceeds from exercise of stock options 3,221
 7,888
 2,731
 2,442
Repayment of trade receivable advances 
 (23,848)
Proceeds from long-term debt obligations 
 7,994
Share repurchases 
 (11,053)
Payment of deferred consideration - acquisition of Caisson Interventional, LLC (14,073) 
Shares repurchased from employees for minimum tax withholding (7,130) (1,594)
Other (3,552) 1,208
 (390) (97)
Net cash used in financing activities (10,000) (62,996)
Net cash provided by (used in) financing activities 927
 (3,367)
Effect of exchange rate changes on cash and cash equivalents 3,501
 1,030
 (2,508) 2,442
Net increase (decrease) in cash and cash equivalents 25,369
 (48,981)
Net (decrease) increase in cash and cash equivalents (46,235) 2,901
Cash and cash equivalents at beginning of period 39,789
 112,613
 93,615
 39,789
Cash and cash equivalents at end of period $65,158
 $63,632
 $47,380
 $42,690


LIVANOVA PLC AND SUBSIDIARIES
NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)
Note 1. Unaudited Condensed Consolidated Financial Statements
Basis of Presentation
The accompanying condensed consolidated financial statements of LivaNova as of, and for the three and ninesix months ended SeptemberJune 30, 20172018 and SeptemberJune 30, 2016,2017, have been prepared in accordance with generally accepted accounting principles in the United States of America (“U.S.” and such principles, “U.S. GAAP”) GAAP for interim financial information and the instructions to Form 10-Q and Article 10 of Regulation S-X. The accompanying condensed consolidated balance sheet of LivaNova at December 31, 20162017 has been derived from audited financial statements contained in our 20162017 Form 10-K, but does not include all of the information and footnotes required by U.S. GAAP for complete financial statements. In the opinion of management, the condensed consolidated financial statements reflect all adjustments (consisting of only normal recurring adjustments) considered necessary for a fair presentationstatement of the operating results of LivaNova and its subsidiaries, for the three and ninesix months ended SeptemberJune 30, 2017,2018 and are not necessarily indicative of the results that may be expected for the year ending December 31, 2017.2018. The financial information presented herein should be read in conjunction with the audited consolidated financial statements and notes thereto accompanying our 20162017 Form 10-K.
DescriptionSale of our Cardiac Rhythm Management Business Franchise
We completed the sale of our Cardiac Rhythm Management (“CRM”) business franchise to MicroPort Cardiac Rhythm B.V. and MicroPort Scientific Corporation (the “CRM Sale”) on April 30, 2018 for total cash proceeds of $195.9 million, less cash transferred of $9.2 million, subject to certain closing adjustments. In conjunction with the CRM Sale, we entered into transition services agreements to provide certain support services for generally up to twelve months from the closing date of the Mergers
On October 19, 2015 LivaNova becamesale. We previously concluded that the holding companysale of CRM represents a strategic shift in our business that will have a major effect on future operations and financial results. As a result, we classified the combined businessesoperating results of Cyberonics, Inc. (“Cyberonics”)CRM as discontinued operations in our condensed consolidated statements of income. The assets and Sorin S.p.A. (“Sorin”) (the “Mergers”). Based onliabilities of CRM are presented as assets or liabilities of discontinued operations in the structure of the Mergers, management determined that Cyberonics was considered to be the accounting acquirer and predecessor for accounting purposes.condensed consolidated balance sheet at December 31, 2017.
Reclassification of Prior-Year Comparative Period Presentation
To conform the condensed consolidated statementWe have reclassified certain prior period amounts for comparative purposes. These reclassifications did not have a material effect on our financial condition, results of income (loss) for the three and nine months ended September 30, 2016, to the current period presentation, we reclassified $0.7 million and $2.2 million, respectively, of Litigation Related Expenses to the Product Remediation line, and $1.7 million and $2.5 million, respectively, of Litigation Related Expenses to Selling, General and Administrative Expenses.operations or cash flows.
To conform the condensed consolidated balance sheet as of December 31, 2016 to the current period presentation we reclassified $4.5 million of Assets Held for Sale, relating to our plan to exit the Costa Rica manufacturing operation, to a separate line item in the condensed consolidated balance sheet from Prepaid Expenses and Other Current Assets. We received $4.9 million in proceeds from the sale of our Costa Rica manufacturing operation during the nine months ended September 30, 2017.
To conformon the condensed consolidated statement of cash flows for the ninesix months ended SeptemberJune 30, 20162017, to the current period presentation certain amounts werefor the year ended December 31, 2017 in our 2017 Form 10-K, loans to cost and equity method investees of $6.8 million was reclassified within Operatingto Investing Activities from Financing Activities. Commencing with nine months ended September 30,
We reclassified $34.0 million to contingent consideration from other long-term liabilities at December 31, 2017 Loans to Equity and Cost Method Investees of 6.9 million were presented as Investing Activities. To conform to the presentation on the condensed consolidated statement of cash flows for the nine months ended Septemberbalance sheet at June 30, 2016 to the current period presentation, Loans to Equity and Cost Method Investees of $6.6 million were reclassified from Financing Activities to Investing Activities.2018.
Significant Accounting Policies
Our significant accounting policies are detailed in "Note 2: Basis of Presentation, Use of Accounting Estimates and Significant Accounting Policies" of our 20162017 Form 10-K. A further explanation
On January 1, 2018, we adopted ASC Update (“ASU”) No 2014-09, Revenue from Contracts with Customers. Refer to “Note 2. Revenue Recognition.” We elected the cumulative effect transition method; however, we recognized no cumulative effect to the opening balance of retained earnings because the impact on the timing of when revenue is recognized within our Cardiac Surgery segment, specifically related to heart-lung machines and preventative maintenance contracts on cardiopulmonary equipment, was insignificant. The timing of revenue recognition for products and related revenue streams within our Neuromodulation segment and discontinued operations did not change.
Note 2. Revenue Recognition
We generate our revenue through contracts with customers that primarily consist of hospitals, healthcare institutions, distributors and other organizations. Revenue is measured based on consideration specified in a contract with a customer, and excludes amounts collected on behalf of third parties. We measure the consideration based upon the estimated amount to be received. The amount of consideration we ultimately receive varies depending upon the return terms, sales rebates, discounts, and other incentives that we may offer, which are accounted for as variable consideration when estimating the amount of revenue to recognize. The estimate of variable consideration requires significant judgment.


We have historically experienced a low rate of product returns and the total dollar value of product returns has not been significant to our financial statements.
We recognize revenue when a performance obligation is satisfied by transferring the control of a product or providing service to a customer. Some of our Foreign Currency accounting policycontracts include the purchase of multiple products and/or services. In such cases, we allocate the transaction price based upon the relative estimated stand-alone price of each product and/or service sold. We record state and local sales taxes net; that is, discussed below:we exclude sales tax from revenue. Typically, our contracts do not have a significant financing component.
Foreign CurrencyWe incur incremental commission fees paid to the sales force associated with the sale of products. We apply the practical expedient within ASC 606-10-50-22 and have elected to recognize the incremental costs of obtaining a contract as an expense when incurred if the amortization period of the asset the entity would otherwise recognize is one year or less. As a result, no commissions are capitalized as contract costs at June 30, 2018.
Our functional currencyThe following is a description of the U.S. dollar, however,principal activities (separated by reportable segments) from which we generate our revenue. For more detailed information about our reportable segments including disaggregated revenue results by major product line and primary geographic markets, see “Note 16. Geographic and Segment Information”.
Cardiac Surgery Products and Services
The Cardiac Surgery (“CS”) segment has three primary product lines: cardiopulmonary products, heart valves and advanced circulatory support.
Cardiopulmonary products include oxygenators, heart-lung machines, autotransfusion systems, perfusion tubing systems, cannulae and other related accessories. Heart valves include mechanical heart valves, tissue heart valves and related repair products. Technical services include installation, repair and maintenance of cardiopulmonary equipment under service contracts or upon customer request.
Cardiopulmonary products may include performance obligations associated with assembly and installation of equipment. Accordingly, we allocate a portion of the revenues earnedsales prices to installation obligations and expenses incurred by certainrecognize that revenue when the service is provided. We recognize revenue for equipment and accessory product sales when control of the equipment or product passes to the customer.
Heart valve revenue is recognized when control passes to the customer, usually at the point of surgery.
Advanced circulatory support revenue, which represents our recently acquired TandemLife business, is principally derived from the sale of temporary life support product kits that can include a combination of pumps, oxygenators, and cannulae. Revenue is recognized when control passes to the customer, usually at the point of shipment.
Technical service agreements generally provide for upfront payments in advance of rendering services or periodic billing over the contract term. Amounts billed in advance are deferred and recognized as revenue when the performance obligation is satisfied. Technical services are not a significant component of CS revenue and have been presented with the related equipment and accessories revenue.
Neuromodulation Products
Our Neuromodulation (“NM”) segment generates its revenue from the sale of neuromodulation therapy systems for the treatment of drug-resistant epilepsy, treatment-resistant depression and obstructive sleep apnea. The NM product line includes the VNS Therapy System, which consists of an implantable pulse generator, a lead that connects the generator to the vagus nerve, and other accessories. The NM product line also includes an implantable device for the treatment of obstructive sleep apnea that stimulates multiple tongue muscles via the hypoglossal nerve, which opens the airway while a patient is sleeping. We recognize revenue for product sales when control passes to the customer.
Discontinued Operations: Cardiac Rhythm Management Products
CRM generated revenue from the sale of products for the diagnosis, treatment, and management of heart rhythm disorders and heart failure. CRM devices include high-voltage defibrillators and low-voltage pacemakers. We recognize revenue for product sales when control passes to the customer.
Contract Balances
Due to the nature of our subsidiariesproducts and services, revenue producing activities may result in contract assets and contract liabilities which are denominated in currencies other thaninsignificant to our financial position and results of operations. These activities relate primarily to CS technical services contracts for short-term and multi-year service agreements. Contract assets are primarily comprised of unbilled revenues, which occur when a performance obligation has been completed, but not billed to the U.S. dollar. We determine the functional currency of our subsidiaries that exist and operate in different economic and currency environments based on the primary economic environment in which the subsidiary operates, that is, the currency of the environment in which an entity primarily generates and expends cash. Our significant foreign subsidiaries are located in Europe and the U.S. The functional currency of our significant European subsidiaries is the Euro and the functional currency of our significant U.S. subsidiaries is the U.S. dollar.customer. Contract



Assets and liabilities are made up of deferred revenue, which occurs when a customer pays for subsidiaries whose functional currency is not the U.S. dollar are translated into U.S. dollars based on a combination of both current and historical exchange rates, while their revenues earned and expenses incurred are translated into U.S. dollars at average period exchange rates. Translation adjustmentsservice, before a performance obligation has been completed. Contract assets are included as ‘Accumulatedwithin “Prepaid expenses and other comprehensive income (loss)’ (“AOCI”)current assets” in the condensed consolidated balance sheets. Gainssheets and losses arising from transactions denominated in a currency different from an entity’s functional currencywere insignificant at June 30, 2018 and December 31, 2017. As of June 30, 2018 and December 31, 2017, contract liabilities of $5.1 million and $3.8 million, respectively, are included within “Accrued liabilities and other” and “Other long-term liabilities” in ‘Foreign exchange and other (losses) gains’ in ourthe condensed consolidated statements of income (loss).balance sheets.
Note 2. Acquisitions3. Business Combinations
In support of our strategic growth initiatives, onCaisson Interventional, LLC
On May 2, 2017, we acquired the remaining 51% equity interests in Caisson Interventional, LLC (“(Caisson”) for a purchase price of up to $72.0 million, net of $6.3 million of debt forgiveness, consisting of $18.0 million paid at closing, $14.4 million to be paid after 12 months,during the second quarter of 2018, and contingent consideration of up to $39.6 million to be paid on a schedule driven primarily by regulatory approvals and a sales-based earnout.
Caisson a clinical-stage medical device company based in Maple Grove, Minnesota, is focused on the design, development and clinical evaluation of a novel transcatheter mitral valve replacement (“TMVR”) implant device with a fully transvenous delivery system.system for the treatment of mitral valve regurgitation. The purchase price allocation was finalized during the second quarter of 2018 and there were no adjustments to the preliminary purchase price allocation during the measurement period.
We performed a quantitative impairment assessment, as of April 1, 2018, for the goodwill and in-process research and development assets arising from the Caisson acquisition. Based upon the assessment performed, we determined that the goodwill and the in-process research and development assets were not impaired. The quantitative impairment assessment was performed using management’s current estimate of future cash flows which are based on the expected timing of future regulatory approvals. A delay in the anticipated timing of these regulatory approvals or a change in management’s estimates could result in a fair value of the in-process research and development that is below its carrying amount. We will continue to monitor any changes in circumstances for indicators of impairment.
ImThera Medical, Inc.
On January 16, 2018, we acquired the remaining 86% outstanding interest in ImThera Medical, Inc. (“ImThera”) for cash consideration of up to $225 million. Cash of $78.3 million was paid at closing with the balance to be paid based on achievement of a certain regulatory milestone and a sales-based earnout.
Headquartered in San Diego, California, ImThera manufactures an implantable device for the treatment of obstructive sleep apnea that stimulates multiple tongue muscles via the hypoglossal nerve, which opens the airway while a patient is sleeping. ImThera has a commercial presence on the European market, and an FDA pivotal study is ongoing in the U.S. ImThera is highly aligned with our Neuromodulation Business Franchise.
The following table presents the acquisition date fair-valuefair value of the consideration transferred and the fair value of our interest in CaissonImThera prior to the acquisition (in thousands):
Cash (1)
 $15,660
Debt forgiven (2)
 6,309
Deferred consideration (1)
 12,994
Contingent consideration (1)
 29,303
Fair value of consideration transferred 64,266
Fair value of our interest prior to the acquisition (2)
 52,505
Fair value of total consideration $116,771
Cash $78,332
Contingent consideration 112,744
Fair value of our interest in ImThera prior to the acquisition (1)
 25,580
Fair value of consideration transferred $216,656
(1)
Concurrent withThe fair value of our previously-held interest in ImThera was determined based on the acquisition,fair value of total consideration transferred and application of a discount for lack of control. As a result, we recognized $5.8a gain of $11.5 million for the fair value in excess of post-combination compensation expense. Of this amount, $2.4 millionour carrying value of $14.1 million. The gain is reflected as a reduction of $18.0 million in cash paid at closing of the acquisition, while $3.4 million increased the deferred consideration and contingent consideration liabilities recognized at the date of the acquisition to a total of $14.1 million and $31.7 million, respectively.
(2)On the acquisition date, we remeasured the notes receivable from Caisson and“Gain on acquisitions” on our existing investment in Caisson at fair value and recognized a pre-tax non-cash gain of $1.3 million and $38.1 million, respectively, which are included in ‘Gain on acquisition of Caisson Interventional, LLC’ in the condensed consolidated statementsstatement of income (loss).for the six months ended June 30, 2018.


The following table presents the preliminary purchase price allocation at fair value for the CaissonImThera acquisition including certain measurement period adjustments (in thousands):
Cash and cash equivalents $1,468
In-process research and development 89,000
Goodwill 42,417
Other assets 918
Current liabilities 1,023
Deferred income tax liabilities, net 16,009
Net assets acquired $116,771
  Initial Purchase Price Allocation 
Measurement Period Adjustments (1)
 Adjusted Purchase Price Allocation
In-process research and development (2)
 $151,605
 $10,677
 $162,282
Developed technology 5,661
 (5,661) 
Goodwill 87,063
 (4,467) 82,596
Deferred income tax liabilities, net (3)
 (27,980) (1,278) (29,258)
Other assets and liabilities, net 836
 200
 1,036
Net assets acquired $217,185
 $(529) $216,656
(1)During the second quarter of 2018, measurement period adjustments were recorded based upon new information obtained about facts and circumstances that existed as of the acquisition date.
(2)The fair value of in-process research and development ("IPR&D") was determined using the income approach, which is a valuation technique that provides a fair value estimate based on the market participant expectations of cash flows the asset would generate. The cash flows were discounted commensurate with the level of risk associated with the asset. The discount rates were developed after assigning a probability of success to achieving the projected cash flows based on the current stage of development, inherent uncertainty in reaching certain regulatory milestones and risks associated with commercialization of the product. The IPR&D amount is included in “Intangible assets, net” in the condensed consolidated balance sheet at June 30, 2018.
(3)The amount includes a provisional estimate for deferred tax assets acquired.
Acquired goodwill of $9.6 millionGoodwill arising from the ImThera acquisition, which is expected to benot deductible for tax purposes. Additionally, $3.0 millionpurposes, primarily represents the synergies anticipated between ImThera and our existing neuromodulation business. The assets acquired, including goodwill, are recognized in our Neuromodulation segment.
During the second quarter of 2018, we determined that developments in the ImThera clinical trial will result in a minimum 12-month delay of regulatory approval. This delay constituted a triggering event that required evaluation of the initial cash payment was deposited in escrowin-process research and development asset for future claims indemnification. Of this amount, $2.0 million is included in ‘Prepaid expenses and other current assets’ and the remaining $1.0 million is included in ‘Other long-term assets’impairment. Based on the condensed consolidated balance sheet asquantitative impairment evaluation, the in-process research and development asset was not impaired; however, a further delay or a change in management’s estimates could result in a fair value that is below the carrying amount for such an asset. We will continue to monitor any changes in circumstances for indicators of Septemberimpairment.
The results of the ImThera acquisition added $0.1 million and $0.2 million in revenue and $2.6 million and $3.6 million in operating losses during the three and six months ended June 30, 2017.
We2018, respectively. Additionally, we recognized ImThera acquisition-related expenses of approximately $1.0$0.2 million and $0.3 million for legal and valuation expenses during the ninethree and six months ended SeptemberJune 30, 2017.2018, respectively. These expenses are included within ‘Selling,“Selling, general and administrative’administrative” expenses in the condensed consolidated statements of income (loss). Additionally, the results of Caisson for the period of May 2, 2017 through September 30, 2017 added no revenue and $16.9 million in expenses in our condensed consolidated statement of income (loss).income. Pro forma financial information assuming the ImThera acquisition had occurred as of the beginning of the calendar year prior to the year of acquisition was not material for disclosure purposes.


The ImThera business combination involved contingent consideration arrangements are composed of potential cash payments upon the achievement of a certain regulatory milestonesmilestone and a sales-based earnout associated with sales of products covered by the purchase agreement. The sales-based earnout was valued using projected sales from our internal strategic plans.plan. Both arrangements are Level 3 fair value measurements and include the following significant unobservable inputs (in thousands):
Caisson Acquisition Fair value at May 2, 2017 Valuation Technique Unobservable Input Ranges
Regulatory milestone-based payments $14,883
 Discounted cash flow Discount rate 2.6% - 3.4%
      Probability of payment 90-95%
      Projected payment years 2018-2023
         
Sales-based earnout 16,805
 Monte Carlo simulation Discount rate 11.5-12.7%
      Sales volatility 36.9%
      Projected years of sales 2019-2033
  $31,688
      
ImThera Acquisition Fair value at January 16, 2018 Valuation Technique Unobservable Input Ranges
Regulatory milestone-based payment $50,429
 Discounted cash flow Discount rate 4.3% - 4.7%
      Probability of payment 85% - 95%
      Projected payment years 2020 - 2021
         
Sales-based earnout 62,315
 Monte Carlo simulation Risk-adjusted discount rate 11.5%
      Credit risk discount rate 4.7% - 5.8%
      Revenue volatility 29.3%
      Probability of payment 85% - 95%
  
   Projected years of earnout 2020 - 2025
  $112,744
      
TandemLife
On April 4, 2018, we acquired CardiacAssist, Inc., doing business as TandemLife (“TandemLife”) for cash consideration of up to $250 million. Cash of $204 million was paid at closing with up to $50 million in contingent consideration based on achieving regulatory milestones. TandemLife, headquartered in Pittsburgh, Pennsylvania, is focused on the delivery of leading-edge temporary life support systems, including cardiopulmonary and respiratory support solutions. TandemLife complements our Cardiac Surgery portfolio, and expands our existing line of cardiopulmonary products.
The following table provides a reconciliationpresents the acquisition date fair value of the beginning and ending balance of the contingent consideration liability, which consisted of arrangements that arose from the Caisson acquisition and other previous acquisitions that also included contingent considerationtransferred (in thousands):
Balance at December 31, 2016 $3,890
Purchase price - Caisson contingent consideration 31,688
Payments (1,841)
Changes in fair value 231
Effect of changes in foreign currency exchange rates 249
Balance at September 30, 2017 (1)
 $34,217
Cash $203,671
Contingent consideration 40,190
Fair value of consideration transferred $243,861
The following table presents the preliminary purchase price allocation at fair value for the TandemLife acquisition (in thousands):
In-process research and development (1) (2) (3)
 $110,977
Trade names (1)
 11,539
Developed technology (1)
 6,387
Goodwill 118,917
Inventory 10,296
Other assets and liabilities, net 3,632
Deferred income tax liabilities, net (3)
 (17,887)
Net assets acquired $243,861
(1)The contingent consideration liability represents contingent payments relatedamounts above are included in “Intangible assets, net” in the condensed consolidated balance sheet at June 30, 2018. Trade names and developed technology are amortized over remaining useful lives of 15 and 2 years, respectively.
(2)The fair value of in-process research and development ("IPR&D") was determined using the income approach, which is a valuation technique that provides a fair value estimate based on the market participant expectations of cash flows the asset would generate. The cash flows were discounted commensurate with the level of risk associated with the asset. The discount rates were developed after assigning a probability of success to three acquisitions:achieving the firstprojected cash flows based on the current stage of development, inherent uncertainty in reaching certain regulatory milestones and second acquisitions, in September 2015, were Cellplex PTY Ltd. in Australiarisks associated with commercialization of the product.
(3)The amounts include provisional estimates based on the information available as of the acquisition date. The Company is gathering additional information necessary to finalize the estimated fair values for deferred tax assets acquired and the commercial activitiesIPR&D.


Goodwill arising from the TandemLife acquisition, which is not deductible for tax purposes, primarily represents the synergies anticipated between TandemLife and our existing cardiac surgery business. The assets acquired, including goodwill, are recognized in our Cardiac Surgery segment.
The results of the TandemLife acquisition added $6.0 million in revenue and $6.1 million in operating losses during each of the three and six months ended June 30, 2018. Additionally, we recognized TandemLife acquisition-related expenses of approximately $1.6 million and $1.9 million for legal and valuation expenses during the three and six months ended June 30, 2018, respectively. These expenses are included within “Selling, general and administrative” expenses in the condensed consolidated statement of income. Pro forma financial information assuming the TandemLife acquisition had occurred as of the beginning of the calendar year prior to the year of acquisition was not material for disclosure purposes.
The TandemLife business combination involved a local distributor in Colombia. The contingent consideration arrangement composed of potential cash payments upon the achievement of certain regulatory milestones. The arrangement is a Level 3 fair value measurement and includes the following significant unobservable inputs (in thousands):
TandemLife Acquisition Fair value at April 4, 2018 Valuation Technique Unobservable Input Ranges
Regulatory milestone-based payments $40,190
 Discounted cash flow Discount rate 4.2% - 4.8%
      Probability of payments 75% - 95%
      Projected payment years 2019 - 2020
Note 4. Discontinued Operations
In November 2017, we concluded that the sale of CRM represented a strategic shift in our business that would have a major effect on future operations and financial results. As a result, we classified the operating results of CRM as discontinued operations in our condensed consolidated statements of income for all the periods presented in this Quarterly Report on Form 10-Q. The assets and liabilities of CRM are presented as assets or liabilities of discontinued operations in the condensed consolidated balance sheets at December 31, 2017.
We completed the CRM Sale on April 30, 2018 for total cash proceeds of $195.9 million, less cash transferred of $9.2 million, subject to certain customary closing adjustments. In conjunction with the sale, we entered into transition services agreements to provide certain support services for generally up to twelve months from the closing date of the sale. The services include, among others, accounting, information technology, human resources, quality assurance, regulatory affairs, supply chain, clinical affairs and customer support. During the six months ended June 30, 2018, we recognized income of $0.9 million for providing these services. Income recognized related to the transition services agreements is recorded as a reduction to the related expenses in the associated expense line items in the condensed consolidated statements of income.


The following table represents assets and liabilities of CRM presented as assets and liabilities of discontinued operations in the condensed consolidated balance sheet:
  December 31, 2017
Accounts receivable, net $64,684
Inventories 54,097
Prepaid taxes 14,725
Prepaid and other assets 3,498
Property, plant and equipment, net 12,104
Deferred tax assets, net 2,517
Investments 6,098
Intangible assets, net 92,966
Assets of discontinued operations $250,689
   
Accounts payable 26,501
Accrued liabilities and other 7,669
Taxes payable 5,084
Accrued employee compensation and benefits 30,753
Deferred income taxes liability 8,068
Liabilities of discontinued operations $78,075
The following table represents the financial results of CRM presented as net (loss) income from discontinued operations in the condensed consolidated statements of income:
 Three Months Ended June 30, Six Months Ended June 30,
 
2018 (1)
 2017 
2018 (1)
 2017
Revenues$27,206
 $65,544
 $87,313
 $123,824
Cost of sales10,391
 24,800
 32,529
 46,285
Gross profit16,815
 40,744
 54,784
 77,539
Selling, general and administrative expenses15,073
 25,960
 46,899
 50,997
Research and development5,929
 9,118
 17,210
 18,377
Merger and integration expenses
 10
 
 32
Restructuring expenses
 (1,479) 651
 (1,359)
Amortization of intangibles
 3,565
 
 7,019
Revaluation gain on assets and liabilities held for sale
 
 (1,213) 
Loss on sale of CRM214
 
 214
 
Total operating expenses21,216
 37,174
 63,761
 75,066
Operating (loss) income from discontinued operations(4,401) 3,570
 (8,977) 2,473
Foreign exchange and other (losses) gains(67) (402) 12
 (172)
(Loss) income from discontinued operations, before tax(4,468) 3,168
 (8,965) 2,301
Income tax (benefit) expense(6) 54
 (1,165) 54
Losses from equity method investments
 (1,295) (1,211) (2,384)
Net (loss) income from discontinued operations (1)
$(4,462) $1,819
 $(9,011) $(137)
(1)CRM financial results for the first acquisition are based on achievement of sales targets by the acquiree throughthree and six month periods ended June 30, 2018 andinclude activity through the contingent payments for the second acquisition are based on sales of cardiopulmonary disposable products and heart lung machinesclose of the acquiree through December 2019. The third acquisition, Caisson, occurred in May 2017 and is discussed above. Refer to “Note 6. Fair Value Measurements.”sale on April 30, 2018.
Cash flows attributable to our discontinued operations are included in our condensed consolidated statements of cash flows. For the six months ended June 30, 2018 and 2017, CRM’s capital expenditures were $0.9 million and $2.4 million, respectively


and stock-based compensation expense was $2.1 million and $0.3 million, respectively. For the six months ended June 30, 2017 depreciation and amortization was $9.9 million.
Note 3.5. Restructuring
Our 2015 and 2016 Reorganization Plans (the “Plans”) were initiated October 2015 and March 2016, respectively, in conjunction with the completion of the Mergers.merger of Cyberonics, Inc. and Sorin S.p.A. in October 2015. We initiated these plans to leverage economies of scale, streamline distribution and logistics and strengthen operational and administrative effectiveness in order to reduce overall costs. Costs associated with these plans wereare reported as ‘Restructuring expenses’ in our operating results in the condensed consolidated statements of income (loss). We estimate that the Plans will result in a net reduction of 326 personnel of which 292 have occurred as of September 30, 2017.income.
In March 2017, we committed to a plan to sell our Suzhou Industrial Park facility in Shanghai, China. As a result of this exit plan we recorded an impairment of the building and equipment of $4.6 million and accrued $0.5 million of additional costs, primarily related to employee severance, during the ninesix months ended SeptemberJune 30, 2017. In addition, the remaining carrying value of theThe land, building and equipment was reclassified to ‘Assetswere recorded as Assets held for sale’ in March 2017, with a balance of $14.1 million as of September 30, 2017,sale on the condensed consolidated balance sheet.


sheet as of December 31, 2017. We completed the sale of the Suzhou facility in April 2018 and received cash proceeds from the sale of $13.3 million.
The following table presents restructuring expense accrual detailthe Plans’ accruals, inventory obsolescence and other reserves, recorded in connection with the Reorganization Plans including the balances and activity related to the discontinued operations, (in thousands):
 Employee Severance and Other Termination Costs Other Total Employee Severance and Other Termination Costs Other Total
Balance at December 31, 2016 $21,092
 $3,056
 $24,148
Balance at December 31, 2017 $3,889
 $2,625
 $6,514
Charges 7,126
 4,934
 12,060
 2,544
 464
 3,008
Cash payments and adjustments (23,804) (5,480) (29,284) (5,431) (470) (5,901)
Balance at September 30, 2017 $4,414
 $2,510
 $6,924
Balance at June 30, 2018 $1,002
 $2,619
 $3,621
The following table presents restructuring expense by reportable segment, with discontinued operations included (in thousands):
 Three Months Ended September 30, Nine Months Ended September 30, Three Months Ended June 30, Six Months Ended June 30,
 2017 2016 2017 2016 2018 2017 2018 2017
Cardiac Surgery(1) $441
 $916
 $6,944
 $5,878
 $398
 $501
 $1,739
 $6,503
Cardiac Rhythm Management (391) 571
 (1,750) 16,592
Neuromodulation 14
 2,882
 513
 7,017
 11
 (233) 17
 439
Other 728
 12
 6,353
 7,732
 67
 2,329
 601
 5,685
Restructuring expense from continuing operations 476
 2,597
 2,357
 12,627
Discontinued operations 
 (1,479) 651
 (1,359)
Total $792
 $4,381
 $12,060
 $37,219
 $476
 $1,118
 $3,008
 $11,268
(1)Cardiac Surgery restructuring expense for the six months ended June 30, 2017 included building and equipment impairment and additional costs of $5.1 million related to the Suzhou, China facility exit plan.
Note 4.6. Product Remediation Liability
On December 29, 2015, we received an FDA Warning Letter (the “Warning Letter”) alleging certain violations of FDA regulations applicable to medical device manufacturing at our Munich, Germany and Arvada, Colorado facilities. On October 13, 2016, the Centers for Disease Control and Prevention (“CDC”) and FDA separately released safety notifications regarding the 3T Heater-Cooler devices in response to which we issued a Field Safety Notice Update for U.S. users of 3T Heater-Cooler devices to proactively and voluntarily contact facilities to facilitate implementation of the CDC and FDA recommendations.
At December 31, 2016, we recognized a liability for a product remediation plan related to our 3T Heater-Cooler device (“3T device”). The remediation plan we developed consists primarily of a modification of the 3T device design to include internal sealing and the addition of a vacuum system to new and existing devices. These changes are intended to address regulatory actions and to reduce further the risk of possible dispersion of aerosols from 3T devices in the operating room. We concluded that it was probable that a liability had been incurred upon management’s approval of the plan and the commitments made by management to various regulatory authorities globally in November and December 2016, and furthermore, the cost associated


with the plan was reasonably estimable. The deployment of this solution for commercially distributed devices has been dependent upon final validation and verification of the design changes and approval or clearance by regulatory authorities worldwide, including FDA clearance in the U.S. It is reasonably possible that our estimate of the remediation liability could materially change in future periods due to the various significant assumptions involved such as customer behavior, market reaction and the timing of approvals or clearance by regulatory authorities worldwide.
In April 2017, we obtained CE Mark in Europe for the design change of the 3T device and in May 2017 we completed our first vacuum and sealing upgrade on a customer-owned device. We are currently implementing the vacuum and sealing upgrade program in as many countries as possible throughout the remainder of 2017.2018 and beyond until all devices are upgraded. As part of the remediation plan, we also intend to perform a no-charge deep disinfection service (deep cleaning service) for 3T device users who have reported confirmed M. chimaera mycobacterium contamination. Although the deep disinfection service is not yet available in the U.S., it is currently offered in many countries around the world and will be expanded to additional geographies as we receive the required regulatory approvals. On April 12, 2018, the FDA agreed to allow us to move forward with the deep cleaning service in the U.S., adding to the growing list of countries around the world in which we offer this service. Finally, we are continuing to offer the loaner program for 3T devices, initiated in the fourth quarter of 2016, to provide existing 3T device users with a new loaner 3T device at no charge pending regulatory approval and implementation of the vacuum system addition and deep disinfection service worldwide. This loaner program began in the U.S. and is being made available progressively on a global basis, prioritizing and allocating devices to 3T device users based on pre-established criteria.
Changes in the carrying amount of the product remediation liability are as follows (in thousands):
Balance at December 31, 2016 $33,487
Adjustments (15)
Remediation activity (5,672)
Effect of changes in foreign currency exchange rates 2,446
Balance at September 30, 2017 (1)
 $30,246
Balance at December 31, 2017 $27,546
Remediation activity (7,272)
Effect of changes in foreign currency exchange rates (557)
Balance at June 30, 2018 (1)
 $19,717
(1)
At SeptemberJune 30, 2017,2018, the product remediation liability balance is held within ‘Accrued liabilities and other’ and ‘Other long-term liabilities’ onin the condensed consolidated balance sheet. Refer to “Note 15. Supplemental Financial Information.”
It is reasonably possible that our estimate of the remediation liability could materially change in future periods dueFor further information, please refer to the various significant assumptions involved, such as customer behavior, market reaction“Note 11. Commitments and the timing of approvals or clearance by regulatory authorities worldwide. We recognize changes in estimates on a prospective basis.Contingencies.” At this stage, we have recognized no liability has


been recognized with respect to any lawsuits involving us related to the 3T device whileand our related legal costs are expensed as incurred. For further information, please refer to “Note 9. Commitments and Contingencies - 3T Heater-Cooler Devices.”
Note 5.7. Investments
Cost-Method Investments
Our cost-method investments are included in ‘Investments’“Investments” in the condensed consolidated balance sheets and consist of our equity positions in the following privately-held companies (in thousands):
 September 30, 2017 December 31, 2016 June 30, 2018 December 31, 2017
Respicardia Inc. (1)
 $21,129
 $17,518
 $17,705
 $17,422
ImThera Medical, Inc. (2)
 12,000
 12,000
 
 12,900
Rainbow Medical Ltd. (3)
 4,178
 3,733
 1,140
 1,172
MD Start II(4) 1,179
 526
 1,164
 1,199
Other (4)
 150
 
Highlife S.A.S. (5)
 1,104
 
Other 17
 17
 $38,636
 $33,777
 $21,130
 $32,710
(1)Respicardia Inc. (“Respicardia”) is a privately funded U.S. company developing an implantable device designed to restore a more natural breathing pattern during sleep in patients with central sleep apnea ("CSA") by transvenously stimulating the phrenic nerve. We have a loan outstanding to Respicardia with a carrying amount of $1.5$0.5 million, as of SeptemberJune 30, 2017,2018, which is included in ‘Prepaid“Prepaid expenses and other current assets’ onassets” in the condensed consolidated balance sheet.
(2)ImThera Medical Inc. (“ImThera”) is a privately funded U.S. company developing a neurostimulation device system forOn January 16, 2018, we acquired the treatment of obstructive sleep apnea. We have a loanremaining outstanding interests in ImThera. Refer to ImThera as of September 30, 2017, with a carrying amount of $1.0 million, which is included in ‘Other assets’ on the condensed consolidated balance sheet.“Note 3. Business Combinations”.
(3)
Rainbow Medical Ltd. is a private Israeli venture capital company that seeds and grows companies developing medical devices in a diverse range of medical fields.
(4)DuringMD Start II is a private venture capital collaboration for the nine months ended September 30, 2017, we sold our investmentdevelopment of medical device technology in Istituto Europeo di Oncologia S.R.L, for a gain of $3.2 million. This gain is included in ‘Foreign exchange and other gains (losses)’ in the condensed consolidated statement of income (loss).
Equity Method Investments
Our equity-method investments are included in ‘Investments’ in the condensed consolidated balance sheets and consist of our equity position in the following entities (in thousands, except for percent ownership):
  
% Ownership (1)
 September 30, 2017 December 31, 2016
MicroPort Sorin CRM (Shanghai) Co. Ltd. (2)
 49.0% $6,948
 $4,867
Highlife S.A.S. (3)
 38.0% 779
 6,009
Caisson Interventional LLC (4)
 
 
 16,423
Other   17
 16
Total   $7,744
 $27,315
(1)Ownership percentages as of September 30, 2017.Europe.
(2)(5)During
Due to an additional investment by a third party during the three months ended SeptemberJune 30, 20172018, our equity interest in Highlife S.A.S. (“Highlife”) decreased to 17.5% from 24.6%. We determined that we invested an additional $4.5 million in MicroPort Sorin CRM (Shanghai) Co. Ltd.
(3)no longer had significant influence over Highlife S.A.Sand it is now considered a privately held clinical-stage medical device company located in France and is focused on the development of a unique transcatheter mitral valve replacement system to treat patients with mitral regurgitation. During the three months ended September 30, 2017, we recognized an impairmentcost method investment. The carrying amount of our equity-method investment in and notes receivable from, Highlife. See the paragraph below for further details.Highlife was $1.8 million at December 31, 2017.
(4)On May 2, 2017, we acquired the 51% remaining equity interests in Caisson Interventional LLC (“Caisson”), and we began consolidating the results of Caisson as of the acquisition date. Refer to “Note 2. Acquisitions” and to “Note 6. Fair Value Measurements” for further information.
Highlife Impairment
We recognized an impairment of our equity-method investment in, and notes receivable from, Highlife S.A.S. (“Highlife”) during the nine months ended September 30, 2017. Certain factors, including a revision in our investment strategy, indicated that the carrying value of our aggregate investment might not be recoverable and that the decrease in value of our aggregate investment was other than temporary. We, therefore, estimated the fair value of our investment and notes receivable using the


market approach. The estimated fair value of our aggregate investment was below our carrying value by $13.0 million. This aggregate impairment was included in ‘Losses from equity method investments’ in the condensed consolidated statements of income (loss). The updated carrying value of our notes receivable from Highlife at September 30, 2017 was $0.8 million and is included in ‘Other assets’ on the condensed consolidated balance sheet.
Note 6.8. Fair Value Measurements
We review the fair value hierarchy classification on a quarterly basis. Changes in the ability to observe valuation inputs may result in a reclassification of levels for certain securities within the fair value hierarchy. There were no transfers between Level 1, Level 2, or Level 3 during the six months ended June 30, 2018.
Assets and Liabilities Measured at Fair Value on a Recurring Basis
The following table provides information by level for assets and liabilities that are measured at fair value on a recurring basis (in thousands):
 Fair Value
as of
 Fair Value Measurements Using Inputs Considered as: Fair Value as of June 30, 2018 Fair Value Measurements Using Inputs Considered as:
 September 30, 2017 Level 1 Level 2 Level 3 Level 1 Level 2 Level 3
Liabilities:                
Derivative liabilities - designated as cash flow hedges (foreign currency exchange rate "FX") $724
 $
 $724
 $
 $1,209
 $
 $1,209
 $
Derivative liabilities - designated as cash flow hedges (interest rate swaps) 1,807
 
 1,807
 $
 1,221
 
 1,221
 
Derivative liabilities - freestanding instruments (FX) 1,456
 
 1,456
 
 827
 
 827
 
Contingent consideration(1) 34,217
 
 
 34,217
 181,133
 
 
 181,133
 $38,204
 $
 $3,987
 $34,217
 $184,390
 $
 $3,257
 $181,133
 Fair Value
as of
 Fair Value Measurements Using Inputs Considered as: Fair Value as of December 31, 2017 Fair Value Measurements Using Inputs Considered as:
 December 31, 2016 Level 1 Level 2 Level 3  Level 1 Level 2 Level 3
Assets:                
Derivative assets - designated as cash flow hedges (FX) $4,911
 $
 $4,911
 $
Derivative assets - freestanding instruments (FX) 3,358
 
 3,358
 
 $519
 $
 $519
 $
 $8,269
 $
 $8,269
 $
 $519
 $
 $519
 $
                
Liabilities:                
Derivative liabilities - designated as cash flow hedges (FX) $942
 $
 $942
 $
 $460
 $
 $460
 $
Derivative liabilities - designated as cash flow hedges (interest rate swaps) 1,392
 
 1,392
 
 1,585
 
 1,585
 
Contingent consideration 3,890
 
 
 3,890
Contingent consideration (1)
 33,973
 
 
 33,973

 $6,224
 $
 $2,334
 $3,890
 $36,018
 $
 $2,045
 $33,973
(1)The contingent consideration liability represents contingent payments related to five completed acquisitions: Cellplex PTY Ltd., Inversiones Drilltex SAS, Caisson, ImThera and TandemLife. See the table below for additional information.


Our recurring fair value measurements, using significant unobservable inputs (level(Level 3), relate solely to our contingent consideration liability. Refer to “Note 2. Acquisitions” forThe following table provides a discussionreconciliation of the changes inbeginning and ending balance of the fair value of our contingent consideration liability.liability (in thousands):
Total contingent consideration liability at December 31, 2017 $33,973
Purchase price - ImThera contingent consideration 112,744
Purchase price - TandemLife contingent consideration 40,190
Payments (196)
Changes in fair value (1)
 (5,546)
Effect of changes in foreign currency exchange rates (32)
Total contingent consideration liability at June 30, 2018 181,133
Less current portion of contingent consideration liability at June 30, 2018 2,684
Long-term portion of contingent consideration liability at June 30, 2018 $178,449
(1)Includes a decrease of $6.1 million due to the delay in the timing of anticipated regulatory approval for ImThera. See “Note 3. Business Combinations” for additional discussion.


Note 7.9. Financing Arrangements
The outstanding principal amount of long-term debt (in thousands, except interest rates):
 September 30, 2017 December 31, 2016 Maturity Interest Rate June 30, 2018 December 31, 2017 Maturity Interest Rate
European Investment Bank (1)
 $78,590
 $78,987
 June 2021 0.95% $58,213
 $69,893
 June 2021
 0.95%
Mediocredito Italiano (3)(2)
 7,719
 7,276
 December 2023 0.50% - 3.07%
 8,406
 9,118
 December 2023
 0.50% - 3.10%
Banca del Mezzogiorno (2)(3)
 6,490
 6,747
 December 2019 0.50% - 3.15%
 4,137
 5,499
 December 2019
 0.50% - 3.15%
Bpifrance (ex-Oséo) 1,603
 1,909
 October 2019 2.58%
Region Wallonne 831
 798
 December 2023 and June 2033 0.00% - 2.45%
 756
 845
 December 2023 and June 2033
 0.00% - 2.45%
Mediocredito Italiano - mortgages and other 742
 799
 September 2021 and September 2026 0.40% - 0.65%
 536
 997
 September 2021 and September 2026
 0.80% - 1.30%
Total debt 95,975
 96,516
  
Bpifrance (ex-Oséo) 
 1,450
 
 2.58%
Total long-term facilities 72,048
 87,802
    
Less current portion of long-term debt 24,122
 21,301
   21,635
 25,844
    
Total long-term debt $71,853
 $75,215
   $50,413
 $61,958
    
(1)The European Investment Bank (“EIB”) loan was obtained in July 2014 to support product development projects. The interest rate for the EIB loan is reset by the lender each quarter based on the Euribor. Interest payments are paid quarterly and principal payments are paid semi-annually.
(2)We obtained the Mediocredito Italiano Bank loan in July 2016 as part of the Fondo Innovazione Teconologica program implemented by the Italian Ministry of Education.
(3)The Banca del Mezzogiorno loan was obtained in January 2015 to support R&D projects as a part of the Large Strategic Project program of the Italian Ministry of Education.
(3)We obtained the Mediocredito Italiano Bank loan in July 2016 as part of the Fondo Innovazione Teconologica program implemented by the Italian Ministry of Education.
Revolving Credit
The outstanding principal amount of our short-term unsecured revolving credit agreements and other agreements with various banks was $28.0$89.0 million and $26.4$58.2 million, at SeptemberJune 30, 20172018 and December 31, 2016,2017, respectively, with interest rates ranging from 0.2%0.1% to 10.5%9.3% and loan terms ranging from one day to 365180 days.
On April 10, 2018, we entered into an amendment and restatement agreement with Barclays Bank PLC amending the revolving facility agreement originally dated October 21, 2016 (the “Amendment”). The Amendment increases the borrowing capacity under the facility from $40.0 million to $70.0 million and extends the term of the facility one year, terminating October 20, 2019. Borrowings under the facility bear interest at a rate of LIBOR plus 0.85%. At June 30, 2018 this facility is fully utilized.
In connection with the CRM sale, the borrowing capacity under our June 2017 finance contract with the European Investment Bank Financingdecreased from €100.0 million (approximately $116.4 million) to €90.0 million (approximately $104.8 million) and the availability for drawdowns was extended through December 31, 2020.


Bridge Facility Agreement
On June 29, 2017, weIn connection with the April 2018 acquisition of TandemLife, LivaNova entered into a new finance contractbridge facility agreement (the “Finance Contract”“Bridge Facility Agreement”) providing a term loan facility with the EIB to support financing of certain R&D projects. The Finance Contract has a borrowing base of €100 million (or approximately $118 million USD equivalent) and can be drawn in up to two tranches, each in a minimumaggregate principal amount of €50$190.0 million. On April 3, 2018, we borrowed $190.0 million (or approximately $59 million USD equivalent). Drawdowns must occur by December 30, 2018, andunder the last repayment dateBridge Facility Agreement to facilitate the initial payment for our acquisition of any tranche will be no earlier than four years and no later than eight years afterTandemLife. We used the disbursementproceeds from the sale of the relevant tranche. LoansCRM business franchise to repay the borrowings under the Finance Contract are subject to certain covenants and other terms and conditions. No loan drawdowns have occurred asBridge Facility Agreement in full during the second quarter of September 30, 2017.2018.
Note 8.10. Derivatives and Risk Management
Due to the global nature of our operations, we are exposed to foreign currency exchange rate fluctuations. In addition, due to certain loans with floating interest rates, we are also subject to the impact of changes in interest rates on our interest payments. We enter into foreign currency exchange rate (“FX”) derivative contracts and interest rate swap contracts to reduce the impact of foreign currency rate and interest rate fluctuations on earnings and cash flow. We measure all outstanding derivatives each period end at fair value and report the fair value as either financial assets or liabilities in the condensed consolidated balance sheets. We do not enter into derivative contracts for speculative purposes. At inception of the contract, the derivative is designated as either a freestanding derivative or a hedge. Derivatives that are not designated as hedging instruments are referred to as freestanding derivatives with changes in fair value included in earnings.
If the derivative qualifies for hedge accounting, depending on the nature of the hedge and hedge effectiveness, changes in the fair value of the derivative will either be recognized immediately in earnings or recorded in accumulated other AOCIcomprehensive income (“AOCI”) until the hedged item is recognized in earnings upon settlement/termination. FX derivative gains and losses in AOCI are reclassified to the condensed consolidated statementstatements of income (loss) as shown in the tables below and interest rate swap gains and losses in AOCI are reclassified to interest expense in the condensed consolidated statementstatements of income (loss).income. We evaluate hedge effectiveness at inception and on an ongoing basis. If a derivative is no longer expected to be highly effective, hedge accounting is discontinued. Hedge ineffectiveness, if


any, is recorded in earnings. Cash flows from derivative contracts are reported as operating activities in the condensed consolidated statements of cash flows.
Freestanding Derivative FX Contracts
The gross notional amount of freestanding derivativesFX derivative contracts, not designated as hedging instruments, outstanding at SeptemberJune 30, 20172018 and December 31, 20162017 was $239.0$256.0 million and $489.1$231.9 million, respectively. These derivative contracts are designed to offset the FX effects in earnings of various intercompany loans, our EIB loan, and trade receivables. We recorded net losses for these freestanding derivatives of $0.7$4.1 million and $7.9$5.4 million for the three and nine months ended SeptemberJune 30, 2018 and June 30, 2017, respectively and net gains (losses)losses of $(1.8)$11.7 million and $0.4$7.2 million for the three and ninesix months ended SeptemberJune 30, 2016,2018 and June 30, 2017, respectively. These gains andThe net losses are included in ‘Foreign“Foreign exchange and other gains (losses) gains” in the condensed consolidated statements of income (loss).income.
Cash Flow Hedges
Notional amounts of open derivative contracts designated as cash flow hedges (in thousands):
Description of Contract September 30, 2017 December 31, 2016
Description of Derivative Contract June 30, 2018 December 31, 2017
FX derivative contracts to be exchanged for British Pounds $16,928
 $6,663
 $11,655
 $16,847
FX derivative contracts to be exchanged for Japanese Yen 44,618
 57,840
 22,122
 32,302
FX derivative contracts to be exchanged for Canadian Dollars 13,341
 
 15,779
 16,494
FX derivative contracts to be exchanged for Euros 38,581
 
Interest rate swap contracts 62,917
 63,246
 46,570
 55,965
 $137,804
 $127,749
 $134,707
 $121,608


After-tax net loss associated with derivatives designated as cash flow hedges recorded in the ending balance of AOCI and the amount expected to be reclassified to earnings in the next 12twelve months (in thousands):
Description of Contract September 30, 2017 Net Amount Expected to be Reclassified to Earnings in the Next 12 Months
Description of Derivative Contract June 30, 2018 Amount Expected to be Reclassified to Earnings in Next 12 Months
FX derivative contracts $(287) $(287) $(1,011) $(1,011)
Interest rate swap contracts (261) (69) (253) (64)
 $(548) $(356) $(1,264) $(1,075)
Pre-tax gains (losses) for derivative contracts designated as cash flow hedges recognized in Other Comprehensive Income (Loss) (“OCI”) and the amount reclassified to earnings from AOCI (in thousands):
 Three Months Ended September 30, Three Months Ended June 30,
 2017 2016 2018 2017
Description of Contract Location in Earnings of Reclassified Gain or Loss Losses Recognized in OCI (Losses) Gains Reclassified from AOCI to Earnings (Losses) Gains Recognized in OCI Losses Reclassified from AOCI to Earnings
Description of Derivative Contract Location in Earnings of Reclassified Gain or Loss Losses Recognized in OCI (Losses) Gains Reclassified from AOCI to Earnings Losses Recognized in OCI (Losses) Gains Reclassified from AOCI to Earnings
FX derivative contracts Foreign exchange and other (losses) gains $(2,537) $(1,623) $2,535
 $2,795
 Foreign exchange and other gains (losses) $(25) $(1,358) $(755) $(532)
FX derivative contracts SG&A 
 269
 
 (1,876) SG&A 
 549
 
 544
Interest rate swap contracts Interest expense 
 797
 263
 (163) Interest expense 
 (17) 
 543
 $(2,537) $(557) $2,798
 $756
 $(25) $(826) $(755) $555
    Six Months Ended June 30,
    2018 2017
Description of Derivative Contract Location in Earnings of Reclassified Gain or Loss Gains Recognized in OCI (Losses) Gains Reclassified from AOCI to Earnings Losses Recognized in OCI (Losses) Gains Reclassified from AOCI to Earnings
FX derivative contracts Foreign exchange and other gains (losses) $189
 $(512) $(7,587) $(5,210)
FX derivative contracts SG&A 
 1,174
 
 1,354
Interest rate swap contracts Interest expense 
 (17) 
 212
    $189
 $645
 $(7,587) $(3,644)


    Nine Months Ended September 30,
    2017 2016
Description of Contract Location in Earnings of Reclassified Gain or Loss Losses Recognized in OCI (Losses) Gains Reclassified from AOCI to Earnings Losses Recognized in OCI Gains (Losses) Reclassified from AOCI to Earnings
FX derivative contracts Foreign exchange and other (losses) gains $(10,124) $(6,833) $(5,932) $2,943
FX derivative contracts SG&A 
 1,623
 
 (3,437)
Interest rate swap contracts Interest expense 
 1,009
 (38) (252)
    $(10,124) $(4,201) $(5,970) $(746)
The following tables present the fair value on a gross basis, and the location of, derivative contracts reported in the condensed consolidated balance sheets (in thousands):
September 30, 2017 Liability Derivatives
June 30, 2018 Liability Derivatives
Derivatives Designated as Hedging Instruments Balance Sheet Location 
Fair Value (1)
 Balance Sheet Location 
Fair Value (1)
Interest rate swap contracts Accrued liabilities $875
 Accrued liabilities $683
Interest rate swap contracts Other long-term liabilities 932
 Other long-term liabilities 538
FX derivative contracts Accrued liabilities 724
 Accrued liabilities 1,209
Total derivatives designated as hedging instruments 
 2,531
 
 2,430
Derivatives Not Designated as Hedging Instruments 
 
 
 
FX derivative contracts Accrued liabilities 1,456
 Accrued liabilities 827
Total derivatives not designated as hedging instruments 
 1,456
 
 827
 
 $3,987
Total derivatives 
 $3,257
December 31, 2016 Asset Derivatives Liability Derivatives
December 31, 2017 Asset Derivatives Liability Derivatives
Derivatives Designated as Hedging Instruments Balance Sheet Location 
Fair Value (1)
 Balance Sheet Location 
Fair Value (1)
 Balance Sheet Location 
Fair Value (1)
 Balance Sheet Location 
Fair Value (1)
Interest rate swap contracts Prepaid expenses and other current assets $
 Accrued liabilities $942
 Prepaid expenses and other current assets $
 Accrued liabilities $834
Interest rate swap contracts Other assets 
 Other long-term liabilities 1,392
 Other assets 
 Other long-term liabilities 751
FX derivative contracts Prepaid expenses and other current assets 4,911
 Accrued liabilities 
 Prepaid expenses and other current assets 
 Accrued liabilities 460
Total derivatives designated as hedging instruments 4,911
 2,334
 
 2,045
Derivatives Not Designated as Hedging Instruments        
FX derivative contracts Prepaid expenses and other current assets 3,358
 Accrued liabilities 
 Prepaid expenses and other current assets 519
 Accrued liabilities 
Total derivatives not designated as hedging instruments 3,358
 
 519
 
 $8,269
 $2,334
Total derivatives $519
 $2,045
(1)For the classification of inputinputs used to evaluate the fair value of our derivatives, refer to “Note 6.8. Fair Value Measurements.”


Note 9.11. Commitments and Contingencies
3T Heater-Cooler Devices
FDA Warning Letter.
On December 29, 2015, the FDA issued LivaNova a Warning Letter (the “Warning Letter”) alleging certain violations of FDA regulations applicable to medical device manufacturers at our Munich, Germany and Arvada, Colorado facilities.
The FDA inspected the Munich facility from August 24, 2015 to August 27, 2015 and the Arvada facility from August 24, 2015 to September 1, 2015. On August 27, 2015, the FDA issued a Form 483 identifying two observed non-conformities with certain regulatory requirements at the Munich facility. We did not receive a Form 483 in connection with the FDA’s inspection of the Arvada facility. Following the receipt of the Form 483, we provided written responses to the FDA describing corrective and preventive actions that were underway or to be taken to address the FDA’s observations at the Munich facility. The Warning Letter responded in part to our responses and identified other alleged violations related to the manufacture of our 3T device that were not previously included in the Form 483.


The Warning Letter further stated that our 3T devices and other devices we manufactured at our Munich facility are subject to refusal of admission into the U.S. until resolution of the issues set forth by the FDA in the Warning Letter. The FDA has informed us that the import alert is limited to the 3T devices, but that the agency reserves the right to expand the scope of the import alert if future circumstances warrant such action. The Warning Letter did not request that existing users cease using the 3T device, and manufacturing and shipment of all of our products other than the 3T device remain unaffected by the import limitation. To help clarify these issues for current customers, we issued an informational Customer Letter in January 2016 and that same month agreed with the FDA on a process for shipping 3T devices to existing U.S. users pursuant to a certificate of medical necessity program.
Finally, the Warning Letter stated that premarket approval applications for Class III devices to which certain Quality System regulation deviations identified in the Warning Letter are reasonably related will not be approved until the violations have been corrected. However,corrected; however, this restriction applies only to the Munich and Arvada facilities, which do not manufacture or design devices subject to Class III premarket approval.
We continue to work diligently to remediate the FDA’s inspectional observations for the Munich facility, as well as the additional issues identified in the Warning Letter. We take these matters seriously and intend to respond timely and fully to the FDA’s requests.
CDC and FDA Safety Communications and Company Field Safety Notice Update
On October 13, 2016, the Centers for Disease ControlCDC and Prevention (“CDC”) andthe FDA separately released safety notifications regarding the 3T devices. The CDC’s Morbidity and Mortality Weekly Report (“MMWR”) and Health Advisory Notice (“HAN”) reported that tests conducted by CDC and its affiliates indicate that there appears to be genetic similarity between both patient and 3T device strains of the non-tuberculous mycobacterium (“NTM”) bacteria M. chimaera isolated in hospitals in Iowa and Pennsylvania. Citing the geographic separation between the two hospitals referenced in the investigation, the report asserts that 3T devices manufactured prior to August 18, 2014 could have been contaminated during the manufacturing process. The CDC’s HAN and FDA’s Safety Communication, issued contemporaneously with the MMWR report, each assess certain risks associated with 3T devices and provide guidance for providers and patients. The CDC notification states that the decision to use the 3T device during a surgical operation is to be taken by the surgeon based on a risk approach and on patient need. Both the CDC’s and FDA’s communications confirm that 3T devices are critical medical devices and enable doctors to perform life-saving cardiac surgery procedures.
Also on October 13, 2016, in response to the Warning Letter and CDC’s HAN and FDA’s Safety Communication, we issued a Field Safety Notice Update for U.S. users of 3T devices to proactively and voluntarily contact facilities to aid in implementation of the CDC and FDA recommendations. In the fourth quarter of 2016, we initiated a program to provide existing 3T device users with a new loaner 3T device at no charge pending regulatory approval and implementation of additional risk mitigation strategies worldwide. This loaner program began in the U.S. and is being made available progressively on a global basis, prioritizing and allocating devices to 3T device users based on pre-established criteria. We anticipate that this program will continue until we are able to address customer needs through a broader solution that includes implementation of one or more of the risk mitigation strategies currently under review with regulatory agencies. We are also currently implementing a vacuum and sealing upgrade program in as many countries as possible throughout 2018 and beyond until all devices are upgraded. Furthermore, we intend to perform a no-charge deep disinfection service (deep cleaning service) for 3T device users as we receive the required regulatory approvals. On April 12, 2018, the FDA agreed to allow us to move forward with the deep cleaning service in the U.S. adding to the growing list of countries around the world in which we offer this service.
On December 31, 2016, we recognized a liability for our product remediation plan related to our 3T device. We concluded that it was probable that a liability had been incurred upon management’s approval of the plan and the commitments made by management to various regulatory authorities globally in November and December 2016, and furthermore, the cost associated with the plan was reasonably estimable. At SeptemberJune 30, 2017,2018, the product remediation liability was $30.2$19.7 million. Refer to “Note 4.6. Product Remediation Liability” for additional information.


Litigation
On February 12, 2016, LivaNova was alerted thatProduct Liability
The Company is currently involved in litigation involving our 3T device. The litigation includes a class action complaint had been filed in the U.S. District Court for the Middle District of Pennsylvania, with respect to our 3T devices. The plaintiffs namedfederal multi-district litigation in the complaint underwent open heart surgeries at WellSpan York HospitalU.S. District Court for the Middle District of Pennsylvania, various U.S. state court cases and Penn State Milton S. Hershey Medical Centercases in 2015, andjurisdictions outside the complaint alleges that: (i) patients were exposed to a harmful formU.S. As of bacteria, known as nontuberculous mycobacterium (“NTM”), from our 3T devices; and (ii)July 31, 2018, we knew or should have known that design or manufacturing defectsare involved in 3T devices can lead to NTM bacterial colonization, regardlessapproximately 135 claims worldwide, with the majority of the cleaningclaims in various federal or state courts throughout the United States. The complaints generally seek damages and disinfection procedures used (and recommended by us).other relief based on theories of strict liability,


negligence, breach of express and implied warranties, failure to warn, design and manufacturing defect, fraudulent and negligent misrepresentation/concealment, unjust enrichment, and violations of various state consumer protection statutes. The class of plaintiffs in the complaintaction consists of all Pennsylvania residents who underwent open heart surgery at WellSpan York Hospital and Penn State Milton S. Hershey Medical Center between 2011 and 2015 and who currently are asymptomatic for NTM infection.
On October 23, 2017, Members of the U.S. District Court for the Middle District of Pennsylvania issued an order certifying a class with respect to the named plaintiffs. The class action, which is currently against Sorin Group Deutschland GmbH and Sorin Group USA, Inc. seeks: (i)seek declaratory relief findingthat the 3T devices are defective and unsafe for intended uses; (ii)uses, medical monitoring; (iii) general damages;monitoring, damages, and (iv) attorneys’ fees. Other lawsuits relatedLivaNova has filed a petition for permission to surgeries in which a 3T device allegedly was used have been filed elsewhere inappeal the class certification order with the U.S., as well as in Canada, and Europe, against various LivaNova entities.
We are defending each Court of these claims vigorously. GivenAppeals for the relatively early stage of these matters, we cannot give any assurances that additional legal proceedings making the same or similar allegations will not be filed against us or one of our subsidiaries, nor that the resolution of these complaints or other related litigation will not have a material adverse effect on our business, results of operations, financial condition or liquidity.Third Circuit. We have not recognized an expense related to damages in connection with these matters because any potential loss is not currently probable or reasonably estimable. In addition, we cannot reasonably estimate a range of potential loss, if any, that may result from these matters.
Other LitigationCivil Investigative Demand
On May 31, 2017, the Company received a Civil Investigative Demand (“CID”) from the US Attorney’s Office for the Northern District of Georgia.  The CID requested, and we have provided, certain documents relating to the sales and marketing of VNS devices and related products in the State of Georgia.  We have not recognized an expense related to this matter because any potential loss is not currently probable or reasonably estimable. In addition we cannot reasonably estimate a range of potential loss, if any, that may result from this matter.
Environmental Liability
SNIA Litigation
Our subsidiary, Sorin S.p.A. (“Sorin”) was created as a result of a spin-off (the “Sorin spin-off”) from SNIA S.p.A. (“SNIA”). The Sorin spin-off, which involved SNIA’s medical technology division, in January, 2004. SNIA subsequently became effective on January 2, 2004. Pursuant to the Italian Civil Code, in a spin-off transaction, the parentinsolvent and the spun-off company can be held jointly liable, up to the actual value of the shareholders’ equity conveyed or received, for certain indebtedness or liabilities of the pre-spin-off company. We estimate that the value of the shareholders’ equity received by Sorin was approximately €573 million (approximately $676 million).
We believe and have argued before the relevant fora that Sorin is not jointly liable with SNIA for its alleged SNIA debts and liabilities. Specifically, between 1906 and 2010, SNIA’s subsidiaries Caffaro Chimica S.r.l. and Caffaro S.r.l. and their predecessors (the “SNIA Subsidiaries”), conducted certain chemical operations (the “Caffaro Chemical Operations”), at sites in Torviscosa, Brescia and Colleferro, Italy (the “Caffaro Chemical Sites”). These activities allegedly resulted in substantial and widely dispersed contamination of soil, water and ground water. In connection with SNIA’s Italian insolvency proceedings, the Italian Ministry of the Environment and the Protection of Land and Sea (the “Italian Ministry of the Environment”), sought compensation from SNIA in an aggregate amount of €3.4approximately $4 billion (approximately $4.0 billion) for remediation costs relating to the environmental damage at the Caffaro Chemical Sites.chemical sites previously operated by SNIA’s other subsidiaries.
In September 2011 and July 2014, the Bankruptcy Court of Udine and in July 2014, the Bankruptcy Court of Milan each held (in proceedings to which we are not parties) that the Italian Ministry of the Environment and other Italian government agencies (the “Public Administrations”) were not creditors of either SNIA Subsidiaries or SNIAits subsidiaries in connection with their claims in the context of their Italian insolvency proceedings. InThe Public Administrations appealed and in January 2016, the Court of Udine rejected the appeal brought by the Italian Public Administrations.appeal. The Public Administrations have also appealed that second loss in pending proceedings before the Italian Supreme Court. The appeal by the Public Administrations before the Court of Milan remains pending.decision.
In January 2012, SNIA filed a civil action against Sorin in the Civil Court of Milan asserting joint liability of a parent and a spun-off company. SNIA’s civil action against Sorin also named the Public Administrations, the Italian Ministry of the Environment and other Italian government agencies, as defendants, in order to have them bound to the final ruling.
On April 1, 2016, the Court of Milan dismissed all legal actions of SNIA and of the Public Administrations against Sorin, further requiring the Public Administrations to pay Sorin €300,000 (or approximately $353,910), as$340,000 for legal fees (of which SNIA is jointly liable for €50,000) (the “2016 Decision”).
On June 21, 2016, thefees. The Public Administrations appealed the 2016 Decision to the Court of Appeal of Milan. The first hearing of the appeal proceedings was held in December 2016,Milan and thea final hearingdecision is now scheduled for November 22, 2017. After the hearing, the parties will file their final briefs, and the Court is expected to render its decision in mid-2018. SNIA did not file an appeal.


pending.
We (as successor to Sorin in the litigation) continue to believe that the risk of material loss relating to the SNIA litigation is not probable as a result of the reasoning contained in, and legal conclusions reached in, the recent court decisions described above. We also believe that the amount of potential losses relating to the SNIA litigation is, in any event, not estimable given that the underlying alleged damages, related remediation costs, allocation and apportionment of any such responsibility, which party is responsible, and various time periods involving different parties, all remain issues in dispute and that no final decision on a remediation plan has been approved. As a result, we have not made any accrualrecognized an expense in connection with the SNIA litigation.
Pursuant to European Union (“EU”), United Kingdom (“UK”) and Italian cross-border merger regulations applicable to the Mergers, legacy Sorin liabilities, includingthis matter because any potential liabilities arisingloss is not currently probable or reasonably estimable. In addition, we cannot reasonably estimate a range of potential loss, if any, that may result from the claims against Sorin relating to the SNIA litigation, are assumed by us as successor to Sorin. Although we believe the claims against Sorin in connection with the SNIA litigation are without merit and continue to contest them vigorously, there can be no assurance as to the outcome. A finding during any appeal or novel proceedings that we are liable for environmental damage at the Caffaro Chemical Sites or its alleged cause(s) could have a material adverse effect on our results of operations, financial condition and/or liquidity.this matter.
Environmental Remediation Order
On July 28, 2015, Sorin and other direct and indirect shareholders of SNIA received an administrative order (the “Remediation Order”) from the Italian Ministry of the Environment (the “Ministry”), directing them to promptly commenceprompt commencement of environmental remediation efforts at the Caffaro Chemical Sites (as described above).chemical sites previously operated by SNIA’s other subsidiaries. We (as successor to Sorin) believe that we should not be liable for damages relating to the Caffaro Chemical Operations pursuant to the Italian statute on which the Remediation Order relies because, inter alia, the statute does not apply to activities occurring prior to 2006, the date on which the statute was enacted. (Sorin was spun off from SNIA in 2004.) Additionally, we believe that Sorin should not be subject to the Remediation Order because Italian environmental regulations only permit such an order to be imposed on an “operator” of a remediation site, and Sorin never operated any activity at any of the industrial sites concerned and, further, was never identified in any legal proceeding as an operator at any of the Caffaro Chemical Sites and could not and in fact did not cause any environmental damage at any of the Caffaro Chemical Sites.
Accordingly, we (as successor to Sorin) alongside other parties, challenged the Remediation Order before the Administrative Court of Lazio in Rome (the “TAR”).
On March 21, 2016, and the TAR annulled the Remediation Order based on the fact that (i) the Remediation Order lacks any detailed analysisOrder. The Italian Ministry of the causal link betweenEnvironment appealed to the alleged damageAdministrative Court of Appeal. A hearing occurred on June 14, 2018, and our activities, a pre-condition to imposition of the measures proposed in the Remediation Order, (ii) the situation of the Caffaro site does not require urgent safety measures, because no new pollution events have occurred and no additional information or evidence of a situation of contamination exists, and (iii) there was no proper legal basis for the Remediation Order, and in any event, the Ministry failed to verify the legal elements that could have led to a conclusion of legal responsibility of the recipients of the Remediation Order.
The TAR decisions described above have been appealed by the Ministry before the Council of State. No information on the timing of the first hearing of this appealfinal decision is presently available.pending. We have not recognized an expense in connection with this matter because any potential loss is not currently probable or reasonably estimable. In addition, we cannot reasonably estimate a range of potential loss, if any, that may result from this matter.
Opposition to Merger Proceedings
On July 28, 2015, the Public Administrations filed an opposition proceeding to the proposed merger between Sorin and Cyberonics, Inc. (the “Merger”), before the Commercial Courts of Milan, asking the Court to prohibit the execution of the Merger. In its initial decision on August 20, 2015, theMilan. The Court authorized the Merger and the Public Administrations did not appeal this decision. The proceeding then continued as a civil case, with the Public Administration seeking damages against us.damages. The Commercial Court of Milan delivered a decision in October 2016, fully rejecting the Public Administration’s request and awarding us €200,000 (approximately $228,000)approximately $480,000 in damages for frivolous litigation plus €200,000 (approximately $228,000) inand legal fees. The Public Administrations has appealed this decision to the Court of Appeal of Milan. The final hearing is scheduled on January 17, 2018. TheOn May 15, 2018, the Court of Appeal is likelyof Milan confirmed its decision authorizing the Merger, but reduced the penalty of $480,000 in damages for frivolous litigation and legal fees to make a$58,000 for legal fees. The Public


Administrations subsequently filed an appeal with the Supreme Court against the decision in mid-June 2018.of the Court of Appeal of Milan. We have not recognized an expense in connection with this matter because any potential loss is not currently probable or reasonably estimable. In addition, we cannot reasonably estimate a range of potential loss, if any, that may result from this matter.

Patent Litigation

On May 11, 2018, a non-practicing entity (NPE) filed a complaint in the Southern District of Texas asserting that the VNS Therapy System, when used with the SenTiva Model 1000 generator, infringes the claims of a single U.S. patent owned by the NPE. The NPE requests damages that include a royalty, costs, interest, and attorneys’ fees. We have not recognized an expense in connection with this matter because any potential loss is not currently probable or reasonably estimable. In addition, we cannot reasonably estimate a range of potential loss, if any, that may result from this matter.
Tax Litigation
In a tax audit report received in October 30, 2009, the Regional Internal Revenue Office of Lombardy (the “Internal Revenue Office”) informed Sorin Group Italia S.r.l. that, among several issues, it was disallowing in part (for a total of €102.6 million (approximately $121.0$119.5 million), related to tax years 2002 through 2006) a tax-deductible write down of the investment in the U.S. company, Cobe Cardiovascular Inc., which Sorin Group Italia S.r.l. recognized in 2002 and deducted in five equal installments, beginning in 2002. In December 2009, the Internal Revenue Office issued notices of assessment for 2002, 2003 and 2004. The assessments for 2002 and 2003 were automatically voided for lack of merit. In December 2010 and October 2011, the Internal Revenue Office issued notices of assessment for 2005 and 2006, respectively. We challenged all three notices of assessment (for 2004, 2005 and 2006) before the relevant Provincial Tax Courts.
The preliminary challenges filed for 2004, 2005 and 2006 were denied at the first jurisdictional level. We appealed these decisions. The appeal submitted against the first-level decision for 2004 was successful. The Internal Revenue Office appealed this second-level decision to the Italian Supreme Court (Corte di Cassazione) inon February 3, 2017. The Italian Supreme Court’s decision is pending.
The appeals submitted against the first-level decisions for 2005 and 2006 were rejected. We appealed these adverse decisions to the Italian Supreme Court, where the matters are still pending.
In November 2012, the Internal Revenue Office served a notice of assessment for 2007, and in July 2013, served a notice of assessment for 2008. In these matters the Internal Revenue Office claims an increase in taxable income due to a reduction (similar to the previous notices of assessment for 2004, 2005 and 2006) of the losses reported by Sorin Group Italia S.r.l. for the 2002, 2003 and 2004 tax periods, and subsequently utilized in 2007 and 2008. We challenged both notices of assessment. The Provincial Tax Court of Milan has stayed its decision for years 2007 and 2008 pending resolution of the litigation regarding years 2004, 2005, and 2006. The total amount of losses in dispute is €62.6 million (approximately $73.8$72.9 million). We have continuously reassessed our potential exposure in these matters, taking into account the recent, and generally adverse, trend to Italian taxpayers in this type of litigation. Although we believe that our defensive arguments are strong, noting the adverse trend in some of the court decisions, we have recognized a reserve for an uncertain tax position of €17.0 million (approximately $20.0$19.7 million).
Other Matters
Additionally, we are the subject of various pending or threatened legal actions and proceedings that arise in the ordinary course of our business. These matters are subject to many uncertainties and outcomes that are not predictable and that may not be known for extended periods of time. Since the outcome of these matters cannot be predicted with certainty, the costs associated with them could have a material adverse effect on our consolidated net income, financial position or liquidity.


Note 10.12. Stockholders’ Equity
Comprehensive income
The table below presents the change in each component of AOCI, net of tax, and the reclassifications out of AOCI into net earningsincome for the ninesix months ended SeptemberJune 30, 20172018 and SeptemberJune 30, 20162017 (in thousands):
 Change in Unrealized Gain (Loss) on Derivatives 
Foreign Currency Translation Adjustments Gain (Loss) (1)
 Total
As of December 31, 2017 $(919) $46,232
 $45,313
Other comprehensive income (loss) before reclassifications, before tax 189
 (38,590) (38,401)
Tax expense (45) 
 (45)
Other comprehensive income (loss) before reclassifications, net of tax 144
 (38,590) (38,446)
Reclassification of gain from accumulated other comprehensive income, before tax (645) (9,011)
(2) 
(9,656)
Reclassification of tax expense 156
 
 156
Reclassification of gain from accumulated other comprehensive income, after tax (489) (9,011) (9,500)
Net current-period other comprehensive (loss) income, net of tax (345) (47,601) (47,946)
As of June 30, 2018 $(1,264) $(1,369) $(2,633)
 Change in Unrealized Gain (Loss) on Derivatives 
Foreign Currency Translation Adjustments Gain (Loss) (1)
 Total      
As of December 31, 2016 $3,619
 $(72,106) $(68,487) $3,619
 $(72,106) $(68,487)
Other comprehensive (loss) income before reclassifications, before tax (10,124) 111,123
 100,999
 (7,587) 72,017
 64,430
Tax benefit 2,784
 
 2,784
 1,821
 
 1,821
Other comprehensive (loss) income before reclassifications, net of tax (7,340) 111,123
 103,783
 (5,766) 72,017
 66,251
Reclassification of loss from accumulated other comprehensive income, before tax 4,201
 
 4,201
 3,644
 
 3,644
Tax benefit (1,028) 
 (1,028)
Reclassification of tax benefit (538) 
 (538)
Reclassification of loss from accumulated other comprehensive income, after tax 3,173
 
 3,173
 3,106
 
 3,106
Net current-period other comprehensive (loss) income, net of tax (4,167) 111,123
 106,956
 (2,660) 72,017
 69,357
As of September 30, 2017 $(548) $39,017
 $38,469
      
As of December 31, 2015 $888
 $(55,116) $(54,228)
Other comprehensive (loss) income before reclassifications, before tax (5,970) 32,598
 26,628
Tax benefit 1,792
 
 1,792
Other comprehensive (loss) income before reclassifications, net of tax (4,178) 32,598
 28,420
Reclassification of loss from accumulated other comprehensive income, before tax 746
 
 746
Tax benefit (279) 
 (279)
Reclassification of loss from accumulated other comprehensive income, after tax 467
 
 467
Net current-period other comprehensive (loss) income, net of tax (3,711) 32,598
 28,887
As of September 30, 2016 $(2,823) $(22,518) $(25,341)
As of June 30, 2017 $959
 $(89) $870
(1)Taxes are not provided for foreign currency translation adjustments as translation adjustments are related to earnings that are intended to be reinvested in the countries where earned.
(2)Cumulative foreign currency translation adjustments eliminated upon the sale of CRM.
Note 11.13. Stock-Based Incentive Plans
Stock-based incentive plans compensation expense (in thousands):
 Three Months Ended September 30, Nine Months Ended September 30, Three Months Ended June 30, Six Months Ended June 30,
 2017 2016 2017 2016 2018 2017 2018 2017
Service-based stock appreciation rights ("SARs") $2,535
 $1,983
 $6,001
 $6,567
 $2,675
 $1,731
 $4,023
 $3,331
Service-based restricted stock units ("RSUs") 2,225
 2,517
 6,718
 8,419
 2,634
 2,114
 4,790
 4,318
Market performance-based restricted stock units 301
 14
 482
 17
 959
 170
 1,305
 174
Operating performance-based restricted stock units 636
 254
 1,060
 572
 1,185
 371
 2,032
 407
Total stock-based compensation expense $5,697
 $4,768
 $14,261
 $15,575
 $7,453
 $4,386
 $12,150
 $8,230
During the ninesix months ended SeptemberJune 30, 2017,2018, we executedissued stock-based compensatory award agreementsawards with contract terms agreed upon by us and the respective individuals, as approved by the Compensation Committee of our Board of


Directors. AwardsThe awards with service conditions generally vest ratably over four years, subject to forfeiture unless service conditions are met. Market


performance-based awards cliff vest ratably over fourafter three years subject to forfeiture unless certain future pricesthe rank of our shares ontotal shareholder’s return for the NASDAQ Stock Market exceed certain threshold prices inthree-year period ending December 31, 2020 relative to the first year following the grant date. And finally, operatingtotal shareholder returns for a peer group of companies. Operating performance-based awards cliff vest ratably over fourafter three years subject to forfeiture unlessthe achievement of certain thresholds of cumulative adjusted net sales and adjusted net income are metfree cash flow for fiscalthe three year 2017.period ending 2020. Compensation expense related to award agreements executedawards granted during 20172018 for the three and ninesix months ended SeptemberJune 30, 2017 were $2.02018 was $3.4 million and $3.2$3.9 million, respectively.
Stock-based compensation agreements executedissued during the ninesix months ended SeptemberJune 30, 2017,2018, representing potential shares and their weighted average grant date fair values by type follows (shares in thousands, fair value in dollars):
 Nine Months Ended September 30, 2017 Six Months Ended June 30, 2018
 Shares Weighted Average Grant Date Fair Value Shares Weighted Average Grant Date Fair Value
Service-based SARs 639
 $17.03
 634
 $27.87
Service-based RSUs 108
 $57.37
 227
 $91.91
Market performance-based RSUs 158
 $25.29
 41
 $99.97
Operating performance-based RSUs 189
 $56.18
 41
 $88.38
Note 12.14. Income Taxes
During the three and nine months ended September 30, 2017, we recorded consolidated income tax expense of $1.9 million and $10.9 million, respectively, with consolidated effective income tax rates of 6.1% and 9.3%, respectively.
Our consolidated effective income tax rate from continuing operations for the three months ended June 30, 2018 was (5.5)% compared with 5.2% for the three months ended June 30, 2017. For the six months ended June 30, 2018, the effective income tax rate from continuing operations was 7.0% compared with 10.6% for the six months ended June 30, 2017. Our effective income tax rate fluctuates based on, among other factors, changes in pretax income in countries with varying statutory tax rates, changes in valuation allowances, changes in tax credits and incentives, and changes in unrecognized tax benefits associated with uncertain tax positions.
Compared with the three and six months ended June 30, 2017, the lower effective tax rates for the three and ninesix months ended SeptemberJune 30, 2017 included2018 were primarily attributable to the impact of variousthe reduction to the U.S. federal statutory tax rate as a result of the U.S. “Tax Cuts and Jobs Act” (the “Tax Act”), the benefit of foreign derived intangible income partially offset by the repeal of the U.S. domestic production activity deduction, certain tax law changes in the UK that occurred during the three months ended December 31, 2017 and the impact of discrete tax items, including a net $4.0 million deferred tax benefit due to the release of valuation allowances on tax losses upon the completion of a reorganization of our legal entities in the U.S. and a $2.1 million tax benefit from the resolution of prior period tax matters. Discrete tax items for the nine months ended September 30, 2017 also included the acquisition of Caisson and the $38.1 million non-taxable gain recognized to re-measure our existing equity investment in Caisson at fair value on the acquisition date, a $3.9 million deferred tax benefit associated with certain temporary differences arising from the Mergers and the recognition of a $3.0 million deferred tax asset related to a reserve for an uncertain tax position recognized in a prior year, in addition to various other discrete items.
During the three and nine months ended SeptemberJune 30, 2016,2018, we recorded consolidatedentered into an audit settlement impacting one of our uncertain tax positions. This audit settlement resulted in the recognition of an additional of $1.7 million in income tax expense of $9.7 million and $16.9 million, respectively, with consolidated effective income tax rates of 45.7% and 514.5%, respectively. The effective tax rate for the nine months ended September 30, 2016 was impacted by the recording of valuation allowances of $23.9 million related to certain tax jurisdictions, including France and the UK, in which we did not record tax benefits generated by their operating losses, as well as the tax expense generated by profitable operations in higher tax jurisdictions, such as the U.S. and Germany, offset by tax savings from our inter-company financing as part of our 2015 tax restructuring.expense.


Note 13.15. Net Income (Loss) Per Share
The following table sets forthReconciliation of the computation ofshares used in the basic and diluted net income (loss)earnings per share computations for the three and six months ended June 30, 2018 and June 30, 2017 are as follows (in thousands, except per share data)thousands):
  Three Months Ended September 30, Nine Months Ended September 30,
  2017 2016 2017 2016
Numerator:        
Net income (loss) $27,830
 $(1,569) $86,599
 $(32,990)
         
Denominator:        
Basic weighted average shares outstanding 48,181
 49,075
 48,130
 49,016
Add effects of share-based compensation instruments (1)
 353
 
 209
 
Diluted weighted average shares outstanding 48,534
 49,075
 48,339
 49,016
Basic income (loss) per share $0.58
 $(0.03) $1.80
 $(0.67)
Diluted income (loss) per share $0.57
 $(0.03) $1.79
 $(0.67)
  Three Months Ended June 30, Six Months Ended June 30,
  2018 2017 2018 2017
Basic weighted average shares outstanding 48,487
 48,140
 48,406
 48,104
Add effects of share-based compensation instruments (1)
 851
 163
 857
 137
Diluted weighted average shares outstanding 49,338
 48,303
 49,263
 48,241
(1)
Excluded from the computation of diluted earnings per share for the three and nine months ended September 30, 2017were1.6 million stock options and SARs outstanding as of September 30, 2017, because to include them would have been anti-dilutive. Excluded from the computation of diluted earnings per share for the three and nine months ended September 30, 2016 were approximately 2.3 million stock options, SARs and restricted share units outstandingtotaling 0.7 million and 1.8 million shares as of SeptemberJune 30, 2016,2018 and June 30, 2017, respectively, because to include them would have been anti-dilutive due to the net losses.be anti-dilutive.
Note 14.16. Geographic and Segment Information
Segment Information
We identify operating segments based on the way we manage, evaluate and internally report our business activities for purposes of allocating resources and assessing performance. We have threetwo reportable segments: Cardiac Surgery Neuromodulation, and Cardiac Rhythm Management.Neuromodulation.
The Cardiac Surgery segment generates its revenue from the development, production and sale of cardiovascular surgery products. Cardiac Surgerycardiopulmonary products, heart valves and advanced circulatory support. Cardiopulmonary products include oxygenators, heart-lung machines, autotransfusion systems, perfusion tubing systems, cannulae and other related accessories. Heart valves include mechanical


heart valves, tissue heart valves and tissue heart valves.related repair products. Advanced circulatory support, which represents our recently acquired TandemLife business, includes temporary life support product kits that can include a combination of pumps, oxygenators, and cannulae.
The Neuromodulation segment generates its revenue from the design, development and marketing of neuromodulation therapy systems for the treatment of drug-resistant epilepsy and treatment resistanttreatment-resistant depression. Neuromodulation products include the VNS Therapy System, which consists of an implantable pulse generator, a lead that connects the generator to the vagus nerve, surgical equipment to assist withand other accessories. On January 16, 2018, we acquired the implant procedure, equipment to enable the treating physician to set the pulse generator stimulation parametersremaining 86% outstanding interest in ImThera which is also included in our Neuromodulation segment. ImThera manufactures an implantable device for the treatment of obstructive sleep apnea that stimulates multiple tongue muscles via the hypoglossal nerve, which opens the airway while a patient instruction manuals and magnets to suspend or induce stimulation manually.
The Cardiac Rhythm Management segment generates its revenue from the development, manufacturing and marketing of products for the diagnosis, treatment, and management of heart rhythm disorders and heart failure. Cardiac Rhythm Management products include high-voltage defibrillators, cardiac resynchronization therapy devices and low-voltage pacemakers.is sleeping.
“Other” includes Corporatecorporate shared servicesservice expenses for finance, legal, human resources and information technology and Corporatecorporate business development (“New Ventures”). New Ventures which includes our recent Caisson acquisition, is focused on new growth platforms and identification of other opportunities for expansion.
Effective January 1, 2018, we began to include the results of heart failure within the Neuromodulation segment for internal reporting purposes in order to manage and evaluate business activities for purposes of allocating resources and assessing performance. Previously, the results of heart failure were reported within “Other”. Segment results for the three and six months ended June 30, 2017 have been recast to conform to the current period presentation.
Net sales of our reportable segments include end-customer revenues from the sale of products they each develop and manufacture or distribute. We define segment income as operating income before merger and integration, restructuring and amortization of intangibles.


Net sales and income from operations by segment (in thousands):
  Three Months Ended September 30, Nine Months Ended September 30,
Net Sales: 2017 2016 2017 2016
Cardiac Surgery $159,822
 $148,518
 $457,612
 $453,012
Neuromodulation 91,016
 89,504
 275,190
 260,901
Cardiac Rhythm Management 58,411
 56,768
 182,235
 188,057
Other 415
 478
 1,119
 1,314
  $309,664
 $295,268
 $916,156
 $903,284
  Three Months Ended September 30, Nine Months Ended September 30,
Income from Operations: 2017 2016 2017 2016
Cardiac Surgery $23,807
 $17,791
 $63,490
 $29,197
Neuromodulation 45,932
 47,049
 139,357
 134,871
Cardiac Rhythm Management 5,427
 (4,598) 13,536
 (14,432)
Other (27,947) (13,525) (79,378) (49,090)
Total Reportable Segments’ Income from Operations 47,219
 46,717
 137,005
 100,546
Merger and integration expenses 2,013
 7,576
 7,743
 20,537
Restructuring expenses 792
 4,381
 12,060
 37,219
Amortization of intangibles 12,350
 11,775
 35,445
 33,959
Income from operations $32,064
 $22,985
 $81,757
 $8,831
The following tables present our assets and capital expenditures by segment (in thousands):
Assets: September 30, 2017 December 31, 2016
Cardiac Surgery $1,414,260
 $1,277,799
Neuromodulation 564,785
 611,085
Cardiac Rhythm Management 351,390
 341,998
Other 272,695
 111,749
  $2,603,130
 $2,342,631
  Three Months Ended September 30, Nine Months Ended September 30,
Capital expenditures: 2017 2016 2017 2016
Cardiac Surgery $5,541
 $6,465
 $13,292
 $16,774
Neuromodulation 370
 1,781
 2,348
 5,602
Cardiac Rhythm Management 1,537
 1,591
 4,343
 2,786
Other 1,633
 2,435
 4,021
 3,766
  $9,081
 $12,272
 $24,004
 $28,928


The changes in the carrying amount of goodwill by reportable segment for the nine months ended September 30, 2017 were as follows (in thousands):
  Neuromodulation Cardiac Surgery Cardiac Rhythm Management Other Total
December 31, 2016 $315,943
 $375,769
 $
 $
 $691,712
Goodwill as a result of acquisitions (1)
 
 
 
 42,418
 42,418
Foreign currency adjustments 
 46,940
 
 
 46,940
September 30, 2017 $315,943
 $422,709
 $
 $42,418
 $781,070
(1)Goodwill recognized as a result of the Caisson acquisition. Refer to “Note 2. Acquisitions.”
Geographic Information
We operate under three geographic regions: United States, Europe, and Rest of world. NetThe table below presents net sales to external customers by geography are determined based on the country the products are shipped tooperating segment and are as followsgeographic region (in thousands):
 Three Months Ended September 30, Nine Months Ended September 30, Three Months Ended June 30, Six Months Ended June 30,
Net Sales 2017 2016 2017 2016
 2018 2017 2018 2017
Cardiopulmonary        
United States $42,139
 $39,719
 $80,584
 $71,895
Europe 35,916
 33,959
 72,786
 64,568
Rest of world 58,584
 50,467
 108,399
 94,980
 136,639
 124,145
 261,769
 231,443
Heart Valves        
United States 6,147
 6,205
 12,683
 12,274
Europe 11,863
 10,684
 23,979
 21,031
Rest of world 15,792
 17,552
 28,182
 33,042
 33,802
 34,441
 64,844
 66,347
Advanced Circulatory Support        
United States 5,468
 
 5,468
 
Europe 353
 
 353
 
Rest of world 194
 
 194
 
 6,015
 
 6,015
 
Cardiac Surgery        
United States 53,754
 45,924
 98,735
 84,169
Europe 48,132
 44,643
 97,118
 85,599
Rest of world 74,570
 68,019
 136,775
 128,022
 176,456
 158,586
 332,628
 297,790
Neuromodulation        
United States 89,395
 81,405
 167,387
 155,064
Europe 11,943
 9,514
 22,234
 17,443
Rest of world 9,315
 6,096
 14,876
 11,667
 110,653
 97,015
 204,497
 184,174
        
Other 389
 242
 771
 704
Totals        
United States $122,208
 $123,810
 $366,115
 $362,358
 143,149
 127,329
 266,122
 239,233
Europe (1) (2)
 92,953
 91,245
 294,338
 301,727
 60,075
 54,157
 119,352
 103,042
Rest of world 94,503
 80,213
 255,703
 239,199
 84,274
 74,357
 152,422
 140,393
Total (3)
 $309,664
 $295,268
 $916,156
 $903,284
 $287,498
 $255,843
 $537,896
 $482,668
(1)
Net sales to external customersinclude $8.4 million and $9.2 million in the UK include $9.6 million and $26.8 millionUnited Kingdom, our country of domicile, for the three and nine months ended SeptemberJune 30, 2018 and June 30, 2017, respectively and $8.8respectively. Net sales in the United Kingdom were $16.6 million and $27.9$17.3 million for the three and ninesix months ended SeptemberJune 30, 2016,2018 and June 30, 2017, respectively.
(2)IncludesEurope sales include those countries in Europe wherewhich we have a direct sales presence. Countries where sales are madepresence, whereas European countries in which we sell through distributors are included in ‘RestRest of world’.world.
(3)No single customer represented over 10% of our consolidated net sales. Except for the U.S.sales and France, no country’s net sales exceeded 10% of our consolidated net sales. French sales were $29.6 million and $96.6 millionexcept for the threeU.S.


Operating income by segment is as follows (in thousands):
  Three Months Ended June 30, Six Months Ended June 30,
Operating Income from Continuing Operations 2018 2017 2018 2017
Cardiac Surgery $16,337
 $23,773
 $26,595
 $39,806
Neuromodulation 61,389
 51,264
 100,123
 92,020
Other (41,417) (33,037) (64,237) (49,903)
Total reportable segment income from continuing operations 36,309
 42,000
 62,481
 81,923
Merger and integration expenses 4,409
 3,512
 7,369
 5,698
Restructuring expenses 476
 2,597
 2,357
 12,627
Amortization of intangibles 9,817
 8,116
 18,618
 16,076
Operating income from continuing operations $21,607
 $27,775
 $34,137
 $47,522
Assets by reportable segment (in thousands):
Assets June 30, 2018 December 31, 2017
Cardiac Surgery $1,535,096
 $1,386,032
Neuromodulation 764,348
 532,894
Other (1)
 297,692
 334,276
Discontinued operations 
 250,689
Total assets $2,597,136
 $2,503,891
(1)Other includes the impact of ASU 2016-16. Refer to “Note 18. New Accounting Pronouncements.”
Capital expenditures by segment (in thousands):
  Three Months Ended June 30, Six Months Ended June 30,
Capital expenditures 2018 2017 2018 2017
Cardiac Surgery $4,594
 $3,957
 $7,725
 $7,751
Neuromodulation 500
 517
 847
 1,978
Other 1,256
 1,148
 2,699
 2,806
Discontinued operations 
 1,185
 925
 2,388
Total $6,350
 $6,807
 $12,196
 $14,923
The changes in the carrying amount of goodwill by reportable segment for the six months ended June 30, 2018 were as follows (in thousands):
  Neuromodulation Cardiac Surgery Other Total
December 31, 2017 $315,943
 $425,882
 $42,417
 $784,242
Goodwill as a result of acquisitions (1)
 82,596
 118,917
 
 201,513
Foreign currency adjustments 
 (20,058) 
 (20,058)
June 30, 2018 $398,539
 $524,741
 $42,417
 $965,697
(1)Goodwill recognized as a result of the ImThera and nine months ended September 30, 2017, respectively, and $28.9 million and $95.9 million for the three and nine months ended September 30, 2016, respectively.TandemLife acquisitions. Refer to “Note 3. Business Combinations.”


Property, plant and equipment, net by geography are as follows (in thousands):
PP&E September 30, 2017 December 31, 2016 June 30, 2018 December 31, 2017
United States $62,630
 $61,279
 $64,298
 $62,154
Europe 137,682
 130,777
 111,045
 119,133
Rest of world 13,457
 31,786
 10,813
 11,072
Total $213,769
 $223,842
 $186,156
 $192,359
Note 15.17. Supplemental Financial Information
Accounts receivable, net, consisted of the following (in thousands):
  September 30, 2017 December 31, 2016
Trade receivables from third parties $326,498
 $285,336
Allowance for bad debt (12,457) (9,606)
  $314,041
 $275,730


Inventories consisted of the following (in thousands):

 September 30, 2017 December 31, 2016 June 30, 2018 December 31, 2017
Raw materials $51,628
 $47,704
 $35,509
 $39,810
Work-in-process 39,873
 32,316
 22,573
 18,206
Finished goods 123,092
 103,469
 99,749
 86,454
 $214,593
 $183,489
 $157,831
 $144,470
Inventories are reported net of the provision for obsolescence. The provision, which reflects normal obsolescence whichand includes components that are phased out or expired, totaled $13.7$9.3 million and $9.8$10.5 million at SeptemberJune 30, 20172018 and December 31, 2016,2017, respectively.
Prepaid expenses and other current assets consisted of the following (in thousands):
  September 30, 2017 December 31, 2016
Income taxes payable on inter-company transfers of property (1)
 $19,445
 $19,445
Deposits and advances to suppliers 7,298
 5,417
Earthquake grant receivable 4,983
 4,748
Unbilled receivables 4,363
 
Escrow deposit - Caisson 2,000
 
Current loans and notes receivable 1,553
 7,093
Derivative contract assets 
 8,269
Other prepaid expenses 15,534
 11,001
  $55,176
 $55,973
(1)
The income taxes payable on intercompany transfers of property asset is the asset account created to defer the income tax effect of an intercompany intellectual property sale pursuant to ASC 810-10-45-8.
Other assets consisted of the following (in thousands):
  September 30, 2017 December 31, 2016
Income taxes payable on inter-company transfers of property (1)
 $109,971
 $124,551
Investments (2)
 2,316
 2,537
Loans and notes receivable 1,964
 2,029
Escrow deposit - Caisson 1,000
 
Guaranteed deposits 777
 940
Other 1,827
 641
  $117,855
 $130,698
(1)The income taxes payable on intercompany transfers of property asset is the asset account created to defer the income tax effect of an intercompany intellectual property sale pursuant to ASC 810-10-45-8.
(2)Primarily cash surrender value of company owned life insurance policies.


Accrued liabilities and other consisted of the following (in thousands):
 September 30, 2017 December 31, 2016 June 30, 2018 December 31, 2017
Product remediation liability (1)
 $20,060
 $23,464
Deferred compensation - Caisson acquisition 14,137
 
Legal and other administrative costs 7,863
 6,184
CRM purchase price adjustment payable to MicroPort Scientific Corporation $14,891
 $
Other amounts payable to MicroPort Scientific Corporation 6,419
 
Product remediation (1)
 9,296
 16,811
Legal and administrative costs 12,619
 6,082
Provisions for agents, returns and other 8,505
 7,271
 6,236
 8,134
Royalty costs 3,162
 3,615
Contract liabilities 3,330
 2,900
Restructuring related liabilities 5,098
 16,859
 3,113
 3,560
Derivative contract liabilities (2)
 2,719
 1,294
Contingent consideration (3)
 2,684
 
Research and development costs 1,172
 797
Product warranty obligations 1,747
 2,736
 940
 1,476
Royalty costs 2,048
 2,503
Escrow indemnity liability - Caisson 2,000
 
Deferred income 4,752
 
Deferred consideration 
 14,300
Uncertain tax positions 
 2,536
Escrow indemnity liabilities - Caisson 
 2,000
Government grants 1,275
 1,708
 
 1,174
Derivative contract liabilities (2)
 3,055
 942
Research and development costs 1,173
 839
Other 20,499
 13,061
Other accrued expenses 19,572
 14,263
 $92,212
 $75,567
 $86,153
 $78,942
(1)Refer to “Note 4.6. Product Remediation Liability.”Liability”
(2)Refer to “Note 8.10. Derivatives and Risk Management.”
Other long-term liabilities consisted of the following (in thousands):

 September 30, 2017 December 31, 2016
Contingent consideration (1)
 $34,217
 $3,890
Uncertain tax positions 12,349
 11,108
Product remediation liability (2)
 10,186
 10,023
Government grants 5,889
 3,803
Derivative contract liabilities (3)
 932
 1,392
Escrow indemnity liability - Caisson 1,000
 
Unfavorable operating leases (4)
 256
 1,672
Other 9,575
 7,599
  $74,404
 $39,487
(1)The contingent consideration liability represents contingent payments related to three acquisitions: the first and second acquisitions, in September 2015, were Cellplex PTY Ltd. in Australia and the commercial activities of a local distributor in Colombia. The contingent payments for the first acquisition are based on achievement of sales targets by the acquiree through June 30, 2018 and the contingent payments for the second acquisition are based on sales of cardiopulmonary disposable products and heart lung machines of the acquiree through December 2019. Refer to “Note 6. Fair Value Measurements.” The third acquisition, Caisson, occurred in May 2017. Refer to “Note 2. Acquisitions.”
(2)Refer to “Note 4. Product Remediation Liability.”Management”
(3)Refer to “Note 8. Derivatives and Risk Management.”
(4)Unfavorable operating leases represent the adjustment to recognize future lease obligations at their estimated fair value in conjunction with the Mergers.Fair Value Measurements”
Note 16.18. New Accounting Pronouncements
In May 2014, the Financial Accounting Standards Board (“FASB”) issued ASC Update (“ASU”) No. 2014-09, Revenue from Contracts with Customers. Update No. 2014-09 requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers and will replace most existing revenue recognition guidance when it becomes effective. This new standard is effective for annual reporting periods beginning after December 15, 2017, and interim periods within that reporting period. The standard permits the use of either the retrospective or cumulative effect transition method. We will adopt the new standard under the cumulative effect transition method.


Based on the Company’s evaluation performed to date, we believe the timing of revenue recognition for products and related revenue streams within our Neuromodulation and Cardiac Rhythm Management segments will not materially change. The Company continues to evaluate the impact of the new standard on the timing of when revenue will be recognized for equipment sales and certain services performed within our Cardiac Surgery segment specifically related to heart-lung machines and preventive maintenance contracts on cardiopulmonary equipment.
Upon adoption of the new standard, we expect to implement new internal controls related to our accounting policies and procedures, including review controls to ensure contractual terms and conditions that may require consideration under the standard are properly identified and analyzed. During the fourth quarter of 2017, we expect to finalize our impact assessment and redesign impacted processes, policies and controls.
In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments-Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities. Update 2016-01 requires equity investments that do not result in consolidation and are not accounted for under the equity method to be measured at fair value with changes recognized in net


income. However, an entity may elect to measure equity investments that do not have readily determinable fair values at cost minus impairment, if any, plus or minus changes resulting from observable price changes in orderly transactions for the identical or a similar investment of the same issuer. We made this election beginning January 1, 2018, resulting in no material impact to our consolidated financial statements.
In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842). This guidance requires lessees to recognize most leases in their balance sheets as lease liabilities with corresponding right-of-use assets and to provide enhanced disclosures. In July 2018, the FASB issued ASU No. 2018-11, Leases (Topic 842): Targeted Improvements, which provides certain practical expedients including an option to apply transition provisions of the new standard, including its disclosure requirements, at its adoption date instead of at the beginning of the earliest comparative period presented. We are in the process of assessing available practical expedients, including the transition provision that we have elected to apply, implementing lease accounting software and evaluating the effect this standard will have on our consolidated financial statements and related disclosures. The standard will be effective for us on January 1, 2019.
In June 2016, the FASB issued ASU Update No. 2016-13, Financial Instruments—Credit Losses (Topic 326): The amendments in addition, reduce complexitythis update require a financial asset (or a group of financial assets) measured at amortized cost basis to be presented at the impairment assessment of equity investments without readily determinable fair values with regardnet amount expected to the other-than-temporary impairment guidance.be collected. The amendments also require separate presentation of financial assets and financial liabilities by measurement category and form of financial asset and liability. This guidance isin this update are effective for fiscal yearsannual periods beginning after December 15, 2017,2019, including interim periods within those fiscal years. Early applicationadoption is permitted as of certain provisionsthe fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. The modified-retrospective approach is permitted.generally applicable through a cumulative-effect adjustment to retained earnings as of the beginning of the first reporting period in which the guidance is effective. We are currently evaluating the effect this standard will have on our consolidated financial statements and related disclosures.
In February 2016, the FASB issued ASU No. 2016-02, Leases. This guidance requires lessees to recognize most leases on their balance sheets as lease liabilities with corresponding right-of-use assets. While many aspects of lessor accounting remain the same, the new standard makes some changes, such as eliminating the current real estate-specific guidance. The new standard requires lessees and lessors to classify most leases using a principle generally consistent with that of “IAS 17 - Leases,” which is similar to U.S. GAAP but without the use of bright lines. The standard also changes what is considered initial direct costs. Entities are required to use a modified retrospective approach for leases that exist or are entered into after the beginning of the earliest comparative period in the financial statements. The standard is effective for annual periods beginning after December 15, 2018 and interim periods within that year. Early adoption is permitted. We are currently evaluating the effect this standard will have on our consolidated financial statements and related disclosures.
In March 2016, the FASB issued ASU No. 2016-09, Compensation—Stock Compensation: Improvements to Employee Share-Based Payment Accounting. This simplified the accounting for certain aspects of share-based payment transactions including the income tax consequences, classification of awards as either equity or liabilities and classification on the statement of cash flows. We adopted the amendments of ASU 2016-09 (each “an Amendment”) effective January 1, 2017, using the following methods:
We adopted the Amendment that requires all of the tax effects related to the settlement of share based compensation awards to be recorded through the income statement on a prospective basis. The adoption of this Amendment did not have a material effect on income tax expense for the nine months ended September 30, 2017.
We adopted the Amendment related to cash flow presentation of tax-related cash flows resulting from share based payments on a prospective basis. The Amendment stipulates that all tax-related cash flows resulting from share based payments are to be reported as operating activities in the statement of cash flows, rather than, under past requirements, to present gross windfall tax benefits as an inflow from financing activities and an outflow from operating activities.
Under the Amendment related to forfeitures, entities are permitted to make a company-wide accounting policy election to either estimate forfeitures each period, as required prior to this Amendment’s effective date, or to account for forfeitures as they occur. We elected to continue to account for forfeitures using the estimation method.
We adopted the Amendment related to the timing of when excess tax benefits are recognized, which requires that all windfalls and shortfalls be recognized when they arise. There were no unrecognized excess tax benefits prior to the adoption of the Amendment.
In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments(Topic 230 -Statement of Cash Flows).Payments. Update 2016-15 provides guidance on the presentation and classification of certain cash receipts and cash payments in the statement of cash flows including debt prepayment or debt extinguishment costs, settlement of zero-coupon debt instruments, contingent consideration payments made after a business combination,


proceeds from the settlement of insurance claims, proceeds from the settlement of corporate-owned life insurance policies, and distributions received from equity method investees. The amendments are effective for fiscal years beginning after December 15, 2017, and interim periods within those fiscal years. The amendments should be applied using a retrospective transition methodflows. We adopted this update on January 1, 2018 resulting in no material impact to each period presented. We are currently evaluating the effect this standard will have on our consolidated financial statements and related disclosures.of cash flows.
In October 2016, the FASB issued ASU No. 2016-16, Income Taxes - (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory (Topic 740).. This update simplifies the accounting for the income tax consequences of transfers of assets from one unit of a corporation to another unit or subsidiary by eliminating an accounting exception that prevents the recognition of current and deferred income tax consequences for such “intra-entity transfers” until the assets have been sold to an outside party. The amendment should be applied using a modified retrospective transition method by means of a cumulative-effect adjustment directly to retained earnings as of the beginning of the period in which the guidance is adopted. The rule is effective for annual periods after December 15, 2017, including interim periods within those annual reporting periods.
We currently estimate the cumulative-effect reduction to retained earnings to be approximately $65.2 million upon adoption atadopted this update on January 1, 2018.2018 and recognized the following balance sheet adjustments (in thousands):
  Balance at December 31, 2017 Adjustment due to ASU No. 2016-16 Balance at January 1, 2018
Assets      
Prepaid expenses and other current assets $39,037
 $(12,604) $26,433
Deferred tax assets, net 11,559
 58,301
 69,860
Other assets 75,984
 (68,127) 7,857
Equity      
Accumulated deficit $(39,664) $(22,430) $(62,094)
In January 2017, the FASB issued ASU No. 2017-04, Intangibles-Goodwill and Other - (Topic 350): Simplifying the Test for Goodwill Impairment (Topic 350).. This update removes step 2 of the goodwill impairment test that compares the implied fair value of goodwill with its carrying amount. Instead, an impairment test is performed by comparing the fair value of a reporting unit with its carrying amount. An impairment charge will be recorded by the amount a reporting unit’s carrying amount exceeds its fair value. The ruleupdate is effective for annual periods after December 15, 2019, including interim periods within those annual reporting periods. We are currently evaluating the impact of adopting this update on our consolidated financial statements.periods with early adoption permitted.
In March 2017, the FASB issued ASU No. 2017-01, Business Combinations (Topic 805): Clarifying the Definition of a Business. This update clarifies when a set of assets and activities is a business. The amendments provide a screen to determine when a set is not a business. The screen requires that when substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, the set is not a business. If the screen is not met, the amendments in this Update (1) require that to be considered a business, a set must include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create output and (2) remove the evaluation of whether a market participant could replace missing elements. This update is effective for annual periods after December 15, 2017, including interim periods within those annual reporting periods. We are currently evaluating the impact of adoptingadopted this update on January 1, 2018. The ImThera and TandemLife acquisitions were considered acquisitions of a business. Refer to “Note 3. Business Combinations” for a discussion of our consolidated financial statements.acquisitions of ImThera and TandemLife.
In March 2017, the FASB issued ASU No. 2017-07, Compensation—Retirement Benefits (Topic(Topic 715): Improving the Presentation of Net Periodic Pension Cost and Net Periodic Post Retirement Benefit Cost. This update requires that an employer report the service cost component in the same line item or items as other compensation costs arising from services


rendered by the pertinent employees during the period. We adopted this update on January 1, 2018, resulting in an immaterial impact to our consolidated financial statements. The other componentscondensed consolidated statements of net benefit cost are requiredincome for the three and six months ended June 30, 2017 have been recast for the adoption of this update.
In June 2018, the FASB issued ASU No. 2018-07, Compensation—Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting. This update simplifies the accounting for nonemployee share-based payment transactions. The amendment specifies that Topic 718 applies to all share-based payment transactions in which a grantor acquires goods or services to be presentedused or consumed in the income statement separately from the service cost component and outside a subtotal of income fromgrantor’s own operations if one is presented. If a separate line item or items are used to present the other components of net benefit cost, that line item or items must be appropriately described. If a separate line item or items are not used, the line item or items used in the income statement to present the other components of net benefit cost must be disclosed.by issuing share-based payment awards. The amendments in this Update also allow only the service cost component to be eligible for capitalization when applicable. This Updateupdate is effective for annual periods after December 15, 2017,2018, including interim periods within those annual reporting periods.periods with early adoption permitted. We are currently evaluatingdo not expect the impactadoption of adopting this update to have a material effect on our consolidated financial statements.
Note 19. Subsequent Event
In July 2018, we borrowed $60.0 million under our June 2017 finance contract with the European Investment Bank to support financing of certain of our R&D projects. Repayment installments, with interest, are due semi-annually, beginning June 30, 2022 and ending June 30, 2026. The interest rate is LIBOR plus 0.966%.
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
The following discussion and analysis should be read in conjunction with our condensed consolidated financial statements and related notes which appear elsewhere in this document and with our Annual Report on2017 Form 10-K for the year ended December 31, 2016 (“2016 Form 10-K”).10-K. Our discussion and analysis may contain forward-looking statements that involve risks and uncertainties. Our actual results may differ materially from those anticipated in these forward-looking statements as a result of certain factors, including those set forth under “Risk Factors” in Item 1A of our 20162017 Form 10-K and elsewhere in this quarterly report.
The capitalized terms used below have been defined in the notes to our condensed consolidated financial statements. In the following text, the terms “LivaNova,” “the Company,” “we,” “us” and “our” refer to LivaNova PLC and its consolidated subsidiaries.


Business Overview
We are a public limited company organized under the laws of England and Wales, headquartered in London, United Kingdom. We are a global medical device company focused on the development and delivery of important therapeutic solutions for the benefit of patients, healthcare professionals and healthcare systems throughout the world. Working closely with medical professionals in the fields of Cardiac Surgery Neuromodulation and Cardiac Rhythm Management,Neuromodulation, we design, develop, manufacture and sell innovative therapeutic solutions that are consistent with our mission to improve our patients’ quality of life, increase the skills and capabilities of healthcare professionals and minimize healthcare costs.
Sale of the CRM Business Franchise
We completed the CRM Sale on April 30, 2018 for total cash proceeds of $195.9 million, less cash transferred of $9.2 million, subject to certain customary closing adjustments. In conjunction with the sale, we entered into transition services agreements to provide certain support services for generally up to twelve months from the closing date of the sale. The services include, among others, accounting, information technology, human resources, quality assurance, regulatory affairs, supply chain, clinical affairs and customer support.
The results of operations of CRM are reflected as discontinued operations for all periods presented in this Quarterly Report on Form 10-Q. Discontinued operations for the three and six months ended June 30, 2018 include CRM activity through the date of the sale, April 30, 2018. The assets and liabilities of CRM are presented as assets or liabilities of discontinued operations in the condensed consolidated balance sheets at December 31, 2017. Refer to “Note 4. Discontinued Operations” to the Financial Statements in this Quarterly Report on Form 10-Q.
Business Franchises
We operate our business through three segments:LivaNova is comprised of two Business Franchises: Cardiac Surgery and Neuromodulation, and Cardiac Rhythm Management. Our three reportable segments correspondcorresponding to our Business Franchises and each Business Franchise corresponds to one of our three main therapeutic areas aligned to best serve our customers.areas. Corporate activities include corporate business development (“New Ventures”). New Ventures is focused on new growth platforms and identification of other opportunities for expansion and investment.expansion.
For further information regarding our business segments, historical financial information and our methodology for the presentation of financial results, please refer to the condensed consolidated financial statements and accompanying notes of this Quarterly Report on Form 10-Q.


Cardiac Surgery Update
On October 5, 2015, we announced the initiation of PERSIST-AVR, the first international, prospective post-market randomized multi-center clinical study evaluating the Perceval sutureless aortic valve compared to standard sutured bioprostheses in patients with aortic valve disease. The Perceval valve, the only sutureless biological aortic valve replacement (“AVR”) on the market today, employs a unique self-anchoring frame that enables the surgeon to replace the diseased valve without suturing it into place. The studyCardiac Surgery segment is expected to enroll 1,234 patients within a two-year enrollment period and patients will be followed until five years post procedure. In January 2017, the independent study, “Aortic Valve Replacement With Sutureless Perceval Bioprosthesis: Single-Center Experience With 617 Implants,” was presented to The Society of Thoracic Surgeons. The study found AVR procedures conducted with the Perceval sutureless valve resulted in low mortality and excellent hemodynamic performance for patients.
In January 2016, we announced FDA approval of the Perceval sutureless valve. While we have been selling Perceval in other parts of the world for several years, we began commercial distribution of the deviceengaged in the United States last year, with the first implant announced on March 8, 2016. The Perceval valve has been implanted in more than 25,000 patients in more than 310 hospitals in 34 countries across the world.
In early February 2016, we announceddevelopment, production and sale of cardiopulmonary products, heart valves and advanced circulatory support. Cardiopulmonary products include oxygenators, heart-lung machines, autotransfusion systems, perfusion tubing systems, cannulae and other related accessories. Heart valves include mechanical heart valves, tissue heart valves and related repair products. Advanced circulatory support, which represents our recently acquired TandemLife business, includes temporary life support product kits that we received FDA approvalcan include a combination of our CROWN PRTvalve for the treatment of aortic valve disease. TheCROWN PRTvalve uses a stented aortic bioprosthesis technologypumps, oxygenators, and features a surgeon-friendly design, with optimized hemodynamics and a patented phospholipid reduction treatment (“PRT”), designed to enhance valve durability. We anticipate launching the CROWN PRT valve in the U.S. later this year.cannulae.
In March 2017, we committed to a plan to sell our Suzhou Industrial Park facility in Shanghai, China, an emerging market greenfield project for the local manufacture of Cardiopulmonarycardiopulmonary disposable products in Suzhou Industrial Park in China. As a result of this exit plan, we recorded an impairmentThe sale of the building and equipment of $4.6 million and accrued $0.5 million of additional costs, primarily related to employee severance, during the nine months ended September 30, 2017, includedSuzhou facility was completed in ‘Restructuring expenses’April 2018.
In April 2018, we acquired TandemLife, headquartered in the condensed consolidated statement of income (loss). In addition, the land, building and equipment were recorded as ‘Assets held for sale’Pittsburgh, Pennsylvania. TandemLife is focused on the condensed consolidated balance sheet, with a carrying valuedelivery of $14.1 million as of September 30, 2017.leading-edge temporary life support products, including cardiopulmonary and respiratory support solutions.
Product Remediation Plan
In September 2017, we received FDA 510(k) clearance for the U.S. market launch of our Optiflow Arterial Cannulae Family. Optiflow aortic arch cannulae provide improved hydrodynamics with a novel dispersive tip design that improves blood flow characteristics resulting in reduced wall shear stress (“WSS”) profiles. Optiflow Arterial cannulae feature a unique basket tip with large openings that allow a more physiologically compatible dispersive design. This design has been shownresponse to significantly reduce WSS and turbulence, thereby improving hydrodynamics and potentially reducing ischemic complications from extracorporeal circulation during cardiac surgery.
3T Heater-Cooler Devices
an FDA Warning Letter,.
On December 29, 2015, the FDA issued LivaNova a Warning Letter (the “Warning Letter”) alleging certain violations of FDA regulations applicable to medical device manufacturers at our Munich, GermanyCDC’s Health Alert Network and Arvada, Colorado facilities.


The FDA inspected the Munich facility from August 24, 2015 to August 27, 2015 and the Arvada facility from August 24, 2015 to September 1, 2015. On August 27, 2015, the FDA issued a Form 483 identifying two observed non-conformities with certain regulatory requirements at the Munich facility. We did not receive a Form 483 in connection with the FDA’s inspection of the Arvada facility. Following the receipt of the Form 483, we provided written responses to the FDA describing corrective and preventive actions that were underway or to be taken to address the FDA’s observations at the Munich facility. The Warning Letter responded in part to our responses and identified other alleged violations not previously included in the Form 483.
The Warning Letter further stated that our 3T devices and other devices we manufactured at our Munich facility are subject to refusal of admission into the U.S. until resolution of the issues set forth by the FDA in the Warning Letter. The FDA has informed us that the import alert is limited to the 3T devices, but that the agency reserves the right to expand the scope of the import alert if future circumstances warrant such action. The Warning Letter did not request that existing users cease using the 3T device, and manufacturing and shipment of all of our products other than the 3T device remain unaffected by the import limitation. To help clarify these issues for current customers, we issued an informational Customer Letter in January 2016, and that same month agreed with the FDA on a process for shipping 3T devices to existing U.S. users pursuant to a certificate of medical necessity program.
Finally, the Warning Letter stated that premarket approval applications for Class III devices to which certain Quality System regulation deviations identified in the Warning Letter are reasonably related will not be approved until the violations have been corrected. However, this restriction applies only to the Munich and Arvada facilities, which do not manufacture or design devices subject to Class III premarket approval.
We continue to work diligently to remediate the FDA’s inspectional observations for the Munich facility, as well as the additional issues identified in the Warning Letter. We take these matters seriously and intend to respond timely and fully to the FDA’s requests.
CDC and FDA Safety Communications and Company Field Safety Notice Update
On October 13, 2016 the Centers for Disease Control and Prevention (“CDC”) and FDA separately released safety notifications regarding the 3T devices. The CDC’s Morbidity and Mortality Weekly Report (“MMWR”) and Health Advisory Notice (“HAN”) reported that tests conducted by CDC and its affiliates indicate that there appears to be genetic similarity between both patient and 3T device strains of the non-tuberculous mycobacterium (“NTM”) bacteria M. chimaera isolated in hospitals in Iowa and Pennsylvania. Citing the geographic separation between the two hospitals referenced in the investigation, the report asserts that 3T devices manufactured prior to August 18, 2014 could have been contaminated during the manufacturing process. The CDC’s HAN and FDA’s Safety Communication, issued contemporaneously with the MMWR report, each assess certain risks associated with 3T devices and provide guidance for providers and patients. The CDC notification states that the decision to use the 3T device during a surgical operation is to be taken by the surgeon based on a risk approach and on patient need. Both the CDC’s and FDA’s communications confirm that 3T devices are critical medical devices and enable doctors to perform life-saving cardiac surgery procedures.
Also on October 13, 2016, we issued a Field Safety Notice Update for U.S. users of 3T devices to proactively and voluntarily contact facilities to aid in implementation of the CDC and FDA recommendations. In the fourth quarter of 2016, we initiated a program to provide existing 3T device users with a new loaner 3T device at no charge pending regulatory approval and implementation of additional risk mitigation strategies worldwide. This loaner program began in the U.S. and is being made available progressively on a global basis, prioritizing and allocating devices to 3T device users based on pre-established criteria. We anticipate that this program will continue until we are able to address customer needs through a broader solution that includes implementation of one or more of the risk mitigation strategies currently under review with regulatory agencies. We are also currently implementing a vacuum and sealing upgrade program in as many countries as possible throughout 2018 and beyond until all devices are upgraded. Furthermore, we intend to perform a no-charge deep disinfection service (deep cleaning service) for 3T device users. On April 12, 2018, the FDA agreed to allow us to move forward with the deep cleaning service in the U.S., adding to the growing list of countries around the world in which we offer the service.
On December 31, 2016, we recognized a liability for our product remediation plan related to our 3T device. We concluded that it was probable that a liability had been incurred upon management’s approval of the plan and the commitments made by management to various regulatory authorities globally in November and December 2016, and furthermore, the cost associated with the plan was reasonably estimable.
At SeptemberJune 30, 2017,2018, the product remediation liability was $30.2$19.7 million. ReferFor further information, please refer to “Note 4.Note 6. Product Remediation Liability” for additional information.Liability” in our condensed consolidated financial statements included in this Quarterly Report on Form 10-Q.

Heart Valves

Litigation
On February 12, 2016,In January 2018, we announced that we had started enrollment in our BELIEVE study. This study focuses on the overall incidence of reduced leaflet motion identified by CT imaging in patients receiving a LivaNova was alerted that a class action complaint had been filedaortic heart valve. We are planning to enroll approximately 230 patients at 15 sites in the U.S. District Court forand Canada.
In March 2018, we announced that we had started enrollment in PERFECT, a Perceval valve clinical study in China. The study is being conducted to demonstrate the Middle Districtsafety and effectiveness of Pennsylvania with respect to our 3T devices. The plaintiffs namedPerceval in the complaint underwent openChinese population. We plan to enroll approximately 160 patients at 8 investigational sites.
In June 2018, we announced that Japan’s Ministry of Health, Labour and Welfare approved our Perceval sutureless aortic heart surgeries at WellSpan York Hospitalvalve to treat aortic valve disease, which will enable us to provide patients and Penn State Milton S. Hershey Medical Centerclinicians in 2015, and the complaint alleges that: (i) patients were exposedJapan with a new option for aortic heart valve replacement. We are currently working to a harmful form of bacteria, known as nontuberculous mycobacterium (“NTM”), from our 3T devices; and (ii)obtain reimbursement in Japan.
In June 2018, we knew or should have known that design or manufacturing defects in 3T devices can lead to NTM bacterial colonization, regardlessannounced FDA 510(k) clearance of the cleaningMEMO 4D semi-rigid mitral annuloplasty ring and disinfection procedures used (and recommended by us). The classconfirmed the first implantation of plaintiffs in the complaint consistsdevice. This next-generation of all Pennsylvania residents who underwent open heart surgery at WellSpan York Hospital and Penn State Milton S. Hershey Medical Center between 2011 and 2015 and who currently are asymptomatic for NTM infection.
On October 23, 2017, the U.S. District Court for the Middle District of Pennsylvania issued an order certifying a class with respect to the named plaintiffs. The class action, which is currently against Sorin Group Deutschland GmbH and Sorin Group USA, Inc. seeks: (i) declaratory relief finding the 3T devices are defective and unsafe for intended uses; (ii) medical monitoring; (iii) general damages; and (iv) attorneys’ fees. Other lawsuits related to surgeries in which a 3TMEMO device allegedly was used have been filed elsewhere in the U.S.,family offers several innovations, such as well as in Canada, and Europe, against various LivaNova entities.
We are defending each of these claims vigorously. Given the relatively early stage of these matters, we cannot give any assurances that additional legal proceedings making the same or similar allegations will not be filed against us or one of our subsidiaries, nor that the resolution of these complaints or other related litigation will not have a material adverse effect on our business, results of operations, financial condition or liquidity. We have not recognized an expense related to damages in connection with these matters because any potential loss is not currently probable or reasonably estimable. In addition we cannot reasonably estimate abroader range of ring sizes, a new ring design and true semi-rigid stability and flexibility that allows us to reach a larger patient population with mitral regurgitation (“MR”) for treatment with the potential loss, if any, that may result from these matters.to improve patient outcomes.
Neuromodulation Update
EpilepsyThe Neuromodulation segment designs, develops and markets neuromodulation therapy for the treatment of drug-resistant epilepsy, treatment-resistant depression, obstructive sleep apnea and heart failure. Through this segment, we market our proprietary implantable VNS Therapy Systems that deliver vagus nerve stimulation therapy for the treatment of epilepsy and depression.


Our product development efforts are directed toward improving the VNS Therapy System and developing new products that provide additional features and functionality. We are conducting ongoing product development activities to enhance the VNS Therapy System pulse generator, lead and programming software. We support studies for our product development efforts and to build clinical evidence for the VNS Therapy System. We will be required to obtain appropriate U.S. and international regulatory approvals, and clinical studies may be a prerequisite to regulatory approvals for some products. Our research and development efforts will require significant funding to complete and may not be successful. Even if successful, additional clinical studies may be needed to achieve regulatory approval and to commercialize any or all new or improved products.
Epilepsy
In June 2017,March 2018, we announced the FDA approvedlaunch and enrollment of the first patient in a clinical study to examine the use of our VNS Therapy device for useSystem using Microburst technology. This feasibility study will determine the initial safety and effectiveness of delivering VNS Therapy using high frequency bursts of stimulation in patients who arehave drug-resistant epilepsy. The study consists of two cohorts, enrolling up to 40 patients at least four years of age and have partial onset seizures that are refractory to antiepileptic medications. VNS Therapy isapproximately 15 sites in the first and only FDA-approved device for drug-resistant epilepsy in this pediatric population. Previously, VNS Therapy was approved by the FDA for patients 12 years or older.U.S.
In addition, in June 2017,April 2018, we received FDA approval, and in Augustobtained CE Mark approval, for our VNS Therapy device for expanded magnetic resonance imaging (“MRI”) labeling affirming VNS Therapy as the only epilepsy device approved by the FDA for MRI scans. Currently, SenTiva, AspireHC and AspireSR models of VNS Therapy technology provide for this expanded MRI access.
In October 2017, we obtained FDA approval to market our SenTiva VNS Therapy System, which followed FDA approval in the U.S., which was received in October 2017. The SenTiva VNS Therapy System consists of the SenTiva implantable generator and the next-generation VNS Therapy Programming System. SenTiva is theour smallest and lightest responsive therapy for epilepsy. The new VNS Therapy Programming System features a wireless wand and new user interface on a small tablet. Together, thethese components offer patients with drug-resistant epilepsy a physician-directed, customizable therapy with smart technology and proven results that reducereduces the number of seizures, lessenlessens the duration of seizures and enableenables a faster recovery.
Depression
In March 2017,January 2018, we announced the American Journal of Psychiatry published the resultslaunch and enrollment of the longestfirst patient in our Global RESTORE-LIFE study, which evaluates the use of our VNS Therapy System in patients who have treatment-resistant depression and largest naturalistic study on effective treatmentsfailed to achieve an adequate response to standard psychiatric management. We expect to enroll a minimum of 500 patients who will be implanted at up to 80 sites outside of the U.S. We are currently enrolling patients in Germany and will expand to other European countries during the year.
In May 2018, the U.S. Centers for patients experiencing chronicMedicare and severeMedicaid Services (“CMS”) published a tracking sheet to reconsider its National Coverage Determination (“NCD”) of our VNS Therapy System for treatment-resistant depression. The findings showedtracking sheet was in response to a letter that we submitted to CMS requesting a formal reconsideration of the additionNCD. We requested this review after a significant body of new evidence emerged about treatment-resistant depression and the role of VNS Therapy to traditional treatment methods is effective in reducing symptoms in patients with treatment-resistant depression.
Cardiac Rhythm Management (“CRM”) Update
In September 2017, we announced that we had commenced aits treatment. The 30-day public comment period on the NCD closed on June 29, 2018. The process to explore strategic optionsrelease a Proposed Decision Memorandum can take up to realizesix months. Once that occurs, CMS will have another 30-day public comment period. By the full valueend of our CRM Business Franchise. While our Board of Directors has approved examining strategic options, amongst which isFebruary 2019, the possibility of divestiture, no commitment toagency will render a plan of sale has been made. Accordingly, the CRM business franchise was not reported as an asset held for sale as of September 30, 2017.


Also in September 2017, we announced that the Company’s Shanghai-based joint venture MicroPort Sorin Cardiac Rhythm Management Co. Ltd. obtained approval for its family of Rega™ pacemakers from the China Food and Drug Administration.
New Ventures Updatefinal decision.
Heart failureFailure
With respect to heart failure, New Ventures isWe are focused on the development and clinical testing of the VITARIA®VITARIA System for treating heart failure through vagus nerve stimulation.
We received CE Mark approval of the VITARIA System in February 2015 for patients who have moderate to severe heart failure (New York Heart Association Class II/III) with left ventricular dysfunction (ejection fraction < 40%) and who remain symptomatic despite stable, optimal heart failure drug therapy. The VITARIA System provides a specific method of VNS called autonomic regulation therapy (“ART”), and it includes the same elements as the VNS Therapy System - pulse generator, lead, programming wand and software, programming computer, tunneling tool and accessory pack - without the patient kit with magnets.System. We conducted a pilot study, ANTHEM-HF, outside the United States, which concluded in 2014. The study results support the safety and efficacy of ART delivered by the VITARIA System. We submitted the results to our European Notified Body, DEKRA, and on February 20, 2015, we received CE Mark approval. The VITARIA System is not approved in the U.S. During 2014, we also initiated a second pilot study, ANTHEM-HFpEF,ANTHEM-HFPEF, to study ART in patients experiencing symptomatic heart failure with preserved ejection fraction. This pilot study is currently underway outside the United States.
Obstructive sleep apneaSleep Apnea
We have invested in ImThera, Medical, Inc. (“ImThera”) is a privately held, emerging-growth company developing an implantable neurostimulation device system for the treatment of obstructive sleep apnea. We have an investment of $12.0 millionapnea (“OSA”) since 2011. On January 16, 2018, we acquired the remaining 86% outstanding interests in ImThera, which is highly aligned with our Neuromodulation Business Franchise. ImThera manufactures an implantable device that stimulates multiple tongue muscles via the hypoglossal nerve, which opens the airway while a patient is sleeping. ImThera has a commercial presence in the European market and an FDA pivotal study is ongoing in the U.S.
During the second quarter of 2018, we determined that developments in the ImThera clinical trial will result in a $1.0 million note receivable due from ImTheraminimum 12-month delay of regulatory approval. This delay constituted a triggering event that required evaluation of the in-process


research and development asset for impairment. Based on the quantitative impairment evaluation, the in-process research and development asset was not impaired; however, a loan made duringfurther delay or a change in management’s estimates could result in a fair value that is below the nine months ended September 30, 2017carrying amount for such an asset. We will continue to fund operating expenses.monitor any changes in circumstances for indicators of impairment.
Corporate Activities and New Ventures
Corporate activities include shared services for finance, legal, human resources and information technology and New Ventures. New Ventures is focused on new growth platforms and identification of other opportunities for expansion.
Mitral valve regurgitationValve Regurgitation
Mitral regurgitation (“MR”) occurs when the heart’s mitral valve does not close tightly, which allows blood to flow backwards in the heart. This reduces the amount of blood that flows to the rest of the body, making the patient feel tired or out of breath. Treatment depends on the nature and the severity of MR. In certain cases, heart surgery may be needed to repair or replace the valve. Left untreated, severe mitral valve regurgitation can cause heart failure or heart rhythm problems (arrhythmias).
OnIn May 2, 2017, we agreed to pay up to $72.0 million to acquireacquired the remaining 51% outstanding equity interestsinterest in Caisson in support of our strategic growth initiatives. Caisson is developingWe are focused on the design, development and clinical evaluation of a device for treating mitral regurgitation through replacement of the nativenovel transcatheter mitral valve usingreplacement (“TMVR”) implant device with a fully transvenous delivery system. As a resultsystem for the treatment of our acquisition of Caisson, we began consolidating the results of Caisson as of May 2, 2017.mitral regurgitation. In April 2016, weCaisson obtained FDA approval of an Investigational Device Exemption study using Caissonits technology for treating mitral regurgitation heart failure with transcatheter mitral valve replacement and we are currently executing against a defined clinical data development plan designed to enable commercialization of the Caisson technology.
We performed a quantitative impairment assessment, as of April 1, 2018, for the goodwill and in-process research and development assets arising from the Caisson acquisition. Based upon the assessment performed, we determined that the goodwill and the in-process research and development assets were not impaired. The quantitative impairment assessment was performed using management’s current estimate of future cash flows which are based on the expected timing of future regulatory approvals. A delay in the anticipated timing of these regulatory approvals or management’s estimates could result in a fair value of the in-process research and development that is below its carrying amount. 
We are also invested in two mitral valve startups.startups, Cardiosolutions Inc. (“Cardiosolutions”) and Highlife.Highlife S.A.S. (“Highlife”). Cardiosolutions, a startup headquartered in the U.S. in which we have held an interest since 2012, is developing an innovative spacer technology for treating mitral regurgitation. Highlife, headquartered in France, is focused on developing devices for treating mitral regurgitation through percutaneous replacement of the native mitral valve. We recognized an impairment of our equity method investment in, and notes receivable from, Highlife during the nine months ended September 30, 2017. The estimated fair value of our investment and notes receivable were below our carrying value by $13.0 million.
Significant Accounting Policies and Critical Accounting Estimates 
There have been no material changesIn addition to our critical accounting policies from the information provided in “Part II, Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in our 20162017 Form 10-K. 10-K, refer to “Note 2. Revenue Recognition” included in this Quarterly Report on Form 10-Q.
The accompanying unaudited condensed consolidated financial statements of LivaNova and its consolidated subsidiaries have been prepared in accordance with U.S. GAAP on an interim basis.
New accounting pronouncements are disclosed in “Note 16.18. New Accounting Pronouncements” contained in the condensed consolidated financial statements in this Quarterly Report on Form 10-Q.
Other
U.S. Tax Reform
On December 22, 2017, the U.S. enacted the Tax Cuts and Jobs Act (the “Act”). The Act, which is also commonly referred to as “U.S. tax reform”, significantly changed U.S. corporate income tax laws by, among other things, reducing the U.S. corporate income tax rate to 21%, which commenced in 2018. In addition, the Act created a one-time mandatory tax, a toll charge, on previously deferred foreign earnings of non-U.S. subsidiaries controlled by a U.S. corporation, or, in our case, a non-U.S. subsidiary controlled by one of our U.S. subsidiaries.
The Act also established various other new U.S. corporate income tax laws that came into effect in 2018, including, but not limited to, (1) elimination of the corporate alternative minimum tax (AMT); (2) the creation of the base erosion anti-abuse tax (BEAT), a new minimum tax; (3) a new provision designed to tax global intangible low-taxed income (GILTI); (4) a new limitation on deductible interest expense; (5) the repeal of the domestic production activity deduction; (6) limitations on the deductibility of certain executive compensation; and (7) limitations on net operating losses (NOLs) generated after December


Other31, 2017, to 80 percent of taxable income. The extent to which these and other provisions of the Act, or future legislation or regulations, could impact our consolidated effective income tax rate in future periods depends on many factors including, but not limited to, the amount of profit generated by our subsidiaries operating in the U.S., the impact of the Company’s current or contemplated tax planning strategies, the impact of new or amended tax laws or regulations by countries outside the U.S., and other factors beyond our control.
Further regulations and notices and state conformity could be issued as a result of U.S. tax reform covering various issues that may affect our tax position including, but not limited to, an increase in the corporate state tax rate and elimination of the interest deduction. The content of any future legislation, the timing for regulations, notices, and state conformity, and the reporting periods that would be impacted cannot be determined at this time. Although we believe the non-cash net charge of $27.5 million recorded in the fourth quarter of 2017 is a reasonable estimate of the impact of the income tax effects of the Act on LivaNova, the estimate is provisional. Once we finalize certain tax positions for our 2017 U.S. consolidated tax return, we will be able to conclude whether any further adjustments to our tax positions are required. During the six months ended June 30, 2018, the Company did not record any material adjustments to the provisional amount recorded in the fourth quarter of 2017 related to the Tax Cuts and Jobs Act.
Brexit
On June 23, 2016, the UK held a referendum in which voters approved an exit from the EU, commonly referred to as “Brexit.” On March 29, 2017, the UK government gave formal notice of its intention to leave the EU, formally commencing the negotiations regarding the terms of withdrawal between the UK and the EU and on March 19, 2018, the UK and the EU released a draft withdrawal agreement highlighting the progress made between the two parties on the terms of a transition period that will usher the UK out of the EU. The withdrawal must occur within two years, unlessUnless the deadline is extended.extended, the UK will leave the EU on March 2, 2019. The negotiation process will determine the future terms of the UK’s relationship with the EU. The notification does not change the application of existing tax laws, and does not establish a clear framework for what the ultimate outcome of the negotiations and legislative process will be.
Various tax reliefs and exemptions that apply to transactions between EU Member States under existing tax laws may cease to apply to transactions between the UK and EU Member States when the UK ultimately withdraws from the EU. It is unclear at this stage if or when any new tax treaties between the UK and the EU or individual EU Member States will replace those reliefs and exemptions. It is also unclear at this stage what financial, trade and legal implications will ensue from Brexit and how Brexit may affect us, our customers, suppliers, vendors, or our industry.
SeveralWe and several of our wholly owned subsidiaries that are domiciled either in the UK, various EU Member States, or in the United Sates, and our parent company, LivaNova PLC,States, are party to intercompany transactions and agreements under which we receive various tax reliefs and exemptions in accordance with applicable international tax laws, treaties and regulations. If certain treaties applicable to our transactions and agreements are not renegotiated or replaced with new treaties containing terms, conditions and attributes similar to those of the existing treaties, Brexit may have a material adverse impact on our future financial results and results of operations. During the two-year negotiation period, we will monitor and assess the potential impact of this event and explore possible tax-planning strategies that may mitigate or eliminate any such potential adverse impact. We will not account for the impact of Brexit in our income tax provisions until changes in tax laws or treaties between the UK and the EU or individual EU Member States with the UK and/or the U.S. are enacted or the withdrawal becomes effective.
European Union State Aid Challenge
On October 26, 2017, the European Commission (“EC”) announced that an investigation will be opened with respect to the UK’s controlled foreign company (“CFC”) rules. The Trump Administration has includedCFC rules under investigation provide certain tax exceptions to entities controlled by UK parent companies that are subject to lower tax rates if the activities being undertaken by the CFC relate to financing. The EC is investigating whether the exemption is a breach of EU State Aid rules. The investigation is in its early stages and is unlikely to be completed within a twelve month period with an appeal process likely to follow. It is unclear as to whether the UK will be part of its agendathe EU once a potential reformdecision has been finalized due to Brexit and what impact, if any, Brexit will have on the outcome of U.S. tax laws.  On September 27, 2017, the White House released its “Unified Framework for Fixing Our Broken Tax Code” (the “Framework”), which was developed byinvestigation or the Trump Administration,enforceability of a decision. Due to the House Committee on Waysmany uncertainties related to this matter, including the preliminary state of the investigation, the pending Brexit negotiations and Means,political environment and the Senate Committee on Financeunknown outcome of the investigation and which includes specific goals for lower businessresulting appeals, no uncertain tax rates. The Framework calls for a 20% corporate tax rateposition reserve has been recognized related to this matter and international reforms that include a territorial tax system and a one-time mandatory repatriation tax. The Framework proposes 100% expensing of new investments in depreciable assets for five years, effective after September 27, 2017, while partially limitingwe are unable to reasonably estimate the tax deduction for net business interest expense. Additionally, the Framework would repeal the section 199 domestic manufacturing deduction and “numerous other special exclusions and deductions” but would retain the research tax credit. The content of any final legislation, the timing for enactment, and the reporting periods that would be impacted cannot be determined at this time.

potential liability.


Results of Operations
We are reporting, in this Quarterly Report on Form 10-Q, the results for LivaNova and its consolidated subsidiaries for the three and ninesix months ended SeptemberJune 30, 2017,2018, as compared to the three and ninesix months ended SeptemberJune 30, 2016.2017.
The following table summarizes our condensed consolidated results of operations (in thousands):
 Three Months Ended September 30, Nine Months Ended September 30, Three Months Ended June 30, Six Months Ended June 30,
 2017 2016 2017 2016 2018 2017 2018 2017
Net sales $309,664
 $295,268
 $916,156
 $903,284
 $287,498
 $255,843
 $537,896
 $482,668
Cost of sales 108,233
 106,454
 318,584
 360,675
 91,993
 84,023
 176,591
 163,991
Product remediation 1,642
 689
 2,573
 2,243
 1,542
 1,723
 5,257
 931
Gross profit 199,789
 188,125
 594,999
 540,366
 193,963
 170,097
 356,048
 317,746
Operating expenses:                
Selling, general and administrative 121,177
 109,233
 353,943
 345,744
 123,439
 94,264
 227,600
 181,604
Research and development 31,393
 32,175
 104,051
 94,076
 34,215
 33,833
 65,967
 54,219
Merger and integration expenses 2,013
 7,576
 7,743
 20,537
 4,409
 3,512
 7,369
 5,698
Restructuring expenses 792
 4,381
 12,060
 37,219
 476
 2,597
 2,357
 12,627
Amortization of intangibles 12,350
 11,775
 35,445
 33,959
 9,817
 8,116
 18,618
 16,076
Total operating expenses 167,725
 165,140
 513,242
 531,535
 172,356
 142,322
 321,911
 270,224
Income from operations 32,064
 22,985
 81,757
 8,831
Operating income from continuing operations 21,607
 27,775
 34,137
 47,522
Interest income 199
 585
 724
 1,119
 232
 252
 679
 525
Interest expense (1,421) (3,495) (5,314) (6,665) (3,006) (1,578) (5,117) (3,893)
Gain on acquisition of Caisson Interventional, LLC 
 
 39,428
 
Foreign exchange and other gains (losses) 491
 1,216
 957
 (2)
Income before income taxes 31,333
 21,291
 117,552
 3,283
Income tax expense 1,913
 9,731
 10,881
 16,891
Gain on acquisitions 
 39,428
 11,484
 39,428
Foreign exchange and other (losses) gains (70) (2,837) (343) 336
Income from continuing operations before tax 18,763
 63,040
 40,840
 83,918
Income tax (benefit) expense (1,030) 3,259
 2,863
 8,914
Losses from equity method investments (1,590) (13,129) (20,072) (19,382) (265) (14,102) (627) (16,098)
Net income (loss) $27,830
 $(1,569) $86,599
 $(32,990)
Net income from continuing operations 19,528
 45,679
 37,350
 58,906
Net (loss) income from discontinued operations (4,462) 1,819
 (9,011) (137)
Net income $15,066
 $47,498
 $28,339
 $58,769


Net Sales
The tabletables below illustratespresent net sales by operating segment and market geographygeographic region (in thousands, except for percentages):
  Three Months Ended September 30,  
  2017 2016 % Change
Cardiac Surgery      
United States $44,991
 $46,768
 (3.8)%
Europe (1)
 40,429
 38,009
 6.4%
Rest of world 74,402
 63,741
 16.7%
  159,822
 148,518
 7.6%
Neuromodulation      
United States 76,286
 74,864
 1.9%
Europe (1)
 8,057
 8,489
 (5.1)%
Rest of world 6,673
 6,151
 8.5%
  91,016
 89,504
 1.7%
Cardiac Rhythm Management      
United States 931
 2,178
 (57.3)%
Europe (1)
 44,468
 44,747
 (0.6)%
Rest of world 13,012
 9,843
 32.2%
  58,411
 56,768
 2.9%
Other 415
 478
 (13.2)%
  $309,664
 $295,268
 4.9%
 Nine Months Ended September 30,  Three Months Ended June 30, Six Months Ended June 30,
 2017 2016 % Change 2018 2017 % Increase (Decrease) 2018 2017 % Increase (Decrease)
Cardiac Surgery     
Cardiopulmonary            
United States $42,139
 $39,719
 6.1 % $80,584
 $71,895
 12.1 %
Europe 35,916
 33,959
 5.8 % 72,786
 64,568
 12.7 %
Rest of world 58,584
 50,467
 16.1 % 108,399
 94,980
 14.1 %
 136,639
 124,145
 10.1 % 261,769
 231,443
 13.1 %
Heart Valves            
United States $129,160
 $133,995
 (3.6)% 6,147
 6,205
 (0.9)% 12,683
 12,274
 3.3 %
Europe (1)
 126,028
 128,229
 (1.7)% 11,863
 10,684
 11.0 % 23,979
 21,031
 14.0 %
Rest of world 202,424
 190,788
 6.1% 15,792
 17,552
 (10.0)% 28,182
 33,042
 (14.7)%
 457,612
 453,012
 1.0% 33,802
 34,441
 (1.9)% 64,844
 66,347
 (2.3)%
Advanced Circulatory Support            
United States 5,468
 
  % 5,468
 
  %
Europe 353
 
  % 353
 
  %
Rest of world 194
 
  % 194
 
  %
 6,015
 
  % 6,015
 
  %
Cardiac Surgery            
United States 53,754
 45,924
 17.0 % 98,735
 84,169
 17.3 %
Europe 48,132
 44,643
 7.8 % 97,118
 85,599
 13.5 %
Rest of world 74,570
 68,019
 9.6 % 136,775
 128,022
 6.8 %
 176,456
 158,586
 11.3 % 332,628
 297,790
 11.7 %
Neuromodulation                 
United States 89,395
 81,405
 9.8 % 167,387
 155,064
 7.9 %
Europe 11,943
 9,514
 25.5 % 22,234
 17,443
 27.5 %
Rest of world 9,315
 6,096
 52.8 % 14,876
 11,667
 27.5 %
 110,653
 97,015
 14.1 % 204,497
 184,174
 11.0 %
            
Other 389
 242
 60.7 % 771
 704
 9.5 %
Totals            
United States 231,350
 220,892
 4.7% 143,149
 127,329
 12.4 % 266,122
 239,233
 11.2 %
Europe (1)
 25,500
 24,208
 5.3% 60,075
 54,157
 10.9 % 119,352
 103,042
 15.8 %
Rest of world 18,340
 15,801
 16.1% 84,274
 74,357
 13.3 % 152,422
 140,393
 8.6 %
 275,190
 260,901
 5.5%
Cardiac Rhythm Management     
United States 5,605
 7,471
 (25.0)%
Europe (1)
 142,811
 149,141
 (4.2)%
Rest of world 33,819
 31,445
 7.5%
 182,235
 188,057
 (3.1)%
Other 1,119
 1,314
 (14.8)%
 $916,156
 $903,284
 1.4%
Total $287,498
 $255,843
 12.4 % $537,896
 $482,668
 11.4 %
(1)IncludesEurope sales include those countries in Europe where LivaNova haswhich we have a direct sales presence. Countries where sales are madepresence, whereas European countries in which we sell through distributors are included in ‘Rest“Rest of world’world”.


The tabletables below illustratespresent segment income (loss) from operations (in thousands):
  Three Months Ended September 30,  
  2017 2016 % Change
Cardiac Surgery $23,807
 $17,791
 33.8 %
Neuromodulation 45,932
 47,049
 (2.4)%
Cardiac Rhythm Management 5,427
 (4,598) 218.0 %
Other (27,947) (13,525) (106.6)%
Total Reportable Segment's Income from Operations (1)
 $47,219
 $46,717
 1.1 %
 Nine Months Ended September 30,   Three Months Ended June 30, Six Months Ended June 30,
 2017 2016 % Change 2018 2017 % Change 2018 2017 % Change
Cardiac Surgery $63,490
 $29,197
 117.5 % $16,337
 $23,773
 (31.3)% $26,595
 $39,806
 (33.2)%
Neuromodulation 139,357
 134,871
 3.3 % 61,389
 51,264
 19.8 % 100,123
 92,020
 8.8 %
Cardiac Rhythm Management 13,536
 (14,432) 193.8 %
Other (79,378) (49,090) (61.7)% (41,417) (33,037) (25.4)% (64,237) (49,903) (28.7)%
Total Reportable Segment's Income from Operations (1)
 $137,005
 $100,546
 36.3 %
Total reportable segment income from continuing operations (1)
 $36,309
 $42,000
 (13.6)% $62,481
 $81,923
 (23.7)%
(1)
For a reconciliation of segment operating income to consolidated operating income refer to “Note 14.16. Geographic and Segment Information” inin the condensed consolidated financial statements in this Quarterly Report on Form 10-Q.
Cardiac Surgery
Cardiac Surgery net sales increased by 7.6% and 1.0% for the three and ninesix months ended SeptemberJune 30, 2017, as2018 compared to the three and ninesix months ended SeptemberJune 30, 2016, respectively. Net2017, primarily due to strong heart-lung machine sales as customers continue to upgrade from legacy S3 to current S5 devices. Additionally, net sales were positively impacted by $6.0 million in sales from the acquisition of TandemLife on April 4, 2018 and foreign currency exchange rate fluctuations. With respect to heart valves, the expected termination of a manufacturing contract resulted in a decrease in net sales of $2.0 million and $4.6 million for the three and six months ended June 30, 2018, respectively, compared to the comparable prior year periods. Strong demand for the Perceval sutureless aortic heart valve offset continuing global declines in traditional tissue and mechanical heart valves.
Cardiac Surgery operating income decreased for the three and six months ended June 30, 2018 compared to the three and six months ended June 30, 2017 as the positive impact to operating income associated with increases in net sales was more than offset by increased sales and marketing expenses related to our efforts to expand market share in international markets, increased R&D investments in support of the next generation heart-lung machine, a negative impact from foreign currency exchange rate fluctuations and increased legal costs associated with our 3T litigation. Additionally, the inclusion of the operating results of TandemLife resulted in a $5.1 million decrease in operating income for the three and six months ended June 30, 2018 as compared to the comparable prior year periods.
Neuromodulation
Effective January 1, 2018, we began to include the results of heart failure within the Neuromodulation segment for internal reporting purposes in order to manage and evaluate business activities for purposes of allocating resources and assessing performance. Segment results for the three and six months ended June 30, 2017 have been recast to conform to the current period presentation.
Neuromodulation net sales increased $11.3 millionfor the three and six months ended June 30, 2018 compared to the three and six months ended June 30, 2017 due to strong adoption of the SenTiva VNS Therapy System in the U.S. and an overall increase in demand internationally. Net sales for the three months ended SeptemberJune 30, 2017, as compared to2018 also benefited from increased sales in Europe following the prior-year period due to growthapproval and launch of Sentiva, the early success of a business model change in both cardiopulmonary product revenue and heart valve revenueJapan and favorable foreign currency exchange rate fluctuations. Cardiopulmonary sales increased 7.6%, or $8.7 million, for the three months ended September 30, 2017, due to strengthreimbursement decisions in heart-lung machines as a result of geographic sales expansion and continued progress towards upgrading customers from older machines to our current S5 device. Heart valve sales increased by 7.7%, or $2.6 million, for the three months ended September 30, 2017, as compared to the prior-year period due primarily to increased demand for the Perceval sutureless tissue valvefive additional countries in the U.S. and quarter over quarter improvement in Europe, which more than offset declines in mechanical heart valve sales globally. Cardiac Surgery net sales increased $4.6 million for the nine months ended September 30, 2017, as compared to the nine months ended September 30, 2016, due primarily to growthRest of $5.3 million in cardiopulmonary product revenue, partially offset by a decline in heart value revenues. Year-to-date cardiopulmonary product sales increased over the prior-year period due to heart-lung machine sales expansion outside of the U.S. and Europe. Cardiac Surgeryworld region.
Neuromodulation operating income for the three months ended September 30, 2017 increased 33.8% over the prior-year period primarily due to increased operating leverage from the $11.3 million increase in sales. The 117.5% increase in operating income for the nine months ended September 30, 2017 over the prior-year period was primarily driven by inventory fair value step-up amortization of $25.2 million that was recognized during the nine months ended September 30, 2016. The inventory fair value step-up was fully amortized by September 30, 2016.
Neuromodulation net sales increased by 1.7% and 5.5% for the three and ninesix months ended SeptemberJune 30, 2017, as2018 compared to the three and ninesix months ended SeptemberJune 30, 2016, respectively.2017. The increasepositive impact to operating income associated with increases in net sales of $1.5 million forand the three months ended September 30, 2017, over the prior-year period was primarily due to increased average selling prices driven by continued AspireSR penetrationadjustment of the U.S. market, partiallyImThera contingent consideration liability were offset by a decline in unitincreased sales dueand marketing expenses associated with efforts to hurricane-related impacts in the U.S. and customer anticipation of the SenTiva system,market direct to consumer, increased R&D expenses for new projects surrounding our new generationSentiva VNS Therapy System which launched in October 2017. The increase in net sales of $14.3 million forand heart failure and the nine months ended September 30, 2017 over the prior-year period was primarily due to strong new patient sales and price premiums partially offset by hurricane-related impacts in the U.S. and customer anticipationinclusion of the SenTiva system. The decrease in Neuromodulation operating income for the three months ended September 30, 2017 as compared to the prior-year period was primarily due to increased selling, general and administrative costs driven by sales force expansion and marketing efforts in the U.S. The increase in Neuromodulation operating income for the nine months ended September 30, 2017 as compared to the prior-year period was primarily driven by increased operating leverage as a resultresults of higher net sales, partially offset by the increased costs associated with sales force expansion and marketing efforts in the U.S.
Cardiac Rhythm Management net sales increased by 2.9% for the three months ended September 30, 2017, as compared to the prior-year period primarily due to favorable foreign currency exchange rate fluctuations. Additionally, growth of theImThera.


PLATINIUM Cardiac Resynchronization Therapy devices (CRT-Ds) in Europe and continued demand for KORA 250 pacemakers in Japan were mostly offset by a decrease in Implantable Cardiac Defibrillator (ICD) sales. Cardiac Rhythm Management net sales decreased by 3.1% for the nine months ended September 30, 2017, as compared to the prior-year period. This decline was primarily due to a decrease in ICD sales and reduced sales in the U.S. and Europe, both of which reflect a change in customer preferences. Cardiac Rhythm Management operating income increased $10.0 million and $28.0 million for the three and nine months ended September 30, 2017, respectively, as compared to the prior-year periods. The increase for the three months ended September 30, 2017 over the prior-year period was due to cost reductions resulting from prior restructuring actions, improvements in selling, general and administrative costs driven by reductions in the overall sales force and increased net sales. The increase for the nine months ended September 30, 2017 as compared to the prior-year period was driven by inventory fair value step-up amortization of $10.0 million that was recognized during the nine months ended September 30, 2016, cost reductions resulting from prior restructuring actions and cost reductions associated with a reduction in the overall sales force partially offset by decreased sales during the nine months ended September 30, 2017.
‘Other’ comprises the results from our corporate and new ventures activity. Operating loss from Other increased $14.4 million for the three months ended September 30, 2017, as compared to the prior-year period, primarily due to $3.9 million of Caisson related expenses and $12.9 million in increased Corporate costs. Operating loss from Other increased $30.3 million for the nine months ended September 30, 2017, as compared to the prior-year period, primarily due to $17.9 million of increased Caisson-related expenses and increased Corporate costs of $20.3 million. Increased Corporate costs during the three and nine months ended September 30, 2017 includes $2.8 million and $8.3 million in legal costs, respectively, primarily associated with litigation related to our 3T devices and investments in building out global capabilities including international expansion, and project-related expenses.
Cost of Sales and Expenses
The table below illustratespresents our comparative cost of sales and majorsignificant expenses as a percentage of sales:
  Three Months Ended September 30,  
  2017 2016 Change
Cost of sales 35.0% 36.1% (1.1)%
Product remediation 0.5% 0.2% 0.3 %
Gross profit 64.5% 63.7% 0.8 %
Operating expenses:      
Selling, general and administrative 39.1% 37.0% 2.1 %
Research and development 10.1% 10.9% (0.8)%
Merger and integration expenses 0.7% 2.6% (1.9)%
Restructuring expenses 0.3% 1.5% (1.2)%
Amortization of intangibles 4.0% 4.0%  %
  Nine Months Ended September 30,  
  2017 2016 Change
Cost of sales 34.8% 39.9% (5.1)%
Product remediation 0.3% 0.2% 0.1 %
Gross profit 64.9% 59.8% 5.1 %
Operating expenses:      
Selling, general and administrative 38.6% 38.3% 0.3 %
Research and development 11.4% 10.4% 1.0 %
Merger and integration expenses 0.8% 2.3% (1.5)%
Restructuring expenses 1.3% 4.1% (2.8)%
Amortization of intangibles 3.9% 3.8% 0.1 %


Cost of Sales
Cost of sales consisted primarily of direct labor, allocated manufacturing overhead, the acquisition cost of raw materials and components. Cost of sales as a percentage of net sales decreased by 1.1% to 35.0% and by 5.1% to 34.8% for the three and nine months ended September 30, 2017, respectively, as compared to the prior-year periods. The cost improvement for the three months ended September 30, 2017 reflects management’s focus on cost efficiencies to improve gross margin. The cost improvement for the nine months ended September 30, 2017 was primarily due to inventory fair value step-up amortization in the prior year, which accounted for 3.9% of the decrease in our cost of sales as a percentage of net sales, as well as the previously mentioned cost efficiencies. The total amount recognized for amortization of the fair value step-up in inventory for the nine months ended September 30, 2016 was $35.2 million. The fair value step-up in inventory basis was fully amortized by September 30, 2016.
  Three Months Ended June 30, Six Months Ended June 30,
  2018 2017 Change 2018 2017 Change
Cost of sales 32.0% 32.8% (0.8)% 32.8% 34.0% (1.2)%
Product remediation 0.5% 0.7% (0.2)% 1.0% 0.2% 0.8 %
Gross profit 67.5% 66.5% 1.0 % 66.2% 65.8% 0.4 %
Operating expenses:            
Selling, general and administrative 42.9% 36.8% 6.1 % 42.3% 37.6% 4.7 %
Research and development 11.9% 13.2% (1.3)% 12.3% 11.2% 1.1 %
Merger and integration expenses 1.5% 1.4% 0.1 % 1.4% 1.2% 0.2 %
Restructuring expenses 0.2% 1.0% (0.8)% 0.4% 2.6% (2.2)%
Amortization of intangibles 3.4% 3.2% 0.2 % 3.5% 3.3% 0.2 %
Sales, General and Administrative (“SG&A”) Expenses
SG&A expenses consisted of sales, marketing, general and administrative activities. SG&A expenses for the three months ended September 30, 2017 increased as a percentage of net sales by 2.1% to 39.1%, asincreased for the three and six months ended June 30, 2018 compared to the prior-year period,three and was consistent at 38.6% for the ninesix months ended SeptemberJune 30, 2017 as compareddue to the prior-year period. The 2.1%key growth driver investments, including efforts to market direct to consumer within our Neuromodulation business, acquisition costs of TandemLife and ImThera and an increase was largelyin sales and marketing expenses internationally for general market expansion. Legal costs primarily attributable to litigation related to our 3T devices, the impact of foreign currency exchange rate fluctuations, and other legal matters.the strengthening of organizational capabilities to support growth also contributed to the increase in SG&A expenses as a percentage of net sales.
Research and Development (“R&D”) Expenses
R&D expenses consistedconsist of product design and development efforts, clinical trialstudy programs and regulatory activities. activities, which are essential to the Company’s strategic portfolio initiatives, including TMVR, Treatment-Resistant Depression, Obstructive Sleep Apnea and Heart Failure.
R&D expenses as a percentage of net sales was consistent fordecreased during the three months ended SeptemberJune 30, 2017,2018 as compared to the prior-year period, and increased by 1.0% to 11.4% for the ninethree months ended SeptemberJune 30, 2017, as compared to the prior-year period. The increase isprimarily due to the acquisition of Caisson inclusiveduring the three months ended June 30, 2017 which resulted in the recognition of $5.8 million in post-combination compensation expense recognized concurrent with the acquisition of Caisson, and $6.4$3.6 million in incremental compensation expense associated with the retention of the employees of Caisson. The three months ended June 30, 2018 includes additional R&D expenses for our development of next generation products, clinical trials and investments in treatment-resistant depression, TMVR and sleep apnea and heart failure.
Merger and Integration Expenses
Merger and integration expenses consisted primarily of consulting costs associated with computer systems integration efforts, organization structure integration, synergy and tax planning, as well as the integration of internal controls for the two legacy organizations. In addition, integration expenses include retention bonuses, branding and renaming efforts and lease cancellation penalties in Milan and Brussels.
Merger and integrationR&D expenses as a percentage of net sales decreased by 1.9% to 0.7% forincreased slightly during the threesix months ended SeptemberJune 30, 20172018 as compared to the prior-year period,six months ended June 30, 2017, primarily due to R&D expenses for our development of next generation products, clinical trials and decreased by 1.5% to 0.8%investments in the aforementioned strategic portfolio initiatives. These expenses more than offset R&D expenses for the ninesix months ended SeptemberJune 30, 2017 as comparedof $6.5 million related to the prior-year period. These decreases were due to a continued decline in integration activities.acquisition of Caisson.
Restructuring Expenses
Restructuring expenses were primarily duerelated to our efforts under our 2015 and 2016 Reorganization Plans and the Suzhou, China exit plan, to leverage economies of scale, eliminate duplicate corporate expenses and streamline distributions, logistics and office functions in order to reduce overall costs.
Restructuring expenses decreased as a percentage of net sales decreased by 1.2% to 0.3% and 2.8% to 1.3% forover the three and ninesix months ended SeptemberJune 30, 2017, respectively,2018, as compared to the prior-year periods duethree and six months ended June 30, 2017, as our restructuring activities continue to a continued decline in restructuring activities.decline.
Gain on Caisson AcquisitionAcquisitions
On January 16, 2018, we acquired the remaining outstanding interest of ImThera for cash consideration of up to $225 million. The fair value of our previously-held interest in ImThera was determined based on the fair value of total consideration transferred and application of a discount for lack of control. As a result, we recognized a pre-tax non-cash gain of $11.5 million for the fair value in excess of our carrying value of $14.1 million.


On May 2, 2017, we acquired the remaining 51% equity interestsinterest in Caisson which we previously accounted for under the equity method.Caisson. On the acquisition date, we remeasured our notes receivable due from Caisson and our existing investment in Caisson at fair value and recognized a pre-tax non-cash gain of $1.3 million and $38.1 million, respectively.
Foreign Exchange and Other Gains (Losses)
Foreign exchange and other gains were $0.5 million and $1.2 million for the three months ended September 30, 2017 and September 30, 2016, respectively. The gains were primarily due to net foreign currency gains associated with foreign currency commercial transactions, freestanding foreign currency forward contracts, intercompany debt, and third-party financial assets and liabilities. The gains of $1.0 million for the nine months ended September 30, 2017 included a $3.2 million gain on a sale of the cost-method investment, Istituto Europeo di Oncologia S.R.L, partially offset by net foreign currency exchange losses of $2.2 million.


Income Taxes
LivaNova PLC is domiciled and resident in the UK. Our subsidiaries conduct operations and earn income in numerous countries and are subject to the laws of taxing jurisdictions within those countries, and the income tax rates imposed in the tax jurisdictions in which our subsidiaries conduct operations vary. As a result of the changes in the overall level of our income, the deployment of various tax strategies and the changes in tax laws, our consolidated effective income tax rate may vary substantially from one reporting period to another.
During the three and nine months ended September 30, 2017, we recorded consolidated income tax expense of $1.9 million and $10.9 million, respectively, with consolidated effective income tax rates of 6.1% and 9.3%, respectively.
Our consolidated effective income tax rate from continuing operations for the three months ended June 30, 2018 was (5.5)% compared with 5.2% for the three months ended June 30, 2017. For the six months ended June 30, 2018, the effective income tax rate from continuing operations was 7.0% compared with 10.6% for the six months ended June 30, 2017. Our effective income tax rate fluctuates based on, among other factors, changes in pretax income in countries with varying statutory tax rates, changes in valuation allowances, changes in tax credits and incentives, and changes in unrecognized tax benefits associated with uncertain tax positions.
Compared with the three and six months ended June 30, 2017, the lower effective tax rates for the three and ninesix months ended SeptemberJune 30, 2017 included2018 were primarily attributable to the impact of variousthe reduction to the U.S. federal statutory tax rate as a result of the U.S. “Tax Cuts and Jobs Act” (the “Tax Act”), the benefit of foreign derived intangible income partially offset by the repeal of the U.S. domestic production activity deduction, certain tax law changes in the UK that occurred during the three months ended December 31, 2017 and the impact of discrete tax items including a net $4.0 million deferred tax benefit due to the release of valuation allowances on tax losses upon the completion of a reorganization of our legal entities in the U.S. and a $2.1 million tax benefit from the resolution of prior period tax matters. Discrete tax items for the nine months ended September 30, 2017 also included the acquisition of Caisson and the $38.1 million non-taxable gain recognized to re-measure our existing equity investment in Caisson at fair value on the acquisition date, a $3.9 million deferred tax benefit associated with certain temporary differences arising from the Mergers and the recognition of a $3.0 million deferred tax asset related to a reserve for an uncertain tax position recognized in a prior year, in addition to various other discrete items.
During the three and nine months ended SeptemberJune 30, 2016,2018, we recorded consolidatedentered into an audit settlement impacting one of our uncertain tax positions. This audit settlement resulted in the recognition of an additional of $1.7 million in income tax expense of $9.7 million and $16.9 million, respectively, with consolidated effective income tax rates of 45.7% and 514.5%, respectively. The effective tax rate for the nine months ended September 30, 2016 was impacted by the recording of valuation allowances of $23.9 million related to certain tax jurisdictions, including France and the UK, in which we did not record tax benefits generated by their operating losses, as well as the tax expense generated by profitable operations in higher tax jurisdictions, such as the U.S. and Germany, offset by tax savings from our inter-company financing as part of our 2015 tax restructuring.expense.
Losses from Equity Method Investments
Due to an additional investment by a third party during the three months ended June 30, 2018, our equity interest in Highlife decreased to 17.5% from 24.6%. As a result, we determined that we no longer had significant influence over Highlife and transferred the investment from our equity method to our cost method investments during the three months ended June 30, 2018. Losses from equity method investments were $1.6$0.3 million and $20.1$0.6 million duringfor the three and ninesix months ended SeptemberJune 30, 2017, respectively. Losses2018, respectively, which were attributable to Highlife, and $14.1 million and $16.1 million for the three and six months ended SeptemberJune 30, 2017, respectively, from our share of investee losses at Highlife and Caisson. These losses were primarily due to our equity method investee losses, primarily from Highlife and MicroPort. Losses for the nine months ended September 30, 2017 included the impairment of our investment in, and notes receivable from, Highlife of $13.0 million which consisted of the investment impairment of $4.7 million and the notes receivable impairment of $8.3 million. We recognized losses of $13.1 million and $19.4 million during the three and nine months ended SeptemberJune 30, 2016, respectively, primarily due to a $9.2 million impairment of our investment in Respicardia and losses from our equity method investees.2017.
Liquidity and Capital Resources
Based on our current business plan, we believe that our existing cash and cash equivalents, future cash generated from continuing operations, and available borrowing capacity under our credit facilities will be sufficient to fund our expected operating needs, working capital requirements, R&D opportunities, capital expenditures and debt service requirements over the next 12 months. We regularly review our capital needs and consider various investing and financing alternatives to support our requirements. Refer to “Note 7.9. Financing Arrangements” in the condensed consolidated financial statements in this Quarterly Report on Form 10-Q for additional information regarding our debt. Our liquidity could be adversely affected by the factors affecting future operating results, including those referred to in “Part II - Item 1A. Risk Factors” in 2016the 2017 Form 10-K.
On June 29, 2017,In connection with the TandemLife acquisition, we entered into a new Finance ContractBridge Facility Agreement providing a term loan facility with the EIB to support financing of certain of our R&D projects. The Finance Contract has a borrowing base of €100 million (or approximately $118 million) and can be drawn in up to two tranches, each in a minimumaggregate principal amount of €50$190.0 million. On April 3, 2018, we borrowed $190.0 million (or approximately $59 million). Drawdowns must occur by December 30, 2018 andunder the last repayment dateBridge Facility Agreement to facilitate the initial payment for our acquisition of any tranche will be no earlier than four years and no later than eight years afterTandemLife. We used the disbursementproceeds from the sale of the relevant tranche. LoansCRM business franchise to repay the borrowings under the Finance Contract are subject to certain covenants and other terms and conditions.Bridge Facility Agreement in full during the three months ended June 30, 2018.
No provision has been made for income taxes on unremitted earnings of our foreign controlled subsidiaries (non-UK subsidiaries) as of SeptemberJune 30, 2017.2018. In the event of the distribution of those earnings in the form of dividends, a sale of the subsidiaries or certain other transactions, we may be liable for income taxes. However, the tax liability on future distributions should not be significant as most jurisdictions with unremitted earnings have various participation exemptions or no withholding tax.


Cash Flows
Net cash and cash equivalents provided by (used in) operating, investing and financing activities and the net (decrease) increase (decrease) in the balance of cash and cash equivalents were as follows (in thousands):
 Nine Months Ended September 30, Six Months Ended June 30,
 2017 2016 2018 2017
Operating activities $73,665
 $49,348
 $48,536
 $31,560
Investing activities (41,797) (36,363) (93,190) (27,734)
Financing activities (10,000) (62,996) 927
 (3,367)
Effect of exchange rate changes on cash and cash equivalents 3,501
 1,030
 (2,508) 2,442
Net increase (decrease) $25,369
 $(48,981)
Net (decrease) increase $(46,235) $2,901
Operating Activities
Cash provided by operating activities during the ninesix months ended SeptemberJune 30, 20172018 increased $24.3$17.0 million as compared to the same prior-year period. The increase wasis primarily the result of andue to a $51.5 million increase in cash from changes in net income of $119.6 million, offset by a $43.2 million change in operating assets and liabilities, partially offset by a $39.4 million gain recognizeddecrease in conjunction with the acquisitionnet income excluding non-cash items of Caisson and a $17.0 million increase in deferred income tax benefit.$34.5 million.
Investing Activities
Cash used in investing activities during the ninesix months ended SeptemberJune 30, 20172018 increased $5.4$65.5 million as compared to the same prior-year period. The increase was primarily the result of netresulted from an increase in cash paid for the acquisitionacquisitions of Caisson of $14.2$265.7 million, as well as $14.1 millionpartially offset by cash received from maturitiesthe sale of short-term investments inCRM of $186.7 million and an $8.1 million increase due to cash received from the prior-year period, offset by $7.1 million in purchasessale of short-term investments in the prior-year period.assets.
Financing Activities
Cash used inprovided by financing activities during the ninesix months ended SeptemberJune 30, 2017 decreased $53.02018 increased $4.3 million as compared to the same prior-year period. The decrease was primarily the result of a decreaseChanges in net debt repaymentsborrowings resulting in an increase of $27.5$23.9 million a decrease in share repurchaseswere partially offset by current year payments of $11.1deferred consideration of $14.1 million and a $5.2 million decrease associated with share-based compensation arrangements.
Contractual Obligations
We had no material changes in our contractual commitments and obligations from amounts listed under “Part II, Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations - Liquidity and Capital Resources” in our Annual Report on Form 10-K for the repayment of trade receivable advances of $23.8 million in the prior-year period, offset by a reduction in proceeds from stock option exercises of $4.7 million.year ended December 31, 2017.
Item 3. Quantitative and Qualitative Disclosures About Market Risk
We are exposed to certain market risks as part of our ongoing business operations, including risks from foreign currency exchange rates, interest rate risks and concentration of procurement suppliers that could adversely affect our consolidated financial position, results of operations or cash flows. We manage these risks through regular operating and financing activities and, at certain times, derivative financial instruments. Quantitative and qualitative disclosures about these risks are included in this Form 10-Q in “Part I, Note 8”10. Derivatives and Risk Management”, “Part I, Item 2. Management’s Discussion and Analysis of Financial Conditions and Results of Operations” and “Part II, Item 1A. Risk Factors”, and in our 20162017 Form 10-K in “Part II, Item 7A Management’s Discussion and Analysis of Financial Condition and Results of Operations.” and “Part I, Item 1A. Risk Factors”. There have been no material changes from the information provided therein.


Item 4. Controls and Procedures
Disclosure Controls and Procedures
(a) Evaluation of Disclosure Controls and Procedures
We maintain a system of disclosure controls and procedures, as defined in Rules 13a-15(e) and 15d-15(e) of the Exchange Act, that are designed to ensure that information required to be disclosed in our reports filed under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms. This information is also accumulated and communicated to management, including our Chief Executive Officer (“CEO”) and Chief Financial Officer (“CFO”), as appropriate, to allow timely decisions regarding required disclosure. Our management, under the supervision and with the participation of our CEO and CFO, evaluated the effectiveness of the design and operation of our disclosure controls and procedures as of the end of the most recent fiscal quarter reported herein. Based on that evaluation, our CEO and CFO concluded that our disclosure controls and procedures were effective as of SeptemberJune 30, 2017.


2018.
(b) Changes in Internal Control Over Financial Reporting
We deployed a new enterprise resource planning (ERP) software system, SAP, to our U.S. locations during the quarter ended September 30, 2017. In conjunction with the implementation of SAP, we reorganized certain U.S. legal entities were to align with our strategic and operational focus. Our internal controls have been updated to reflect these changes. There have been no other changesNo change in our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-5(f) under the Exchange Act) occurred during the period covered by this Quarterly Report on Form 10-Qquarter ended June 30, 2018 that havehas materially affected, or areis reasonably likely to materially affect, our internal control over financial reporting.


PART II. OTHER INFORMATION
Item 1. Legal Proceedings
For a description of our material pending legal and regulatory proceedings and settlements, refer to “Note 9.11. Commitments and Contingencies” in our condensed consolidated financial statements included in this Report on Form 10-Q. 
Item 1A. RISKRisk FACTORSFactors
Our business faces many risks. AnyThere were no material changes to the description of the risks referenced below or elsewhere in this Report on Form 10-Q, other Reports on Form 10-Qs or our other SEC filings could have a material impact onrisk factors associated with our business and consolidated financial position or results of operations. Additional risks and uncertainties not presently known to us or that we currently believe to be immaterial may also impair our business operations.
For additional detailed discussion of risk factors that should be understood by any investor contemplating investmentpreviously disclosed in our stock, please refer to “Part I.Part I, Item 1A. Risk1A “Risk Factors” in our 2016 Form 10-K and elsewhere as described in this Report on Form 10-Q.
The results of the UK’s referendum on withdrawal from the EU may have a negative effect on global economic conditions, financial markets and our business, which could reduce the price of our ordinary shares.
On June 23, 2016, the UK held a referendum in which voters approved an exit from the EU, commonly referred to as “Brexit.” On March 29, 2017 the UK Government gave formal notice of its intention to leave the EU, formally commencing the negotiations regarding the terms of withdrawal between the UK and the EU. The withdrawal must occur within two years, unless the deadline is extended or a withdrawal agreement is negotiated sooner. The negotiation process will determine the future terms of the UK’s relationship with the EU. The notification does not change the application of existing tax laws, and does not establish a clear framework for what the ultimate outcome of the negotiations and legislative process will be.
Various tax reliefs and exemptions that apply to transactions between EU Member States under existing tax laws may cease to apply to transactions between the UK and EU Member States when the UK ultimately withdraws from the EU. It is unclear at this stage if or when any new tax treaties between the UK and the EU or individual EU Member States will replace those reliefs and exemptions. It is also unclear at this stage what financial, trade and legal implications the withdrawal of the UK from the EU will have and how Brexit may affect us, our customers, suppliers, vendors, or our industry.
Several of our wholly-owned subsidiaries that are domiciled either in the UK, various EU Member States, or in the United States, and our parent company, LivaNova PLC, are party to intercompany transactions and agreements under which we receive various tax reliefs and exemptions. If certain treaties applicable to our transactions and agreements are not renegotiated or replaced with new treaties containing terms, conditions and attributes similar to those of the existing treaties, the departure of the UK from the EU may have a material adverse impact on our future financial results and results of operations. During the two-year negotiation period, We will monitor and assess the potential impact of this event and explore possible tax-planning strategies that may mitigate or eliminate any such potential adverse impact. We will not account for the impact of Brexit in our income tax provisions until changes in tax laws or treaties between the UK and the EU or individual EU Member States are enacted or the withdrawal becomes effective.
Our acquisition of Caisson may fail to further our strategic objectives or strengthen our existing businesses.
Acquisitions of medical technology companies are inherently risky, and we cannot guarantee that such acquisitions will be successful or will not materially adversely affect our consolidated earnings, financial condition, and/or cash flows. Caisson is in the early stages of clinical development, and therefore, there are risks inherent in the outcome of the clinical studies or regulatory approvals that may impact Caisson’s success. Further, our integration of Caisson’s operations requires significant efforts, including the coordination of information technologies, research and development, operations and finance. These efforts result in additional expenses and significant supervision by management. Our failure to manage and coordinate the growth of Caisson successfully could have an adverse impact on our business. In addition, we cannot be certain that the acquisition will become profitable or remain so. These effects, individually or in the aggregate, could cause a deterioration of our credit rating and result in increased borrowing costs and interest expense.Form 10-K.



Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
None
Item 3. Defaults Upon Senior Securities
None.
Item 4. Mine Safety Disclosures
Not applicable.
Item 5. Other Information
None.


Item 6. Exhibits
The exhibits marked with the asterisk symbol (*) are filed or furnished (in the case of Exhibit 32.1) with this Quarterly Report on Form 10-Q. The exhibits marked with the cross symbol (†) are management contracts or compensatory plans or arrangements filed pursuant to Item 601(b)(10)(iii) of Regulation S-K. 
Exhibit
Number
 
Document Description
 
 Report or Registration Statement
SEC File or
Registration
Number
Exhibit
Reference
Document Description Report or Registration StatementSEC File or
Registration
Number
Exhibit
Reference
Stock and Asset Purchase Agreement, dated as of March 8, 2018, by and among LivaNova PLC, MicroPort Cardiac Rhythm B.V. and MicroPort Scientific Corporation LivaNova PLC Current Report on Form 8-K, filed on March 8, 2018001-375992.1
3.2 LivaNova Plc Current Report on Form 8-K, filed on June 15, 2017001-375993.1
Amended Articles of Association of LivaNova PLC, effective as from 14 June 2017

 LivaNova PLC Current Report on Form 8-K, filed on June 15, 2017001-375993.1
Amendment and Restatement Agreement related to a Facility Agreement dated 21 October 2016 between LivaNova PLC and Barclays Bank PLC, dated 10 April 2018   
Amendment No. 1, dated 17 April 2018, to the Finance Contract entered into by and between the European Investment Bank, LivaNova PLC, Sorin CRM and Sorin Group Italia S.r.l., dated 29 June 2017; and Amendment No. 2, dated 17 April 2018, to the Finance Contract entered into by and between the European Investment Bank, LivaNova PLC, Sorin CRM S.A.S. and Sorin Group Italia S.r.l. on 6 May 2014, as amended and restated on 2 Oct 2015; and Waiver of Articles 4.03A(3), 6.05 and 6.06 of the aforementioned Amendments   
2018 Director RSU Agreement LivaNova PLC Current Report on Form 8-K, filed on June 15, 2018001-3759910.1
General Provisions of the LivaNova Global Employee Share Purchase Plan dated 12 June 2018   
Form of Letter of Appointment as Non-Executive Director, dated 18 July 2018   
31.1*   Certification of the Chief Executive Officer of LivaNova PLC pursuant to Section 302 of the Sarbanes-Oxley Act of 2002   
31.2*   Certification of the Chief Financial Officer of LivaNova PLC pursuant to Section 302 of the Sarbanes-Oxley Act of 2002   
32.1*   Certification of the Chief Executive Officer and Chief Financial Officer of LivaNova PLC pursuant to Section 906 of the Sarbanes-Oxley Act of 2002   
101*Interactive Data Files Pursuant to Rule 405 of Regulation S-T: (i) the Condensed Consolidated Statement of Income (Loss) for the three and nine months ended September 30, 2017 and September 30, 2016, (ii) the Condensed Consolidated Statement of Comprehensive Income for the three and nine months ended September 30, 2017 and September 30, 2016, (iii) the Condensed Consolidated Balance Sheet as of September 30, 2017 and December 31, 2016, (iv) the Condensed Consolidated Statement of Cash Flows for the nine months ended September 30, 2017 and September 30, 2016, and (vi) the Notes to the Condensed Consolidated Financial Statements. Interactive Data Files Pursuant to Rule 405 of Regulation S-T: (i) the Condensed Consolidated Statements of Income for the three and six months ended June 30, 2018 and June 30, 2017, (ii) the Condensed Consolidated Statements of Comprehensive Income for the three and six months ended June 30, 2018 and June 30, 2017, (iii) the Condensed Consolidated Balance Sheet as of June 30, 2018 and December 31, 2017, (iv) the Condensed Consolidated Statements of Cash Flows for the six months ended June 30, 2018 and June 30, 2017, and (vi) the Notes to the Condensed Consolidated Financial Statements.   


SIGNATURE
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
 
 LIVANOVA PLC
   
 By:/s/ DAMIEN MCDONALD
  Damien McDonald
  Chief Executive Officer
  (Principal Executive Officer)
 LIVANOVA PLC
   
 By:/s/ THAD HUSTON
  Thad Huston
  Chief Financial Officer
  (Principal Financial Officer)
Date: NovemberAugust 2, 20172018


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