Shockwave Medical (SWAV) 10-Q 7 Aug 23 2023 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2023	Aug. 02, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2023
Document Transition Report	false
Entity File Number	001-38829
Entity Registrant Name	Shockwave Medical, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	27-0494101
Entity Address, Address Line One	5403 Betsy Ross Drive
Entity Address, City or Town	Santa Clara
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	95054
City Area Code	510
Local Phone Number	279-4262
Title of 12(b) Security	Shockwave Medical, Inc., common stock, par value $0.001 per share
Trading Symbol	SWAV
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		36,750,397
Entity Central Index Key	0001642545
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q2
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
CURRENT ASSETS:
Cash and cash equivalents	$ 141,458	$ 156,586	[1]
Short-term investments	117,131	147,907	[1]
Accounts receivable, net	96,562	71,366	[1]
Inventory	92,093	75,112	[1]
Prepaid expenses and other current assets	9,118	8,292	[1]
Total current assets	456,362	459,263	[1]
Operating lease right-of-use assets	31,117	32,365	[1]
Property and equipment, net	59,803	48,152	[1]
Equity method investment	2,543	3,512	[1]
Intangible assets, net	94,692	0
Goodwill	39,789	0
Deferred tax assets	94,699	97,568
Other assets	7,599	5,229	[1]
TOTAL ASSETS	786,604	646,089	[1]
CURRENT LIABILITIES:
Accounts payable	12,869	6,721	[1]
Accrued liabilities	65,769	55,375	[1]
Lease liability, current portion	1,582	1,278	[1]
Total current liabilities	80,220	63,374	[1]
Lease liability, noncurrent portion	33,205	34,928	[1]
Debt, noncurrent portion	24,266	24,198	[1]
Related party contract liability, noncurrent portion	12,273	12,273	[1]
Deferred tax liabilities	10,421	0
Other liabilities	9,307	0
TOTAL LIABILITIES	169,692	134,773	[1]
STOCKHOLDERS’ EQUITY:
Preferred stock	0	0	[1]
Common stock	37	36	[1]
Additional paid-in capital	586,092	548,960	[1]
Accumulated other comprehensive loss	(391)	(867)	[1]
Retained earnings (accumulated deficit)	31,174	(36,813)	[1]
TOTAL STOCKHOLDERS’ EQUITY	616,912	511,316	[1]
TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY	$ 786,604	$ 646,089	[1]
[1]The condensed consolidated balance sheet as of December 31, 2022 is derived from the audited consolidated financial statements as of that date.

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Revenue:
Product revenue	$ 180,165	$ 120,746	$ 341,231	$ 214,377
Cost of revenue:
Cost of product revenue	24,493	16,730	45,559	29,620
Gross profit	155,672	104,016	295,672	184,757
Operating expenses:
Research and development	36,829	20,760	63,800	37,779
Sales and marketing	56,738	40,515	110,749	76,476
General and administrative	29,731	13,165	48,935	25,554
Total operating expenses	123,298	74,440	223,484	139,809
Income from operations	32,374	29,576	72,188	44,948
Loss from equity method investment	(146)	(1,464)	(969)	(1,511)
Interest expense	(810)	(304)	(1,446)	(601)
Other income (expense), net	1,586	(1,473)	3,968	(1,783)
Net income before taxes	33,004	26,335	73,741	41,053
Income tax expense	4,142	774	5,754	971
Net income	28,862	25,561	67,987	40,082
Other comprehensive income (loss):
Unrealized gain (loss) on available-for-sale securities	(24)	(320)	481	(1,135)
Adjustment for net gain realized and included in other income	0	0	5	0
Total comprehensive income	$ 28,838	$ 25,241	$ 68,463	$ 38,947
Net income per share
Basic (USD per share)	$ 0.79	$ 0.71	$ 1.86	$ 1.12
Diluted (USD per share)	$ 0.76	$ 0.68	$ 1.78	$ 1.06
Denominator:
Basic (in shares)	36,663,327	35,825,947	36,545,948	35,707,301
Diluted (in shares)	38,226,153	37,690,094	38,139,948	37,690,320
Type of Revenue [Extensible List]	Product [Member]	Product [Member]	Product [Member]	Product [Member]
Type of Cost, Good Or Service [Extensible List]	Product [Member]	Product [Member]	Product [Member]	Product [Member]

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total		Common Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Income	Accumulated Deficit
Beginning balance, shares (in shares) at Dec. 31, 2021			35,444,472,000
Beginning balance at Dec. 31, 2021	$ 241,830		$ 35	$ 494,806	$ (202)	$ (252,809)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of stock options (in shares)			54,913,000
Exercise of stock options	391		$ 1	390
Unrealized gain on available-for-sale securities, net of tax	(815)				(815)
Issuance of common stock under employee stock purchase plan (in shares)			14,172,000
Issuance of common stock under employee stock purchase plan	2,135			2,135
Issuance of common stock in connection with vesting of restricted stock (in shares)			210,835,000
Taxes withheld on net settled vesting of restricted stock units (in shares)			(31,000)
Taxes withheld on net settled vesting of restricted stock units	(6)			(6)
Stock-based compensation	9,767			9,767
Net income (loss)	14,521					14,521
Ending balance, shares (in shares) at Mar. 31, 2022			35,724,361,000
Ending balance at Mar. 31, 2022	267,823		$ 36	507,092	(1,017)	(238,288)
Beginning balance, shares (in shares) at Dec. 31, 2021			35,444,472,000
Beginning balance at Dec. 31, 2021	241,830		$ 35	494,806	(202)	(252,809)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adjustment for net gain realized and included in other income	0
Net income (loss)	40,082
Ending balance, shares (in shares) at Jun. 30, 2022			35,907,453,000
Ending balance at Jun. 30, 2022	305,068		$ 36	519,096	(1,337)	(212,727)
Beginning balance, shares (in shares) at Mar. 31, 2022			35,724,361,000
Beginning balance at Mar. 31, 2022	267,823		$ 36	507,092	(1,017)	(238,288)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of stock options (in shares)			111,601,000
Exercise of stock options	500			500
Unrealized gain on available-for-sale securities, net of tax	(320)				(320)
Adjustment for net gain realized and included in other income	0
Issuance of common stock in connection with vesting of restricted stock (in shares)			71,491,000
Stock-based compensation	11,504			11,504
Net income (loss)	25,561					25,561
Ending balance, shares (in shares) at Jun. 30, 2022			35,907,453,000
Ending balance at Jun. 30, 2022	305,068		$ 36	519,096	(1,337)	(212,727)
Beginning balance, shares (in shares) at Dec. 31, 2022			36,235,546,000
Beginning balance at Dec. 31, 2022	511,316	[1]	$ 36	548,960	(867)	(36,813)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of stock options (in shares)			77,230,000
Exercise of stock options	320		$ 1	319
Unrealized gain on available-for-sale securities, net of tax	505				505
Adjustment for net gain realized and included in other income	(5)				(5)
Issuance of common stock under employee stock purchase plan (in shares)			19,124,000
Issuance of common stock under employee stock purchase plan	3,092			3,092
Issuance of common stock in connection with vesting of restricted stock (in shares)			257,624,000
Taxes withheld on net settled vesting of restricted stock units (in shares)			(19,000)
Taxes withheld on net settled vesting of restricted stock units	(3)			(3)
Stock-based compensation	16,337			16,337
Net income (loss)	39,125					39,125
Ending balance, shares (in shares) at Mar. 31, 2023			36,589,505,000
Ending balance at Mar. 31, 2023	570,687		$ 37	568,705	(367)	2,312
Beginning balance, shares (in shares) at Dec. 31, 2022			36,235,546,000
Beginning balance at Dec. 31, 2022	$ 511,316	[1]	$ 36	548,960	(867)	(36,813)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of stock options (in shares)	125,512,000
Adjustment for net gain realized and included in other income	$ (5)
Net income (loss)	67,987
Ending balance, shares (in shares) at Jun. 30, 2023			36,728,617,000
Ending balance at Jun. 30, 2023	616,912		$ 37	586,092	(391)	31,174
Beginning balance, shares (in shares) at Mar. 31, 2023			36,589,505,000
Beginning balance at Mar. 31, 2023	570,687		$ 37	568,705	(367)	2,312
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of stock options (in shares)			48,282,000
Exercise of stock options	403			403
Unrealized gain on available-for-sale securities, net of tax	(24)				(24)
Adjustment for net gain realized and included in other income	0
Issuance of common stock in connection with vesting of restricted stock (in shares)			90,837,000
Taxes withheld on net settled vesting of restricted stock units (in shares)			(7,000)
Taxes withheld on net settled vesting of restricted stock units	(4)			(4)
Stock-based compensation	16,988			16,988
Net income (loss)	28,862					28,862
Ending balance, shares (in shares) at Jun. 30, 2023			36,728,617,000
Ending balance at Jun. 30, 2023	$ 616,912		$ 37	$ 586,092	$ (391)	$ 31,174
[1]The condensed consolidated balance sheet as of December 31, 2022 is derived from the audited consolidated financial statements as of that date.

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income (loss)	$ 67,987	$ 40,082
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	4,274	2,060
Loss from equity method investment	969	1,511
Stock-based compensation	33,013	20,515
Non-cash lease expense	1,561	1,537
Amortization of premium and discount on available-for-sale securities	(1,343)	354
Loss on write down of fixed assets	26	0
Deferred Income Taxes and Tax Credits	1,939	0
Amortization of debt issuance costs	68	310
Foreign currency remeasurement	(773)	1,540
Changes in operating assets and liabilities:
Accounts receivable	(23,563)	(22,477)
Inventory	(15,683)	(16,222)
Prepaid expenses and other current assets	13	(2,774)
Other assets	(3,057)	(430)
Accounts payable	3,991	1,160
Accrued and other current liabilities	6,019	3,942
Lease liabilities	(1,742)	(300)
Net cash provided by operating activities	73,699	30,808
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchase of available-for-sale securities	(55,739)	(52,633)
Proceeds from maturities of available-for-sale securities	88,500	37,923
Purchase of property and equipment	(15,936)	(6,888)
Business combination, net of cash acquired	(94,411)	0
Net cash used in investing activities	(77,586)	(21,598)
CASH FLOWS FROM FINANCING ACTIVITIES:
Payments of taxes withheld on net settled vesting of restricted stock units	(7)	(6)
Proceeds from stock option exercises	723	891
Proceeds from issuance of common stock under employee stock purchase plan	3,092	2,135
Principal payment of debt	(80,000)	0
Proceeds from debt financing	80,000	0
Payment of assumed warrant liability	(16,240)	0
Net cash (used in) provided by financing activities	(12,432)	3,020
Effect of exchange rate changes on cash and cash equivalents	470	(1,526)
Net (decrease) increase in cash, cash equivalents and restricted cash	(15,849)	10,704
Cash, cash equivalents and restricted cash at beginning of period	158,302	90,874
Cash, cash equivalents and restricted cash equivalents at end of period	142,453	101,578
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION:
Interest paid	1,386	292
Income tax paid	4,523	382
NON-CASH INVESTING AND FINANCING ACTIVITIES:
Property and equipment purchases included in accounts payable and accrued liabilities	$ 4,778	$ 5,059

Organization and Basis of Prese

Organization and Basis of Presentation	6 Months Ended
	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Basis of Presentation	Organization and Basis of Presentation Shockwave Medical, Inc. (the “Company”) was incorporated on June 17, 2009. The Company is primarily engaged in the development of Intravascular Lithotripsy (“IVL”) technology for the treatment of calcified plaque in patients with peripheral vascular, coronary vascular and heart valve disease. Built on a balloon catheter platform, the IVL technology uses lithotripsy to disrupt both superficial and deep vascular calcium, while minimizing soft tissue injury, and an integrated angioplasty balloon to dilate blockages at low pressures, restoring blood flow. In 2016, the Company began commercial and manufacturing operations, and began selling catheters based on the IVL technology. The Company is headquartered in Santa Clara, California and operates primarily in the United States. The unaudited condensed financial statements include the accounts of Shockwave Medical, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation. As of June 30, 2023, the Company had cash, cash equivalents and short-term investments of $258.6 million, w hich are available to fund future working capital requirements, investments, acquisitions, or repayments of credit facilities. The Company believes that its cash, cash equivalents, and short-term investments as of June 30, 2023, will be sufficient for the Company to continue as a going concern for at least 12 months from the date these unaudited condensed consolidated financial statements are filed with the Securities and Exchange Commission (“SEC”). The Company’s future capital requirements will depend on many factors, including its growth rate, the timing and extent of its spending to support research and development activities, and the timing and cost of establishing additional sales and marketing capabilities and the scope. Risk and Uncertainties The Company is subject to continuing risks and uncertainties in connection with the current macroeconomic environment, including inflation, rising interest rates, the federal budget and instability in the global banking system, geopolitical factors, including the ongoing conflict between Russia and Ukraine and the responses thereto, and supply chain disruptions. The Company is closely monitoring the impact of these factors on all aspects of its business, including the impacts on its customers, patients, employees, suppliers, vendors, business partners and distribution channels. In particular, while the Company has not experienced material disruptions in its supply chain to date, the Company has been and continues to be impacted by disruptions in the operations of certain of its third-party suppliers, resulting in increased lead-times, higher component costs and lower allocations for the purchase of some components. In certain cases, the Company has incurred higher logistical expenses. The Company is continuing to work closely with its manufacturing partners and suppliers to source key components and maintain appropriate inventory levels to meet customer demand. The Company’s future results of operations and liquidity could be adversely impacted by a variety of factors, including those discussed in the section titled “Risk Factors” of the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 , filed with the SEC on February 27, 2023 (the “2022 Annual Report”), together with any updates in the section titled “Risk Factors” of the Quarterly Report on Form 10-Q for the quarter ended March 31, 2023 and in this Quarterly Report on Form 10-Q. As of the date of issuance of these condensed consolidated financial statements, the extent to which the current macroeconomic environment may materially impact the Company’s financial condition, liquidity, or results of operations remains uncertain.

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) and applicable rules and regulations of the SEC regarding interim financial reporting. The unaudited interim condensed consolidated financial statements have been prepared on the same basis as the annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary to present fairly the Company’s consolidated financial position, results of operations and cash flows. The results of operations for the three and six months ended June 30, 2023 are not necessarily indicative of the results to be expected for the year ending December 31, 2023 or for any other future annual or interim period. The condensed consolidated balance sheet as of December 31, 2022 included herein was derived from the audited financial statements as of that date. The unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements and related notes included in the 2022 Annual Report. Cash, Cash Equivalents, and Restricted Cash The Company considers all highly liquid investments purchased with original maturities of three months or less from the purchase date to be cash equivalents. Cash equivalents consist primarily of amounts invested in money market accounts. The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the condensed consolidated statements of cash flows: June 30, June 30, (in thousands) Cash and cash equivalents $ 141,458 $ 99,913 Restricted cash 995 1,665 Total cash, cash equivalents, and restricted cash $ 142,453 $ 101,578 Restricted cash as of June 30, 2023 and December 31, 2022 relates to corporate credit card security, customer bank guarantee security, and letters of credit established for the real property leases relating to the Company’s office buildings, and is recorded as other assets on the condensed consolidated balance sheets. Equity Method Investments Entities for which the Company has significant influence over the activities of the entity, but does not control, are accounted for under the equity method of accounting in accordance with Topic 323, Investments - Equity Method and Joint Ventures . The Company’s carrying value in the equity method investment is reported as equity method investment on the Company’s consolidated balance sheets. The Company records its proportionate share of the underlying income or loss which is recognized in earnings or loss from the equity method investment. T he Company eliminates a portion of intra-entity profit to the extent the goods sold by the Company have not yet been sold through by the equity method investee to an end customer at the end of the reporting period. The profit earned by the Company from the equity method investee for items not yet sold through is eliminated through equity method earnings or loss which is recognized in income (loss) from equity method investment. The Company assesses its equity method investment for impairment when events or circumstances suggest that the carrying amount of the investment may be impaired. The Company considers all available evidence in assessing whether a decline in fair value is other than temporary. If the decline in fair value is determined to be other than temporary, the difference between the carrying amount of the investment and estimated fair value is recognized as an impairment charge. Revenue To determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, Revenue from Contracts with Customers , the Company performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. Product Revenue The Company records product revenue primarily from the sale of its IVL catheters. The Company sells its products to hospitals, primarily through direct sales representatives, as well as through distributors in selected international markets. Additionally, a portion of the Company’s revenue is generated through a consignment model under which inventory is maintained at hospitals. Product revenue is recognized when a customer obtains control of promised goods or services, in an amount that reflects the consideration which the entity expects to receive in exchange for those goods or services. For products sold through direct sales representatives, control is transferred upon delivery to customers. For products sold to distributors internationally and products sold to customers that utilize stocking orders, control is transferred upon shipment or delivery to the customer’s named location, based on the contractual shipping terms. For consignment inventory, control is transferred at the time the IVL catheters are consumed in a procedure. The Company has elected to account for shipping and handling activities that occur after the customer has obtained control as a fulfillment activity, and not a separate performance obligation. The Company may provide for the use of an IVL generator and connector cable under an agreement to customers at no charge to facilitate use of the IVL catheters. These agreements generally do not contain contractually enforceable minimum commitments and are generally cancellable by either party with 30 days ’ notice. License Revenue For arrangements that contain a license of the Company’s functional intellectual property with a customer, the Company considers whether the license grant is distinct from other performance obligations in the arrangement. A license grant of functional intellectual property is generally considered to be capable of being distinct if a customer can benefit from the license on its own or together with other readily available resources. License revenue for licenses of functional intellectual property is recognized at a point in time when the Company satisfies its performance obligation of transferring the license to the customer. Consideration received in advance of the satisfaction of a performance obligation is recognized as a contract liability. No license revenues were recognized for the three and six months ended June 30, 2023. Stock-Based Compensation The Company accounts for share-based payments at fair value. The fair value of stock options is measured using the Black-Scholes option-pricing model. For share-based awards that vest subject to the satisfaction of a service requirement, the fair value measurement date for stock-based compensation awards is the date of grant and the expense is recognized on a straight-line basis, over the vesting period. For share-based awards that vest upon the satisfaction of a performance target, the related compensation cost is recognized over the requisite service period based on the expected achievement of the performance target. The Company accounts for forfeitures as they occur. Business combinations The Company applies the provisions of ASC 805, Business Combinations , in accounting of its acquisitions. ASC 805 requires recognition of assets acquired, liabilities assumed, and contingent consideration at their fair value on the acquisition date with subsequent changes recognized in earnings; requires acquisition-related expenses to be recognized separately from the business combination and expensed as incurred; requires in-process research and development to be capitalized at fair value as an indefinite-lived intangible asset until completion or abandonment; and requires that changes in accounting for deferred tax asset valuation allowances and acquired uncertain tax positions after the measurement period be recognized as a component of provision for taxes. When an integrated set of assets and activities does not meet the practical screen test and otherwise meets the definition of a “business” under ASC 805, the Company accounts for such acquisitions as business combinations. The purchase price of an acquisition is allocated to the tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values as of the acquisition date. The Company bases the estimated fair value of identifiable intangible assets acquired in an acquisition on independent third-party valuations that use information and assumptions provided by the Company's management and considers inputs and assumptions that a market participant would use. Any excess purchase price over the estimated fair values of the assets acquired and liabilities assumed is recorded as goodwill. During the measurement period, which may be up to one year from the acquisition date, the Company may record adjustments to the provisional amounts of assets acquired and liabilities assumed with the corresponding offset to goodwill. Upon the conclusion of the measurement period or final determination of the values of assets acquired or liabilities assumed, whichever comes first, any subsequent adjustments would be recorded in earnings. In addition, uncertain tax positions and tax related valuation allowances assumed in a business combination are initially estimated as of the acquisition date and therefore are also provisional by nature. The Company reevaluates these items quarterly based upon facts and circumstances that existed as of the acquisition date with any adjustments to its preliminary estimates being recorded to goodwill if identified within the measurement period. Goodwill In accordance with ASC 350, Intangibles-Goodwill and Other , the acquired goodwill is not amortized but is tested for impairment on an annual basis or whenever events or changes in circumstances indicate that the carrying amount of these assets may not be recoverable. The Company performs annual impairment reviews of its goodwill balance during the fourth fiscal quarter or more frequently if business factors indicate. In testing for impairment, the Company compares the fair value of its reporting unit to its carrying value including the goodwill of that unit. If the carrying value, including goodwill, exceeds the reporting unit’s fair value, the Company will recognize an impairment loss for the amount by which the carrying amount exceeds the reporting unit’s fair value. The loss recognized cannot exceed the total amount of goodwill allocated to that reporting unit. The Company did not incur any goodwill impairment losses during the six months ended June 30, 2023. In-process research and development Intangible assets related to in-process research and development costs (“IPR&D”) are considered indefinite-lived intangible assets until the completion or abandonment of the associated research and development efforts. If and when development is complete, the associated assets would be deemed finite-lived intangible assets and would then be amortized based on their respective estimated useful lives at that point in time. Prior to the completion or abandonment of the associated research and development efforts, the assets are not amortized but are tested for impairment on an annual basis and between annual tests if the Company becomes aware of any events occurring or changes in circumstances that would indicate a reduction in the fair value of the IPR&D projects below their respective carrying amounts. During the fourth fiscal quarter and if business factors indicate more frequently, the Company performs an assessment of the qualitative factors affecting the fair value of its IPR&D projects. If the fair value exceeds the carrying value, there is no impairment. Impairment losses on indefinite-lived intangible assets are recognized based solely on a comparison of the fair value of an asset to its carrying value, without consideration of any recoverability test. Intangible assets Amortizable intangible assets include customer relationships and developed technology acquired as part of the business combination. Customer relationships and developed technology acquired through business combinations subject to amortization are amortized using the straight-line method over their estimated useful lives ranging from five to 20 years. All intangible assets subject to amortization are reviewed for impairment during the fourth fiscal quarter or more frequently if business factors indicate in accordance with Topic 360, Property, Plant and Equipment . Contingent Consideration Liabilities Related to Business Combination At each reporting period, the Company evaluates the likelihood of any expected future payments and the associated discount rate to determine the fair value of the contingent consideration. The Company remeasures the fair value of contingent consideration liabilities each reporting period, based on new developments, and records any necessary adjustments as a component of total operating expenses within the condensed consolidated statements of operations until either the contingent consideration obligation is satisfied through payment upon the achievement of, or the obligation no longer exists due to the failure to achieve, the specified milestones. Contingent consideration liabilities are recorded within other liabilities in the condensed consolidated balance sheets.

Financial Instruments and Fair

Financial Instruments and Fair Value Measurements	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Financial Instruments and Fair Value Measurements	Financial Instruments and Fair Value Measurements The following tables summarize the Company’s financial assets measured at fair value on a recurring basis by level within the fair value hierarchy: June 30, 2023 Level 1 Level 2 Level 3 Total (in thousands) Assets: U.S. Treasury securities $ 55,390 $ — $ — $ 55,390 Money market funds 30,129 — — 30,129 Commercial paper — 30,137 — 30,137 Corporate bonds — 12,121 — 12,121 U.S. agency securities — 13,779 — 13,779 Asset-backed securities — 5,704 — 5,704 Total assets $ 85,519 $ 61,741 $ — $ 147,260 Liabilities: Contingent consideration liability $ — $ — $ 9,307 $ 9,307 Total liabilities $ — $ — $ 9,307 $ 9,307 December 31, 2022 Level 1 Level 2 Level 3 Total (in thousands) Assets: U.S. Treasury securities $ 111,631 $ — $ — $ 111,631 Money market funds 12,076 — — 12,076 Commercial paper — 8,039 — 8,039 Corporate bonds — 18,808 — 18,808 U.S. agency securities — 9,429 — 9,429 Total assets $ 123,707 $ 36,276 $ — $ 159,983 Contingent Consideration Liabilities Related to Business Combination In connection with the acquisition of Neovasc Inc. (“Neovasc”), preliminary fair value of $9.3 million was recorded for the Neovasc contingent consideration on April 11, 2023, to which there were no changes in the estimated fair value as of June 30, 2023. See Note 5 “Business Combination” for information regarding existing contingent consideration liabilities as of June 30, 2023.

Cash Equivalents and Short-Term

Cash Equivalents and Short-Term Investments	6 Months Ended
	Jun. 30, 2023
Cash and Cash Equivalents [Abstract]
Cash Equivalents and Short-Term Investments	4. Cash Equivalents and Short-Term Investments The following is a summary of the Company’s cash equivalents and short-term investments: June 30, 2023 Amortized Unrealized Unrealized Fair Value (in thousands) U.S. Treasury securities $ 55,662 $ — $ (272) $ 55,390 Money market funds 30,129 — — 30,129 Commercial paper 30,263 — (126) 30,137 Corporate bonds 12,135 12 (26) 12,121 U.S. agency securities 13,868 — (89) 13,779 Asset-backed securities 5,720 — (16) 5,704 Total $ 147,777 $ 12 $ (529) $ 147,260 Reported as: Cash equivalents $ 30,129 Short-term investments 117,131 Total $ 147,260 December 31, 2022 Amortized Unrealized Unrealized Fair Value (in thousands) U.S. Treasury securities $ 112,719 $ 3 $ (1,091) $ 111,631 Money market funds 12,076 — — 12,076 Commercial paper 8,039 — — 8,039 Corporate bonds 18,876 8 (76) 18,808 U.S. agency securities 9,432 4 (7) 9,429 Total $ 161,142 $ 15 $ (1,174) $ 159,983 Reported as: Cash equivalents $ 12,076 Short-term investments 147,907 Total $ 159,983 There were $105.2 million and $123.8 million of investments in unrealized loss positions of $0.5 million and $1.2 million as of June 30, 2023 and December 31, 2022, respectively. During the three and six months ended June 30, 2023 and 2022, the Company did not record any other-than-temporary impairment charges on its available-for-sale securities. Based on the Company’s procedures under the expected credit loss model, including an assessment of unrealized losses on the portfolio, the Company concluded that the unrealized losses for its marketable securities were not attributable to credit and therefore an allowance for credit losses for these securities has not been recorded as of June 30, 2023 and December 31, 2022. Also, based on the scheduled maturities of the investments, the Company was more likely than not to hold these investments for a period of time sufficient for a recovery of the Company’s cost basis. The remaining contractual maturities of the Company’s cash equivalents and short-term investments were as follows: June 30, Fair Value (in thousands) Money market funds $ 30,129 One year or less 96,512 Greater than one year and less than two years 20,619 Total $ 147,260

Balance Sheet Components

Balance Sheet Components	6 Months Ended
	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Balance Sheet Components	Balance Sheet Components Inventory Inventory consists of the following: June 30, December 31, (in thousands) Raw materials $ 22,664 $ 18,456 Work in progress 17,465 7,666 Finished goods 51,458 48,735 Consigned inventory 506 255 Total inventory $ 92,093 $ 75,112 Accrued Liabilities Accrued liabilities consist of the following: June 30, December 31, (in thousands) Employee compensation $ 32,931 $ 32,885 Research and development costs 6,404 4,007 Asset purchases 4,820 4,600 Professional services 9,602 4,044 Excise, sales, income and other taxes 3,548 4,036 Other 8,464 5,803 Total accrued liabilities $ 65,769 $ 55,375

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Operating Leases The Company’s operating leases consist of leased facilities for the Company’s headquarter offices, leased facilities for Neovasc, and leased facilities for laboratory and manufacturing space. Also included in operating leases are leases for vehicles, for use by certain employees of the Company, which were not material for the periods presented. Short-term leases are leases having a term of 12 months or less. The Company recognizes short-term leases on a straight-line basis and does not record a related lease asset or liability for such leases. As of June 30, 2023, the Company has no material finance leases. In September 2021, the Company entered into an office lease agreement (“3003 Bunker Hill Lease”) for the 3003 Bunker Hill facility which expires in December 2031. Concurrently, the Company entered into an Amendment to Office Lease (Net) (the “First Lease Amendment”) which extended the lease terms of the 5353 Betsy Ross and 5403 Betsy Ross facilities to December 2031. The 5403 Betsy Ross lease (“5403 Lease”) continued in its existing terms (and with no changes to its terms, including its base rent) until its expiration in August 2022, at which point the leased space under the 5403 Lease became subject to the terms of the First Lease Amendment. The 3003 Bunker Hill Lease and the First Lease Amendment contain options to extend the lease term at the respective facilities for up to two additional five-year terms at the then fair market rate. As of June 30, 2023, the Company is not reasonably certain it will exercise these extension options. Additionally, included in the First Lease Amendment was an expansion option that stipulated that the Company had an option to lease the space in the adjacent building located at 5303 Betsy Ross (“5303 Lease”). The Company exercised this expansion option by entering into a Second Amendment to Office Lease (Net) (the “Second Lease Amendment”) on May 26, 2023. The 5303 Lease will commence on February 1, 2024 and will expire on December 31, 2031. The Company recognizes rent expense for these operating leases on a straight-line basis over the lease period. The components of lease costs, which the Company includes in operating expenses in the condensed consolidated statements of operations and comprehensive income, were as follows: Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) Operating lease cost $ 1,217 $ 1,142 $ 2,428 $ 2,283 Variable lease cost 288 121 588 242 Total lease cost $ 1,506 $ 1,263 $ 3,017 $ 2,526 During the three months ended June 30, 2023 and 2022, the Company recorded operating lease cost of $1.2 million and $1.1 million, respectively, and paid $1.4 million and $0.6 million of operating lease payments, respectively, related to the lease liabilities. During the six months ended June 30, 2023 and 2022, the Company recorded operating lease cost of $2.4 million and $2.3 million, respectively, and paid $2.7 million and $1.0 million of operating lease payments, respectively, related to the lease liabilities. The Company includes operating lease payments in net cash used in operating activities in the condensed consolidated statements of cash flows. The weighted average remaining lease term and discount rate used to measure the Company’s operating lease liabilities were 8.5 years and 5.3%, respectively. The Company estimated the discount rate using the incremental borrowing rate as the rate implicit in the lease was not readily determinable. As of June 30, 2023, the maturities of the payments due under the Company’s operating lease liabilities were as follows: Years ending December 31, (in thousands) 2023 (remainder) $ 2,768 2024 5,517 2025 5,526 2026 5,690 2027 5,832 Thereafter 24,957 Total minimum lease payments $ 50,290 Less: imputed interest (9,835) Less: Lease incentive (5,668) Total lease liability $ 34,787 Less: current portion (1,582) Lease liability, noncurrent portion $ 33,205

Term Notes

Term Notes	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Term Notes	9. Debt On October 19, 2022, the Company entered into a Credit Agreement (the “Credit Agreement”) with Wells Fargo Bank, National Association, as administrative agent, Wells Fargo Bank, National Association, as swingline lender and an issuing lender, Wells Fargo Securities, LLC and Silicon Valley Bank, as joint lead arrangers and joint bookrunners, Silicon Valley Bank, as syndication agent, and the several lenders party thereto. The Credit Agreement provides for a revolving credit facility in an aggregate principal amount of $175 million with the right to request increases to the revolving commitments (subject to certain conditions) of up to the greater of (x) $100 million or (y) the Company’s consolidated EBITDA for the four fiscal quarter period most recently ended prior to the date of such increase. Concurrent with entering into the Credit Agreement, the Company drew down $25.0 million. On March 16, 2023, the Company drew down an additional $80.0 million under the Credit Agreement. On April 26, 2023, the Company repaid the $80.0 million drawn under the Credit Agreement in March 2023. The revolving credit facility accrues for interest, at the election of the Company, at (A) the Base Rate (as defined below) plus a margin ranging from 0% to 1% depending on the Company's Consolidated Total Net Leverage Ratio (as defined in the Credit Agreement) (which rate is currently 0%) or (B) the applicable secured overnight financing rate (“SOFR”) plus a margin from 1% to 2%, depending on the Company's Consolidated Total Net Leverage Ratio (which rate is currently 1%). Base Rate means, at any time, the highest of (a) the Wells Fargo Bank, National Association's announced prime rate, (b) the federal funds rate plus 0.5% and (c) Term SOFR for a one-month tenor in effect on such day plus 1%. The Credit Agreement matures on October 19, 2027. The interest rate was 6.1% as of June 30, 2023. The Company recorded interest expense of $0.8 million and $0.3 million for the three months ended June 30, 2023 and 2022, respectively. The Company recorded interest expense of $1.4 million and $0.6 million for the six months ended June 30, 2023 and 2022, respectively. Debt and debt issuance costs are as follows: June 30, December 31, (in thousands) Principal amount of debt $ 25,000 $ 25,000 Discount associated with debt issuance costs (734) (802) Debt 24,266 24,198 Less: debt, current portion — — Debt, noncurrent portion $ 24,266 $ 24,198

Stock-Based Compensation

Stock-Based Compensation	6 Months Ended
	Jun. 30, 2023
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	Stock-Based Compensation Total stock-based compensation was as follows: Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) Cost of product revenue $ 1,374 $ 518 $ 2,328 $ 1,171 Research and development 3,876 2,476 7,671 4,714 Sales and marketing 6,593 4,408 13,059 8,340 General and administrative 5,203 3,603 9,955 6,290 Total stock-based compensation $ 17,046 $ 11,005 $ 33,013 $ 20,515 Stock-based compensation of nil and $0.5 million was capitalized into inventory for the three months ended June 30, 2023 and 2022, respectively. Stock-based compensation of $0.3 million and $0.8 million was capitalized into inventory for the six months ended June 30, 2023 and 2022, respectively. Stock-based compensation capitalized into inventory is recognized as cost of product revenue when the related product is sold. 2009 Equity Incentive Plan and 2019 Equity Incentive Plan On June 17, 2009, the Company adopted the 2009 Equity Incentive Plan (the “2009 Plan”) under which the Company's Board of Directors (the “Board”) had the authority to issue stock options to employees, directors and consultants. In February 2019, the Company adopted the 2019 Equity Incentive Plan (the “2019 Plan”), which became effective in connection with the Company's initial public offering (the “IPO”). As a result, effective as of March 6, 2019, the Company may not grant any additional awards under the 2009 Plan. The 2009 Plan will continue to govern outstanding equity awards granted thereunder. The Company initially reserved 2,000,430 shares of common stock for the issuance of a variety of awards under the 2019 Plan, including stock options, stock appreciation rights, awards of restricted stock and awards of restricted stock units (“RSUs”). In addition, the number of shares of common stock reserved for issuance under the 2019 Plan will automatically increase on the first day of January for a period of up to ten years, which commenced on January 1, 2020, in an amount equal to 3% of the total number of shares of the Company’s capital stock outstanding on the last day of the preceding year, or a lesser number of shares determined by the Board. As of June 30, 2023, there were 3,695,216 shares available for issuance under the 2019 Plan. Stock Options Option activity under the 2009 Plan and 2019 Plan is set forth below: Number Weighted- Weighted- Aggregate (in years) (in thousands) Balance, December 31, 2022 1,122,009 $ 5.87 4.60 $ 224,115 Options exercised (125,512) 5.75 Options cancelled (6,133) 2.41 Balance, June 30, 2023 990,364 $ 5.90 4.13 $ 276,815 Vested and exercisable, 990,364 $ 5.90 4.13 $ 276,815 Vested and expected to vest, 990,364 $ 5.90 4.13 $ 276,815 Restricted Stock Units RSUs are share awards that entitle the holder to receive freely tradable shares of the Company’s common stock upon vesting. RSUs cannot be transferred and the awards are subject to forfeiture if the holder’s employment terminates prior to the release of the vesting restrictions. RSUs generally vest over a four-year period with straight-line quarterly vesting with a one year cliff or straight-line annual vesting, provided the employee remains continuously employed with the Company. The fair value of RSUs is equal to the closing price of the Company’s common stock on the grant date. In February 2022 and 2023, the Company granted performance-based restricted stock units (“PRSUs”) to certain key executives. The vesting of these PRSUs is dependent on the achievement of certain performance targets related to the Company’s compound annual growth rate of revenue over a two three RSU and PRSU activity under the 2019 Plan is set forth below. Grant activity for all PRSUs is disclosed at target (100%): Restricted Stock Units Performance-Based Restricted Stock Units Number Weighted- Number Weighted- Balance, December 31, 2022 1,125,991 $ 127.39 38,797 165.74 RSUs and PRSUs granted 397,217 215.03 29,473 191.36 RSUs and PRSUs forfeited (54,104) 157.04 (175) 278.52 RSUs and PRSUs vested (348,461) 99.82 — — Balance, June 30, 2023 1,120,643 165.59 68,095 176.54 Employee Stock Purchase Plan In February 2019, the Company adopted the 2019 Employee Stock Purchase Plan (“ESPP”), which became effective in connection with the IPO on March 6, 2019. The Company initially reserved 300,650 shares of common stock for purchase under the ESPP. Each offering under the ESPP to Company employees to purchase stock under the ESPP begins on each September 1 and March 1 and ends on the following February 28 or 29 and August 31, respectively. On each purchase date, which falls on the last date of each offering period, ESPP participants will purchase shares of common stock at a price per share equal to 85% of the lesser of (1) the fair market value per share of the common stock on the offering date or (2) the fair market value of the common stock on the purchase date. The occurrence and duration of offering periods under the ESPP are subject to the determinations of the Company’s Compensation Committee of the Board, in its sole discretion. The fair value of the ESPP shares is estimated using the Black-Scholes option pricing model. The Company recorded $0.6 million and $0.4 million of stock-based compensation expense related to the ESPP for the three months ended June 30, 2023 and 2022, respectively. The Company recorded $1.9 million and $0.8 million of stock-based compensation expense related to the ESPP for the six months ended June 30, 2023 and 2022, respectively. At June 30, 2023, a total of 1,540,527 shares were available for issuance under the ESPP.

Net Income (Loss) Per Share

Net Income (Loss) Per Share	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Net Income (Loss) Per Share	Net Income Per Share The components of basic and diluted net income (loss) per share were as follows (in thousands, except share and per share amounts): Three Months Ended Six Months Ended 2023 2022 2023 2022 Numerator: Net income $ 28,862 $ 25,561 $ 67,987 $ 40,082 Denominator: Basic: Weighted average number of common shares outstanding - basic 36,663,327 35,825,947 36,545,948 35,707,301 Diluted: Weighted average number of common shares outstanding - basic 36,663,327 35,825,947 36,545,948 35,707,301 Dilutive effect of outstanding common stock options 991,442 1,353,081 1,016,497 1,395,427 Dilutive effect of restricted stock units 564,697 511,046 572,888 587,097 Dilutive effect of common stock pursuant to employee stock purchase plan 6,687 20 4,615 495 Weighted average number of common shares outstanding - diluted 38,226,153 37,690,094 38,139,948 37,690,320 Net income per share: Basic $ 0.79 $ 0.71 $ 1.86 $ 1.12 Diluted $ 0.76 $ 0.68 $ 1.78 $ 1.06

Revenue

Revenue	6 Months Ended
	Jun. 30, 2023
Disaggregation of Revenue [Abstract]
Revenue	Revenue The following table represents the Company’s product revenue based on product line: Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) Coronary $ 125,777 $ 87,828 $ 239,652 $ 158,165 Peripheral 52,262 31,886 98,392 54,738 Reducer 1,231 — 1,231 — Other 895 1,032 1,956 1,474 Product revenue $ 180,165 $ 120,746 $ 341,231 $ 214,377 Coronary product revenue encompasses sales of the Company’s C 2 catheter and C 2+ catheter. Peripheral product revenue encompasses sales of the Company’s M 5 catheter, M 5+ catheter, S 4 catheter, and L 6 catheter. Reducer revenue encompasses sales of the Company’s Reducer product, which was acquired through the Neovasc acquisition. Other product revenue encompasses sales of the Company’s generators and related accessories. The following table represents the Company’s product revenue based on the location to which the product is shipped: Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) United States $ 144,941 $ 100,096 $ 276,564 $ 178,615 Europe 18,915 13,394 35,149 25,461 All other countries 16,309 7,256 29,518 10,301 Product revenue $ 180,165 $ 120,746 $ 341,231 $ 214,377

Equity Method Investments

Equity Method Investments	6 Months Ended
	Jun. 30, 2023
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments	13. Equity Method Investments Genesis Shockwave Private Limited On March 19, 2021, the Company entered into the Joint Venture Deed (or “JV Agreement”) with Genesis MedTech International Private Limited (“Genesis”) to establish a long-term strategic partnership to develop, manufacture and commercialize certain of the Company’s interventional products in the People’s Republic of China, excluding Taiwan and the Special Administrative Regions of Hong Kong and Macau (the “PRC”). Under the JV Agreement, Genesis Shockwave Private Ltd. (the “JV”) was formed under the laws of Singapore to serve as a joint venture of Genesis and the Company for the purpose of establishing and managing the strategic partnership. On the same date, Genesis and the Company entered into a Share Subscription Agreement pursuant to which, among other things, the JV issued (i) 54,900 ordinary shares, which represents 55% of the total equity of the JV, to Genesis in exchange for a cash contribution of $15.0 million, of which 50% was due upon signing and the remaining 50% was due within one year of signing, and (ii) 45,000 ordinary shares, which represents 45% of the total equity of the JV, to the Company as consideration for the Shockwave License Agreement (the “License Agreement”). Under the License Agreement, the Company has agreed to contribute to the JV an exclusive license under certain of the Company’s intellectual property rights to develop, manufacture, distribute and commercialize certain products in the PRC and is entitled to receive royalties on the sales of the licensed products in the PRC. Further, the Company entered into a Distribution Agreement, pursuant to which the Company has agreed to sell certain Company-manufactured products to the JV or a PRC subsidiary of the JV for commercialization and distribution in the PRC. In May 2022, the JV obtained regulatory approval from the China National Medical Products Administration to sell the Company-manufactured Shockwave IVL System with the Company's C 2 catheter, M 5 catheter, and S 4 catheter in the PRC. The Company has accounted for its investment in the JV under the equity method of accounting. As of June 30, 2023, the carrying value of the Company’s investment in the JV was $2.5 million and the Company owned a 45% interest in the entity. During the three and six months ended June 30, 2023, the Company continued to recognize product revenue on sales to the JV and eliminate a portion of intra-entity profit to the extent the goods have not yet either been consumed by the JV for use in clinical trials, or sold by the JV to an end customer at the end of the reporting period. The profit earned by the Company from the JV for items not yet sold through to an end customer is eliminated through equity method earnings or loss which is recognized in income (loss) from equity method investment. The Company’s product revenue for products sold to the JV during the three and six months ended June 30, 2023 and related accounts receivable from the JV as of June 30, 2023 were immaterial. Intra-entity profit, which was recorded as a reduction to equity method investment as of and for the three and six months ended June 30, 2023 was also immaterial. For the three months June 30, 2023 and 2022, the Company’s loss from the equity method was $0.1 million and $1.5 million, respectively. For the six months ended June 30, 2023 and 2022, the Company’s loss from the equity method was $1.0 million and $1.5 million, respectively. Upon execution of the License Agreement, on March 19, 2021, the Company received a 45% equity stake in the JV. The Company determined that the JV met the definition of a customer under Topic 606, and that the promised goods and services of the contribution of the license of intellectual property and associated manufacturing technology transfer to the

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2023
Income Tax Disclosure [Abstract]
Income Tax Disclosure	14. Income Taxes On a quarterly basis, the Company provides for income taxes based upon an estimated annual effective income tax rate, adjusted for discrete items. The Company recognized income tax expense of $4.1 million and $0.8 million for the three months ended June 30, 2023 and 2022, respectively, representing an effective tax rate of 12.55% and 2.94%, respectively. The Company recognized income tax expense of $5.8 million and $1.0 million for the six months ended June 30, 2023 and 2022, respectively, representing an effective tax rate of 7.80% and 2.37%, respectively. The year-over-year increase in tax expense for the three and six month periods ended June 30, 2023 was primarily due to the valuation allowance on the U.S. federal and other-than-California state deferred tax assets as of June 30, 2023, which was released in the fourth quarter of fiscal year 2022. For the three months ended June 30, 2023, the effective tax rate differed from the U.S. federal statutory rate primarily due to stock-based compensation for tax purposes. For the three months ended June 30, 2022, the effective tax rate differed from the U.S. federal statutory rate primarily due to the valuation allowance on the U.S. deferred tax assets. For the six months ended June 30, 2023, the effective tax rate differed from the U.S. federal statutory rate primarily due to stock-based compensation for tax purposes. For the six months ended June 30, 2022, the effective tax rate differed from the U.S. federal statutory rate primarily due to the valuation allowance on the U.S. deferred tax assets. The Company’s effective tax rate may be subject to fluctuation due to several factors, including the Company’s ability to accurately predict the pre-tax earnings in the various jurisdictions, valuation allowances against deferred tax assets, the recognition or de-recognition of tax benefits related to uncertain tax positions and the effects of tax law changes. During the fourth quarter of 2022, the Company determined that the positive evidence overcame any negative evidence, primarily due to the Company’s transition from a cumulative loss in recent years to cumulative income in 2022 and concluded that it was more likely than not that the U.S. federal and other-than-California state deferred tax assets were realizable. As a result, the Company released the valuation allowance against all of the U.S. federal deferred tax assets and other-than-California state deferred tax assets during the fourth quarter of fiscal year 2022.

Business Combination

Business Combination	6 Months Ended
	Jun. 30, 2023
Business Combination and Asset Acquisition [Abstract]
Business Combination	5. Business Combination Neovasc Inc. On January 16, 2023, the Company entered into a definitive agreement to acquire Neovasc, a company focused on the minimally invasive treatment of refractory angina. On April 11, 2023, the closing conditions were met and the transaction was consummated. Upon the closing of the transaction, the Company acquired all of Neovasc’s issued and outstanding common stock equity for a cash payment of $27.25 per share. During the three and six months ended June 30, 2023, the Company incurred $2.6 million and $4.9 million of buyer related transaction costs related to the acquisition of Neovasc, which was recorded as general and administrative expenses. The purchase price consideration for the acquisition totaled $121.4 million, which was comprised of cash paid of $112.1 million to the selling shareholders, and the estimated fair value of the contingent consideration liability in the amount of $9.3 million. The contingent consideration liability consisted of estimated amounts in relation to a contingent value right (a “CVR”) entitling the holders of Neovasc common stock and eligible equity awards to receive an additional cash payment of up to $12.00 per share or per share underlying an eligible equity award (equivalent to a maximum cash payment of $47.0 million) contingent on the attainment of a milestone. The milestone is defined as the grant by the United States Food and Drug Administration's final approval of the premarket approval application for Neovasc’s coronary sinus reducer (“Reducer”) product for the treatment of angina. The milestone achievement timeline and respective payment per share ranges from $12.00 per CVR if the milestone is achieved on or prior to June 30, 2026, $8.00 per CVR if the milestone is achieved between July 1, 2026 and December 31, 2026 and $4.00 per CVR if the milestone is achieved between January 1, 2027 and December 31, 2027. The Company estimated the fair value of the contingent consideration liability using the probability-weighted discounted cash flow method based on the probability of achieving the milestone on each specified milestone date and consequently calculated the fair value of the CVR in the amount of $9.3 million as of the acquisition date. The material factors that may impact the fair value of the contingent consideration are (i) the number of diluted shares outstanding as of the acquisition date that are eligible for the CVR, (ii) the probabilities and timing of achievement of the milestone, and (iii) discount rates, all of which are unobservable Level 3 inputs not supported by market activity. Significant changes in any of these inputs may result in a significant change in fair value, which is estimated at each reporting date with changes reflected as general and administrative expense. The following table summarizes the purchase price consideration for Neovasc: Purchase Price (in thousands) Cash transferred $ 112,129 Contingent consideration liability 9,307 Total $ 121,436 Assets acquired and liabilities assumed are recorded based on valuations derived from estimated fair value assessments and Level 3 inputs and assumptions used by the Company. While the Company believes that its estimates and assumptions underlying the valuations are reasonable, different estimates and assumptions could result in different valuations assigned to the individual assets acquired and liabilities assumed, and the residual amount of goodwill. The following table summarizes the preliminary fair values of assets acquired and liabilities assumed through the Company's Neovasc acquisition at the acquisition date based on management’s best estimates and assumptions as of the reporting date: Purchase Price (in thousands) Cash and cash equivalents $ 17,273 Accounts receivable, net 1,345 Inventory 918 Prepaid expenses and other current assets 841 Operating lease right-of-use assets 310 Property and equipment 156 Intangible assets 95,500 Other assets 502 Total identifiable assets acquired 116,845 Accounts payable 3,334 Accrued liabilities 4,082 Lease liability, current portion 253 Lease liability, noncurrent portion 64 Deferred tax liabilities 11,185 Other liabilities 16,280 Total liabilities assumed 35,198 Net identifiable assets acquired 81,647 Goodwill 39,789 Total purchase price $ 121,436 The purchase price allocation for the acquisition is preliminary and subject to revision as additional information about fair value of assets acquired and liabilities assumed becomes available, primarily related to the Company’s deferred tax liability and the related impact to goodwill. Additional information that existed as of the acquisition date but at the time was unknown to the Company may become known to the Company during the remainder of the measurement period, a period not to exceed 12 months from the acquisition date. The Company measured the identifiable assets and liabilities assumed at their acquisition date fair values separately from goodwill. The intangible assets acquired are the developed technology related to Neovasc’s Reducer, IPR&D for its Reducer technology, and Neovasc’s customer relationships in place at the time of acquisition. The fair value of the intangible assets acquired as of the acquisition date and, the method used to value these assets as well as the estimated economic lives for amortizable intangible assets were as follows (in thousands, except estimated useful life which is in years): Fair value Estimated useful life Valuation method Customer relationships $ 2,900 5 years Avoided cost / lost profit Developed technology 61,200 20 years Multi-period excess earnings In-process research and development 31,400 N/A Multi-period excess earnings Total $ 95,500 Goodwill represents the excess of the purchase price over the fair value of the net assets acquired. The acquisition of Neovasc resulted in the recognition of $39.8 million of goodwill which the Company believes relates primarily to the anticipated benefits of synergies created through the acquisition and assembled workforce. The intangible asset and goodwill created as a result of the acquisition of Neovasc is not deductible for tax purposes. As such, the Company recorded deferred tax liabilities of $11.2 million related to the intangible assets in connection with the Company’s acquisition of Neovasc. Supplemental Unaudited Pro Forma Information The following are the supplemental condensed consolidated financial results of the Company and Neovasc on an unaudited pro forma basis, as if the Neovasc acquisition had been consummated on January 1, 2022. Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) Net revenue $ 180,193 $ 121,564 $ 342,700 $ 215,806 Net income $ 34,383 $ 16,440 $ 69,199 $ 18,528

Goodwill and intangible assets

Goodwill and intangible assets	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and intangible assets	6. Goodwill and intangible assets Goodwill The changes in the carrying amounts of goodwill were as follows: (in thousands) Balance as of December 31, 2022 $ — Goodwill acquired - Neovasc 39,789 Goodwill deductions — Balance as of June 30, 2023 $ 39,789 The Company performs annual impairment reviews of goodwill during the fourth fiscal quarter or more frequently if and as required. Intangible assets The following table presents details of the acquired intangible assets as of June 30, 2023 (in thousands, except useful life and estimated remaining useful life which are in years): Gross Carrying Amount Accumulated Impairment Intangible Assets, Net Customer relationships $ 2,900 $ 129 $ — $ 2,771 5 years 4.8 years Developed technology 61,200 679 — 60,521 20 years 19.8 years In-process research and development 31,400 — — 31,400 N/A N/A Total $ 95,500 $ 808 $ — $ 94,692 19.3 years 19.1 years Acquisition-related intangibles included in the above table are finite-lived, other than in-process research and development which has an indefinite life , and are carried at cost less accumulated amortization. Customer relationships and developed technology are amortized on a straight-line basis over their estimated lives, which approximates the pattern in which the economic benefits of the intangible assets are expected to be realized. Amortization expense was $0.8 million for the three and six months ended June 30, 2023, respectively, and was recorded to sales and marketing for customer relationships and to cost of revenue for developed technology. The following table summarizes the estimated future amortization expense of intangible assets with finite lives as of June 30, 2023: Years ending December 31, (in thousands) 2023 (remainder) $ 1,820 2024 3,640 2025 3,640 2026 3,640 2027 3,640 Thereafter 46,912 Total estimated future amortization expense $ 63,292 Actual amortization expense to be reported in future periods could differ from these estimates as a result of asset impairments, acquisitions, or other facts and circumstances. The Company performs annual impairment reviews of its intangible assets during the fourth fiscal quarter or more frequently if business factors indicate.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Pay vs Performance Disclosure
Net income (loss)	$ 28,862	$ 25,561	$ 67,987	$ 40,082

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended	6 Months Ended
	Jun. 30, 2023 shares	Jun. 30, 2023 shares
Douglas Godshall [Member]
Trading Arrangements, by Individual
Name	Douglas Godshall
Title	Chief Executive Officer
Rule 10b5-1 Arrangement Adopted	true
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	true
Non-Rule 10b5-1 Arrangement Terminated	false
Laura Francis [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		On May 23, 2023, Laura Francis, a member of the Company’s Board of Directors, entered into a pre-arranged written stock sale plan in accordance with Rule 10b5-1 (the “Francis Rule 10b5-1 Plan”) under the Exchange Act, for the sale of shares of the Company’s common stock. The Francis Rule 10b5-1 Plan was entered into during an open trading window in accordance with the Company’s policies regarding transactions in the Company’s securities and is intended to satisfy the affirmative defense of Rule 10b5-1(c) under the Exchange Act. The Francis Rule 10b5-1 Plan provides for the potential sale of up to 4,000 shares of the Company’s common stock, including upon the exercise of vested stock options for shares of the Company’s common stock, so long as the market price of the Company’s common stock is higher than certain minimum threshold prices specified in the Francis Rule 10b5-1 Plan, between August 22, 2023 and August 30, 2024.
Name	Laura Francis,
Title	Board of Directors
Rule 10b5-1 Arrangement Adopted	true
Non-Rule 10b5-1 Arrangement Adopted	false
Adoption Date	May 23, 2023
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Aggregate Available	4,000	4,000
D Godshall August 2022 Plan [Member] | Douglas Godshall [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		On May 8, 2023, Douglas Godshall, the Company’s Chief Executive Officer, terminated a pre-arranged written stock sale plan previously adopted on August 31, 2022 in accordance with Rule 10b5-1 (the “Terminated Rule 10b5-1 Plan”) under the Securities Exchange Act of 1934, as amended (the “Exchange Act”), for the sale of up to 140,000 shares of the Company’s common stock. The Terminated Rule 10b5-1 Plan was entered into during an open trading window in accordance with the Company’s policies regarding transactions in the Company’s securities and was intended to satisfy the affirmative defense of Rule 10b5-1(c) under the Exchange Act.
Adoption Date	May 8, 2023
Aggregate Available	140,000	140,000
D Goodshall May 2023 Plan [Member] | Douglas Godshall [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		On May 25, 2023, Mr. Godshall entered into a pre-arranged written stock sale plan in accordance with Rule 10b5-1 (the “Godshall Rule 10b5-1 Plan”) under the Exchange Act, for the sale of shares of the Company’s common stock. The Godshall Rule 10b5-1 Plan was entered into during an open trading window in accordance with the Company’s policies regarding transactions in the Company’s securities and is intended to satisfy the affirmative defense of Rule 10b5-1(c) under the Exchange Act. The Godshall Rule 10b5-1 Plan provides for the potential sale of up to 180,000 shares of the Company’s common stock, including upon the exercise of vested stock options for shares of the Company’s common stock, so long as the market price of the Company’s common stock is higher than certain minimum threshold prices specified in the Godshall Rule 10b5-1 Plan between August 24, 2023 and August 15, 2024.
Adoption Date	May 25, 2023
Aggregate Available	180,000	180,000

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) and applicable rules and regulations of the SEC regarding interim financial reporting. The unaudited interim condensed consolidated financial statements have been prepared on the same basis as the annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary to present fairly the Company’s consolidated financial position, results of operations and cash flows. The results of operations for the three and six months ended June 30, 2023 are not necessarily indicative of the
Cash, Cash Equivalents and Restricted Cash	Cash, Cash Equivalents, and Restricted Cash The Company considers all highly liquid investments purchased with original maturities of three months or less from the purchase date to be cash equivalents. Cash equivalents consist primarily of amounts invested in money market accounts.
Equity Method Investments	Equity Method Investments Entities for which the Company has significant influence over the activities of the entity, but does not control, are accounted for under the equity method of accounting in accordance with Topic 323, Investments - Equity Method and Joint Ventures . The Company’s carrying value in the equity method investment is reported as equity method investment on the Company’s consolidated balance sheets. The Company records its proportionate share of the underlying income or loss which is recognized in earnings or loss from the equity method investment. T he Company eliminates a portion of intra-entity profit to the extent the goods sold by the Company have not yet been sold through by the equity method investee to an end customer at the end of the reporting period. The profit earned by the Company from the equity method investee for items not yet sold through is eliminated through equity method earnings or loss which is recognized in income (loss) from equity method investment. The Company assesses its equity method investment for impairment when events or circumstances suggest that the carrying amount of the investment may be impaired. The Company considers all available evidence in assessing whether a decline in fair value is other than temporary. If the decline in fair value is determined to be other than temporary, the difference between the carrying amount of the investment and estimated fair value is recognized as an impairment charge.
Revenue	Revenue To determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, Revenue from Contracts with Customers , the Company performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. Product Revenue The Company records product revenue primarily from the sale of its IVL catheters. The Company sells its products to hospitals, primarily through direct sales representatives, as well as through distributors in selected international markets. Additionally, a portion of the Company’s revenue is generated through a consignment model under which inventory is maintained at hospitals. Product revenue is recognized when a customer obtains control of promised goods or services, in an amount that reflects the consideration which the entity expects to receive in exchange for those goods or services. For products sold through direct sales representatives, control is transferred upon delivery to customers. For products sold to distributors internationally and products sold to customers that utilize stocking orders, control is transferred upon shipment or delivery to the customer’s named location, based on the contractual shipping terms. For consignment inventory, control is transferred at the time the IVL catheters are consumed in a procedure. The Company has elected to account for shipping and handling activities that occur after the customer has obtained control as a fulfillment activity, and not a separate performance obligation. The Company may provide for the use of an IVL generator and connector cable under an agreement to customers at no charge to facilitate use of the IVL catheters. These agreements generally do not contain contractually enforceable minimum commitments and are generally cancellable by either party with 30 days ’ notice. License Revenue For arrangements that contain a license of the Company’s functional intellectual property with a customer, the Company considers whether the license grant is distinct from other performance obligations in the arrangement. A license grant of functional intellectual property is generally considered to be capable of being distinct if a customer can benefit from the license on its own or together with other readily available resources. License revenue for licenses of functional intellectual property is recognized at a point in time when the Company satisfies its performance obligation of transferring the license to the customer. Consideration received in advance of the satisfaction of a performance obligation is recognized as a contract liability. No license revenues were recognized for the three and six months ended June 30, 2023.
Share-based Payment Arrangement	Stock-Based Compensation The Company accounts for share-based payments at fair value. The fair value of stock options is measured using the Black-Scholes option-pricing model. For share-based awards that vest subject to the satisfaction of a service requirement, the fair value measurement date for stock-based compensation awards is the date of grant and the expense is recognized on a straight-line basis, over the vesting period. For share-based awards that vest upon the satisfaction of a performance target, the related compensation cost is recognized over the requisite service period based on the expected achievement of the performance target. The Company accounts for forfeitures as they occur.
Business Combinations Policy	Business combinations The Company applies the provisions of ASC 805, Business Combinations , in accounting of its acquisitions. ASC 805 requires recognition of assets acquired, liabilities assumed, and contingent consideration at their fair value on the acquisition date with subsequent changes recognized in earnings; requires acquisition-related expenses to be recognized separately from the business combination and expensed as incurred; requires in-process research and development to be capitalized at fair value as an indefinite-lived intangible asset until completion or abandonment; and requires that changes in accounting for deferred tax asset valuation allowances and acquired uncertain tax positions after the measurement period be recognized as a component of provision for taxes. When an integrated set of assets and activities does not meet the practical screen test and otherwise meets the definition of a “business” under ASC 805, the Company accounts for such acquisitions as business combinations. The purchase price of an acquisition is allocated to the tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values as of the acquisition date. The Company bases the estimated fair value of identifiable intangible assets acquired in an acquisition on independent third-party valuations that use information and assumptions provided by the Company's management and considers inputs and assumptions that a market participant would use. Any excess purchase price over the estimated fair values of the assets acquired and liabilities assumed is recorded as goodwill. During the measurement period, which may be up to one year from the acquisition date, the Company may record adjustments to the provisional amounts of assets acquired and liabilities assumed with the
Goodwill and Intangible Assets, Goodwill, Policy	Goodwill In accordance with ASC 350, Intangibles-Goodwill and Other , the acquired goodwill is not amortized but is tested for impairment on an annual basis or whenever events or changes in circumstances indicate that the carrying amount of these assets may not be recoverable. The Company performs annual impairment reviews of its goodwill balance during the fourth fiscal quarter or more frequently if business factors indicate. In testing for impairment, the Company compares the fair value of its reporting unit to its carrying value including the goodwill of that unit. If the carrying value, including goodwill, exceeds the reporting unit’s fair value, the Company will recognize an impairment loss for the amount by which the carrying amount exceeds the reporting unit’s fair value. The loss recognized cannot exceed the total amount of goodwill allocated to that reporting unit. The Company did not incur any goodwill impairment losses during the six months ended June 30, 2023.
Intangible Assets, Finite-Lived, Policy	In-process research and development Intangible assets related to in-process research and development costs (“IPR&D”) are considered indefinite-lived intangible assets until the completion or abandonment of the associated research and development efforts. If and when development is complete, the associated assets would be deemed finite-lived intangible assets and would then be amortized based on their respective estimated useful lives at that point in time. Prior to the completion or abandonment of the associated research and development efforts, the assets are not amortized but are tested for impairment on an annual basis and between annual tests if the Company becomes aware of any events occurring or changes in circumstances that would indicate a reduction in the fair value of the IPR&D projects below their respective carrying amounts.
Goodwill and Intangible Assets, Intangible Assets, Policy	Intangible assets Amortizable intangible assets include customer relationships and developed technology acquired as part of the business combination. Customer relationships and developed technology acquired through business combinations subject to amortization are amortized using the straight-line method over their estimated useful lives ranging from five to 20 years. All intangible assets subject to amortization are reviewed for impairment during the fourth fiscal quarter or more frequently if business factors indicate in accordance with Topic 360, Property, Plant and Equipment .
Contingent Consideration Liabilities	Contingent Consideration Liabilities Related to Business Combination At each reporting period, the Company evaluates the likelihood of any expected future payments and the associated discount rate to determine the fair value of the contingent consideration. The Company remeasures the fair value of contingent consideration liabilities each reporting period, based on new developments, and records any necessary adjustments as a component of total operating expenses within the condensed consolidated statements of operations until either the contingent consideration obligation is satisfied through payment upon the achievement of, or the obligation no longer exists due to the failure to achieve, the specified milestones. Contingent consideration liabilities are recorded within other liabilities in the condensed consolidated balance sheets.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Restrictions on Cash and Cash Equivalents	The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the condensed consolidated statements of cash flows: June 30, June 30, (in thousands) Cash and cash equivalents $ 141,458 $ 99,913 Restricted cash 995 1,665 Total cash, cash equivalents, and restricted cash $ 142,453 $ 101,578
Schedule of Cash and Cash Equivalents	The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the condensed consolidated statements of cash flows: June 30, June 30, (in thousands) Cash and cash equivalents $ 141,458 $ 99,913 Restricted cash 995 1,665 Total cash, cash equivalents, and restricted cash $ 142,453 $ 101,578

Financial Instruments and Fai_2

Financial Instruments and Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Schedule of Financial Assets and Liabilities Measured at Fair Value	The following tables summarize the Company’s financial assets measured at fair value on a recurring basis by level within the fair value hierarchy: June 30, 2023 Level 1 Level 2 Level 3 Total (in thousands) Assets: U.S. Treasury securities $ 55,390 $ — $ — $ 55,390 Money market funds 30,129 — — 30,129 Commercial paper — 30,137 — 30,137 Corporate bonds — 12,121 — 12,121 U.S. agency securities — 13,779 — 13,779 Asset-backed securities — 5,704 — 5,704 Total assets $ 85,519 $ 61,741 $ — $ 147,260 Liabilities: Contingent consideration liability $ — $ — $ 9,307 $ 9,307 Total liabilities $ — $ — $ 9,307 $ 9,307 December 31, 2022 Level 1 Level 2 Level 3 Total (in thousands) Assets: U.S. Treasury securities $ 111,631 $ — $ — $ 111,631 Money market funds 12,076 — — 12,076 Commercial paper — 8,039 — 8,039 Corporate bonds — 18,808 — 18,808 U.S. agency securities — 9,429 — 9,429 Total assets $ 123,707 $ 36,276 $ — $ 159,983

Cash Equivalents and Short-Te_2

Cash Equivalents and Short-Term Investments (Tables)	6 Months Ended
	Jun. 30, 2023
Cash and Cash Equivalents [Abstract]
Summary of Cash Equivalents and Short-Term Investments	The following is a summary of the Company’s cash equivalents and short-term investments: June 30, 2023 Amortized Unrealized Unrealized Fair Value (in thousands) U.S. Treasury securities $ 55,662 $ — $ (272) $ 55,390 Money market funds 30,129 — — 30,129 Commercial paper 30,263 — (126) 30,137 Corporate bonds 12,135 12 (26) 12,121 U.S. agency securities 13,868 — (89) 13,779 Asset-backed securities 5,720 — (16) 5,704 Total $ 147,777 $ 12 $ (529) $ 147,260 Reported as: Cash equivalents $ 30,129 Short-term investments 117,131 Total $ 147,260 December 31, 2022 Amortized Unrealized Unrealized Fair Value (in thousands) U.S. Treasury securities $ 112,719 $ 3 $ (1,091) $ 111,631 Money market funds 12,076 — — 12,076 Commercial paper 8,039 — — 8,039 Corporate bonds 18,876 8 (76) 18,808 U.S. agency securities 9,432 4 (7) 9,429 Total $ 161,142 $ 15 $ (1,174) $ 159,983 Reported as: Cash equivalents $ 12,076 Short-term investments 147,907 Total $ 159,983
Summary of Remaining Contractual Maturities for Available-for-sale Securities	The remaining contractual maturities of the Company’s cash equivalents and short-term investments were as follows: June 30, Fair Value (in thousands) Money market funds $ 30,129 One year or less 96,512 Greater than one year and less than two years 20,619 Total $ 147,260

Balance Sheet Components (Table

Balance Sheet Components (Tables)	6 Months Ended
	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Inventory	Inventory consists of the following: June 30, December 31, (in thousands) Raw materials $ 22,664 $ 18,456 Work in progress 17,465 7,666 Finished goods 51,458 48,735 Consigned inventory 506 255 Total inventory $ 92,093 $ 75,112
Schedule of Accrued Liabilities	Accrued liabilities consist of the following: June 30, December 31, (in thousands) Employee compensation $ 32,931 $ 32,885 Research and development costs 6,404 4,007 Asset purchases 4,820 4,600 Professional services 9,602 4,044 Excise, sales, income and other taxes 3,548 4,036 Other 8,464 5,803 Total accrued liabilities $ 65,769 $ 55,375

Commitments and Contingencies (

Commitments and Contingencies (Tables)	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Lease, Cost	The Company recognizes rent expense for these operating leases on a straight-line basis over the lease period. The components of lease costs, which the Company includes in operating expenses in the condensed consolidated statements of operations and comprehensive income, were as follows: Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) Operating lease cost $ 1,217 $ 1,142 $ 2,428 $ 2,283 Variable lease cost 288 121 588 242 Total lease cost $ 1,506 $ 1,263 $ 3,017 $ 2,526
Schedule of Minimum Future Rental Payments	As of June 30, 2023, the maturities of the payments due under the Company’s operating lease liabilities were as follows: Years ending December 31, (in thousands) 2023 (remainder) $ 2,768 2024 5,517 2025 5,526 2026 5,690 2027 5,832 Thereafter 24,957 Total minimum lease payments $ 50,290 Less: imputed interest (9,835) Less: Lease incentive (5,668) Total lease liability $ 34,787 Less: current portion (1,582) Lease liability, noncurrent portion $ 33,205
Lessor, Operating Lease, Payment to be Received, Maturity	The table below summarizes the undiscounted future non-cancellable lease payments for the 5303 Lease facility under the Second Lease Amendment, which had not yet commenced as of June 30, 2023. Years ending December 31, (in thousands) 2023 (remainder) $ — 2024 476 2025 1,173 2026 1,207 2027 1,244 Thereafter 5,359 Total undiscounted lease payments $ 9,459

Term Notes (Tables)

Term Notes (Tables)	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Schedule of Current and Noncurrent Debt and Net Discount or Premium Balances	June 30, December 31, (in thousands) Principal amount of debt $ 25,000 $ 25,000 Discount associated with debt issuance costs (734) (802) Debt 24,266 24,198 Less: debt, current portion — — Debt, noncurrent portion $ 24,266 $ 24,198

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2023
Share-Based Payment Arrangement [Abstract]
Schedule of Total Stock-Based Compensation	Total stock-based compensation was as follows: Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) Cost of product revenue $ 1,374 $ 518 $ 2,328 $ 1,171 Research and development 3,876 2,476 7,671 4,714 Sales and marketing 6,593 4,408 13,059 8,340 General and administrative 5,203 3,603 9,955 6,290 Total stock-based compensation $ 17,046 $ 11,005 $ 33,013 $ 20,515
Schedule of Option Activity under 2009 Plan and 2019 Plan	Stock Options Option activity under the 2009 Plan and 2019 Plan is set forth below: Number Weighted- Weighted- Aggregate (in years) (in thousands) Balance, December 31, 2022 1,122,009 $ 5.87 4.60 $ 224,115 Options exercised (125,512) 5.75 Options cancelled (6,133) 2.41 Balance, June 30, 2023 990,364 $ 5.90 4.13 $ 276,815 Vested and exercisable, 990,364 $ 5.90 4.13 $ 276,815 Vested and expected to vest, 990,364 $ 5.90 4.13 $ 276,815
Schedule of RSU Activity under 2019 Plan	RSU and PRSU activity under the 2019 Plan is set forth below. Grant activity for all PRSUs is disclosed at target (100%): Restricted Stock Units Performance-Based Restricted Stock Units Number Weighted- Number Weighted- Balance, December 31, 2022 1,125,991 $ 127.39 38,797 165.74 RSUs and PRSUs granted 397,217 215.03 29,473 191.36 RSUs and PRSUs forfeited (54,104) 157.04 (175) 278.52 RSUs and PRSUs vested (348,461) 99.82 — — Balance, June 30, 2023 1,120,643 165.59 68,095 176.54

Net Income (Loss) Per Share (Ta

Net Income (Loss) Per Share (Tables)	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Components of Basic and Diluted Net Income (Loss) Per Share	The components of basic and diluted net income (loss) per share were as follows (in thousands, except share and per share amounts): Three Months Ended Six Months Ended 2023 2022 2023 2022 Numerator: Net income $ 28,862 $ 25,561 $ 67,987 $ 40,082 Denominator: Basic: Weighted average number of common shares outstanding - basic 36,663,327 35,825,947 36,545,948 35,707,301 Diluted: Weighted average number of common shares outstanding - basic 36,663,327 35,825,947 36,545,948 35,707,301 Dilutive effect of outstanding common stock options 991,442 1,353,081 1,016,497 1,395,427 Dilutive effect of restricted stock units 564,697 511,046 572,888 587,097 Dilutive effect of common stock pursuant to employee stock purchase plan 6,687 20 4,615 495 Weighted average number of common shares outstanding - diluted 38,226,153 37,690,094 38,139,948 37,690,320 Net income per share: Basic $ 0.79 $ 0.71 $ 1.86 $ 1.12 Diluted $ 0.76 $ 0.68 $ 1.78 $ 1.06

Revenue (Tables)

Revenue (Tables)	6 Months Ended
	Jun. 30, 2023
Disaggregation of Revenue [Abstract]
Schedule of Product Revenue Based on Product Line and Location	The following table represents the Company’s product revenue based on product line: Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) Coronary $ 125,777 $ 87,828 $ 239,652 $ 158,165 Peripheral 52,262 31,886 98,392 54,738 Reducer 1,231 — 1,231 — Other 895 1,032 1,956 1,474 Product revenue $ 180,165 $ 120,746 $ 341,231 $ 214,377 The following table represents the Company’s product revenue based on the location to which the product is shipped: Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) United States $ 144,941 $ 100,096 $ 276,564 $ 178,615 Europe 18,915 13,394 35,149 25,461 All other countries 16,309 7,256 29,518 10,301 Product revenue $ 180,165 $ 120,746 $ 341,231 $ 214,377

Business Combination (Tables)

Business Combination (Tables)	6 Months Ended
	Jun. 30, 2023
Business Combination and Asset Acquisition [Abstract]
Schedule of Business Acquisitions, by Acquisition	The following table summarizes the purchase price consideration for Neovasc: Purchase Price (in thousands) Cash transferred $ 112,129 Contingent consideration liability 9,307 Total $ 121,436
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The following table summarizes the preliminary fair values of assets acquired and liabilities assumed through the Company's Neovasc acquisition at the acquisition date based on management’s best estimates and assumptions as of the reporting date: Purchase Price (in thousands) Cash and cash equivalents $ 17,273 Accounts receivable, net 1,345 Inventory 918 Prepaid expenses and other current assets 841 Operating lease right-of-use assets 310 Property and equipment 156 Intangible assets 95,500 Other assets 502 Total identifiable assets acquired 116,845 Accounts payable 3,334 Accrued liabilities 4,082 Lease liability, current portion 253 Lease liability, noncurrent portion 64 Deferred tax liabilities 11,185 Other liabilities 16,280 Total liabilities assumed 35,198 Net identifiable assets acquired 81,647 Goodwill 39,789 Total purchase price $ 121,436
Finite-Lived and Indefinite-Lived Intangible Assets Acquired as Part of Business Combination	The fair value of the intangible assets acquired as of the acquisition date and, the method used to value these assets as well as the estimated economic lives for amortizable intangible assets were as follows (in thousands, except estimated useful life which is in years): Fair value Estimated useful life Valuation method Customer relationships $ 2,900 5 years Avoided cost / lost profit Developed technology 61,200 20 years Multi-period excess earnings In-process research and development 31,400 N/A Multi-period excess earnings Total $ 95,500
Business Acquisition, Pro Forma Information	Supplemental Unaudited Pro Forma Information The following are the supplemental condensed consolidated financial results of the Company and Neovasc on an unaudited pro forma basis, as if the Neovasc acquisition had been consummated on January 1, 2022. Three Months Ended Six Months Ended 2023 2022 2023 2022 (in thousands) (in thousands) Net revenue $ 180,193 $ 121,564 $ 342,700 $ 215,806 Net income $ 34,383 $ 16,440 $ 69,199 $ 18,528

Goodwill and intangible assets

Goodwill and intangible assets (Tables)	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The changes in the carrying amounts of goodwill were as follows: (in thousands) Balance as of December 31, 2022 $ — Goodwill acquired - Neovasc 39,789 Goodwill deductions — Balance as of June 30, 2023 $ 39,789
Schedule of Finite-Lived Intangible Assets	The following table presents details of the acquired intangible assets as of June 30, 2023 (in thousands, except useful life and estimated remaining useful life which are in years): Gross Carrying Amount Accumulated Impairment Intangible Assets, Net Customer relationships $ 2,900 $ 129 $ — $ 2,771 5 years 4.8 years Developed technology 61,200 679 — 60,521 20 years 19.8 years In-process research and development 31,400 — — 31,400 N/A N/A Total $ 95,500 $ 808 $ — $ 94,692 19.3 years 19.1 years
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	The following table summarizes the estimated future amortization expense of intangible assets with finite lives as of June 30, 2023: Years ending December 31, (in thousands) 2023 (remainder) $ 1,820 2024 3,640 2025 3,640 2026 3,640 2027 3,640 Thereafter 46,912 Total estimated future amortization expense $ 63,292

Organization and Basis of Pre_2

Organization and Basis of Presentation - Additional Information (Details) $ in Millions	Jun. 30, 2023 USD ($)
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Cash, cash equivalents and short-term investments	$ 258.6

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Schedule of Reconciliation of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022	[1]	Jun. 30, 2022
Accounting Policies [Abstract]
Cash and cash equivalents	$ 141,458	$ 156,586		$ 99,913
Restricted cash	995			1,665
Total cash, cash equivalents, and restricted cash	$ 142,453			$ 101,578
[1]The condensed consolidated balance sheet as of December 31, 2022 is derived from the audited consolidated financial statements as of that date.

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Additional Information (Details) - USD ($)	3 Months Ended	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2023
Accounting Policies [Abstract]
Notice period for cancellation of agreement		30 days
Revenue recognized	$ 0	$ 0

Financial Instruments and Fai_3

Financial Instruments and Fair Value Measurements - Schedule of Financial Assets and Liabilities Measured at Fair Value (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Apr. 11, 2023	Dec. 31, 2022
Neovasc Inc.
Assets:
Contingent consideration liability		$ 9,307
Recurring
Assets:
Total assets	$ 147,260		$ 159,983
Contingent consideration liability	9,307
Total liabilities	9,307
Recurring | Level 1
Assets:
Total assets	85,519		123,707
Contingent consideration liability	0
Total liabilities	0
Recurring | Level 2
Assets:
Total assets	61,741		36,276
Contingent consideration liability	0
Total liabilities	0
Recurring | Level 3
Assets:
Total assets	0		0
Contingent consideration liability	9,307
Total liabilities	9,307
Recurring | U.S. Treasury securities
Assets:
Total assets	55,390		111,631
Recurring | U.S. Treasury securities | Level 1
Assets:
Total assets	55,390		111,631
Recurring | U.S. Treasury securities | Level 2
Assets:
Total assets	0		0
Recurring | U.S. Treasury securities | Level 3
Assets:
Total assets	0		0
Recurring | Money market funds
Assets:
Total assets	30,129		12,076
Recurring | Money market funds | Level 1
Assets:
Total assets	30,129		12,076
Recurring | Money market funds | Level 2
Assets:
Total assets	0		0
Recurring | Money market funds | Level 3
Assets:
Total assets	0		0
Recurring | Commercial paper
Assets:
Total assets	30,137		8,039
Recurring | Commercial paper | Level 1
Assets:
Total assets	0		0
Recurring | Commercial paper | Level 2
Assets:
Total assets	30,137		8,039
Recurring | Commercial paper | Level 3
Assets:
Total assets	0		0
Recurring | Corporate bonds
Assets:
Total assets	12,121		18,808
Recurring | Corporate bonds | Level 1
Assets:
Total assets	0		0
Recurring | Corporate bonds | Level 2
Assets:
Total assets	12,121		18,808
Recurring | Corporate bonds | Level 3
Assets:
Total assets	0		0
Recurring | US Government Agencies Debt Securities
Assets:
Total assets	13,779		9,429
Recurring | US Government Agencies Debt Securities | Level 1
Assets:
Total assets	0		0
Recurring | US Government Agencies Debt Securities | Level 2
Assets:
Total assets	13,779		9,429
Recurring | US Government Agencies Debt Securities | Level 3
Assets:
Total assets	0		$ 0
Recurring | Asset-Backed Securities
Assets:
Total assets	5,704
Recurring | Asset-Backed Securities | Level 1
Assets:
Total assets	0
Recurring | Asset-Backed Securities | Level 2
Assets:
Total assets	5,704
Recurring | Asset-Backed Securities | Level 3
Assets:
Total assets	$ 0

Cash Equivalents and Short-Te_3

Cash Equivalents and Short-Term Investments - Summary of Cash Equivalents and Short-Term Investments (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Cash And Cash Equivalents [Line Items]
Money market funds	$ 30,129	$ 12,076
Cash equivalents and short-term investments, amortized cost basis	147,777	161,142
Unrealized Gains	12	15
Unrealized Losses	(529)	(1,174)
Cash equivalents and short-term investments, fair value	147,260	159,983
Short-term investments	117,131	147,907	[1]
U.S. Treasury securities
Cash And Cash Equivalents [Line Items]
Short-term investments, amortized cost basis	55,662	112,719
Unrealized Gains	0	3
Unrealized Losses	(272)	(1,091)
Short-term investments, fair value	55,390	111,631
Money market funds
Cash And Cash Equivalents [Line Items]
Money market funds	30,129	12,076
Commercial paper
Cash And Cash Equivalents [Line Items]
Short-term investments, amortized cost basis	30,263	8,039
Unrealized Gains	0	0
Unrealized Losses	(126)	0
Short-term investments, fair value	30,137	8,039
Corporate Bond Securities
Cash And Cash Equivalents [Line Items]
Short-term investments, amortized cost basis	12,135	18,876
Unrealized Gains	12	8
Unrealized Losses	(26)	(76)
Short-term investments, fair value	12,121	18,808
US Government Agencies Debt Securities
Cash And Cash Equivalents [Line Items]
Short-term investments, amortized cost basis	13,868	9,432
Unrealized Gains	0	4
Unrealized Losses	(89)	(7)
Short-term investments, fair value	13,779	$ 9,429
Asset-Backed Securities
Cash And Cash Equivalents [Line Items]
Short-term investments, amortized cost basis	5,720
Unrealized Gains	0
Unrealized Losses	(16)
Short-term investments, fair value	$ 5,704
[1]The condensed consolidated balance sheet as of December 31, 2022 is derived from the audited consolidated financial statements as of that date.

Cash Equivalents and Short-Te_4

Cash Equivalents and Short-Term Investments - Summary of Remaining Contractual Maturities for Available-for-sale Securities (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Cash and Cash Equivalents [Abstract]
Money market funds	$ 30,129	$ 12,076
One year or less	96,512
Greater than one year and less than two years	20,619
Total	$ 147,260

Cash Equivalents and Short-Te_5

Cash Equivalents and Short-Term Investments - Narrative (Details) - USD ($) $ in Millions	Jun. 30, 2023	Dec. 31, 2022
Cash and Cash Equivalents [Abstract]
Debt Securities, Available-for-Sale, Unrealized Loss Position	$ 105.2	$ 123.8
Debt Securities, Available-for-Sale, Continuous Unrealized Loss Position, 12 Months or Longer, Accumulated Loss	$ 0.5	$ 1.2

Balance Sheet Components - Sche

Balance Sheet Components - Schedule of Inventory (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials	$ 22,664	$ 18,456
Work in progress	17,465	7,666
Finished goods	51,458	48,735
Consigned inventory	506	255
Total inventory	$ 92,093	$ 75,112	[1]
[1]The condensed consolidated balance sheet as of December 31, 2022 is derived from the audited consolidated financial statements as of that date.

Balance Sheet Components - Sc_2

Balance Sheet Components - Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Employee compensation	$ 32,931	$ 32,885
Research and development costs	6,404	4,007
Asset purchases	4,820	4,600
Professional services	9,602	4,044
Excise, sales, income and other taxes	3,548	4,036
Other	8,464	5,803
Total accrued liabilities	$ 65,769	$ 55,375	[1]
[1]The condensed consolidated balance sheet as of December 31, 2022 is derived from the audited consolidated financial statements as of that date.

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) $ in Thousands	1 Months Ended	3 Months Ended		6 Months Ended
	Sep. 30, 2021 term	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Operating lease cost | $		$ 1,217	$ 1,142	$ 2,428	$ 2,283
Operating Lease, Payments | $		$ 1,400	$ 600	$ 2,700	$ 1,000
Operating lease, weighted average remaining lease term		8 years 6 months		8 years 6 months
Operating lease, weighted average discount rate		5.30%		5.30%
Three Zero Zero Three Bunker Hill Lane
Commitments and Contingencies Disclosure [Abstract]
Number of Additional Five Year Term | term	2
Operating Lease Extended Duration	5 years
Other Commitments [Line Items]
Number of Additional Five Year Term | term	2
Operating Lease Extended Duration	5 years

Commitments and Contingencies_2

Commitments and Contingencies - Schedule of Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Operating lease cost	$ 1,217	$ 1,142	$ 2,428	$ 2,283
Variable lease cost	288	121	588	242
Total lease cost	$ 1,506	$ 1,263	$ 3,017	$ 2,526

Commitments and Contingencies_3

Commitments and Contingencies - Schedule of Minimum Future Rental Payments (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022	[1]
Operating Lease Liabilities Payments Due [Abstract]
2023 (remainder of year)	$ 2,768
2024	5,517
2025	5,526
2026	5,690
2027	5,832
Thereafter	24,957
Total minimum lease payments	50,290
Less: imputed interest	(9,835)
Lessee, Operating Lease, Lease Incentive	(5,668)
Total lease liability	34,787
Lease liability, current portion	(1,582)	$ (1,278)
Lease liability, noncurrent portion	$ 33,205	$ 34,928
[1]The condensed consolidated balance sheet as of December 31, 2022 is derived from the audited consolidated financial statements as of that date.

Commitments and Contingencies_4

Commitments and Contingencies - Schedule of Maturities of Operating Lease Liabilities (Details) $ in Thousands	Jun. 30, 2023 USD ($)
Commitments and Contingencies Disclosure [Abstract]
2023 (remainder of year)	$ 0
2024	476
2025	1,173
2026	1,207
2027	1,244
Thereafter	5,359
Total undiscounted lease payments	$ 9,459

Term Notes - Additional Informa

Term Notes - Additional Information (Details) - USD ($)				3 Months Ended		6 Months Ended
	Apr. 26, 2023	Mar. 16, 2023	Oct. 19, 2022	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Debt Instrument [Line Items]
Debt amount				$ 25,000,000		$ 25,000,000		$ 25,000,000
Interest Expense				$ 810,000	$ 304,000	$ 1,446,000	$ 601,000
Revolving Credit Facility | Line of Credit
Debt Instrument [Line Items]
Proceeds of supplemental term loan		$ 80,000,000
Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity			$ 175,000,000
Incremental revolving commitments, maximum			100,000,000
Proceeds of supplemental term loan			$ 25,000,000
Line of Credit Facility, Interest Rate at Period End				6.10%		6.10%
Secured Overnight Financing Rate (SOFR) | Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Debt interest rate basis			1%
Fed Funds Effective Rate Overnight Index Swap Rate | Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Debt interest rate basis			0.50%
Minimum | Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Debt interest rate basis			0%
Minimum | Base Rate | Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Debt interest rate basis			0%
Minimum | Secured Overnight Financing Rate (SOFR) | Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Debt interest rate basis			1%
Maximum | Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Debt interest rate basis			1%
Maximum | Base Rate | Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Debt interest rate basis			1%
Maximum | Secured Overnight Financing Rate (SOFR) | Line of Credit | Revolving Credit Facility
Debt Instrument [Line Items]
Debt interest rate basis			2%
Loan and Security Agreement
Debt Instrument [Line Items]
Debt extinguished	$ 80,000,000

Term Notes - Schedule of Curren

Term Notes - Schedule of Current and Noncurrent Debt and Net Discount or Premium Balances (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Debt Instrument, Periodic Payment [Abstract]
Principal amount of debt	$ 25,000	$ 25,000
Discount associated with debt issuance costs	(734)	(802)
Debt	24,266	24,198
Less: debt, current portion	0	0
Debt, noncurrent portion	$ 24,266	$ 24,198

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Total Stock-Based Compensation (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation	$ 17,046	$ 11,005	$ 33,013	$ 20,515
Cost of product revenue
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation	1,374	518	2,328	1,171
Research and development
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation	3,876	2,476	7,671	4,714
Sales and marketing
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation	6,593	4,408	13,059	8,340
General and administrative
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation	$ 5,203	$ 3,603	$ 9,955	$ 6,290

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended		6 Months Ended
	Feb. 28, 2019	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Mar. 06, 2019
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share-based compensation expenses capitalized amount		$ 0	$ 500	$ 300	$ 800
Common stock reserved for issuance (in shares)	2,000,430
Maximum period of automatic annual increase in common stock reserved for issuance	10 years
Automatic annual increase in common stock reserved for issuance	3%
Shares available for issuance (in shares)		3,695,216		3,695,216
Stock-based compensation expense		$ 17,046	11,005	$ 33,013	20,515
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period				4 years
Employee Stock
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common stock reserved for issuance (in shares)						300,650
Shares available for issuance (in shares)		1,540,527		1,540,527
Purchase shares of common stock, price per share, percentage of fair market value				85%
Stock-based compensation expense		$ 600	$ 400	$ 1,900	$ 800
Performance-Based Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting percentage				100%
Performance-Based Restricted Stock Units | Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period				2 years
Vesting percentage				0%
Performance-Based Restricted Stock Units | Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period				3 years
Vesting percentage				200%

Stock-Based Compensation - Sc_2

Stock-Based Compensation - Schedule of Option Activity (Details) $ / shares in Units, $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2023 USD ($) $ / shares shares	Dec. 31, 2022 USD ($) $ / shares shares
Number of Shares
Balance beginning of period (in shares) | shares	1,122,009,000
Options exercised (in shares) | shares	(125,512,000)
Options cancelled (in shares) | shares	(6,133,000)
Balance end of period (in shares) | shares	990,364,000	1,122,009,000
Vested and exercisable shares (in shares) | shares	990,364,000
Vested and expected to vest shares (in shares) | shares	990,364,000
Weighted- Average Exercise Price Per Share
Beginning balance of period (USD per share) | $ / shares	$ 5,870
Options exercised (USD per share) | $ / shares	5,750
Options cancelled (USD per share) | $ / shares	2,410
Ending balance of period (USD per share) | $ / shares	5,900	$ 5,870
Vested and exercisable shares (USD per share) | $ / shares	5,900
Vested and expected to vest shares (USD per share) | $ / shares	$ 5,900
Weighted- Average Remaining Term
Balance (USD per share)	4 years 1 month 17 days	4 years 7 months 6 days
Vested and exercisable, June 30, 2023	4 years 1 month 17 days
Vested and expected to vest,  June 30, 2023	4 years 1 month 17 days
Aggregate Intrinsic Value
Balance | $	$ 276,815	$ 224,115
Vested and exercisable, June 30, 2023 | $	276,815
Vested and expected to vest,  June 30, 2023 | $	$ 276,815

Stock-Based Compensation - Sc_3

Stock-Based Compensation - Schedule of RSU Activity (Details)	6 Months Ended
	Jun. 30, 2023 $ / shares shares
Restricted Stock Units
Number of Shares
Beginning balance of period (in shares) | shares	1,125,991,000
RSUs granted (in shares) | shares	397,217,000
RSUs forfeited (in shares) | shares	(54,104,000)
RSUs vested (in shares) | shares	(348,461,000)
Ending balance of period (in shares) | shares	1,120,643,000
Weighted-Average Grant Date Fair Value Per Share
Beginning balance of period (USD per share) | $ / shares	$ 127,390
RSUs granted (USD per share) | $ / shares	215,030
RSUs forfeited (USD per share) | $ / shares	157,040
RSUs vested (USD per share) | $ / shares	99,820
Ending balance of period (USD per share) | $ / shares	$ 165,590
Performance-Based Restricted Stock Units
Number of Shares
Beginning balance of period (in shares) | shares	38,797,000
RSUs granted (in shares) | shares	29,473,000
RSUs forfeited (in shares) | shares	(175,000)
RSUs vested (in shares) | shares	0
Ending balance of period (in shares) | shares	68,095,000
Weighted-Average Grant Date Fair Value Per Share
Beginning balance of period (USD per share) | $ / shares	$ 165,740
RSUs granted (USD per share) | $ / shares	191,360
RSUs forfeited (USD per share) | $ / shares	278,520
RSUs vested (USD per share) | $ / shares	0
Ending balance of period (USD per share) | $ / shares	$ 176,540

Net Income (Loss) Per Share - C

Net Income (Loss) Per Share - Components of Basic and Diluted Net Income (Loss) Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Numerator:
Net income (loss)	$ 28,862	$ 25,561	$ 67,987	$ 40,082
Denominator:
Basic (in shares)	36,663,327	35,825,947	36,545,948	35,707,301
Diluted (in shares)	38,226,153	37,690,094	38,139,948	37,690,320
Net income per share:
Basic (USD per share)	$ 0.79	$ 0.71	$ 1.86	$ 1.12
Diluted (USD per share)	$ 0.76	$ 0.68	$ 1.78	$ 1.06
Restricted Stock Units
Denominator:
Dilutive effect of share-based payment arrangements (in shares)	564,697	511,046	572,888	587,097
Employee Stock
Denominator:
Dilutive effect of share-based payment arrangements (in shares)	6,687	20	4,615	495
Stock Options
Denominator:
Dilutive effect of share-based payment arrangements (in shares)	991,442	1,353,081	1,016,497	1,395,427

Revenue - Schedule of Product R

Revenue - Schedule of Product Revenue Based on Product Line (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Disaggregation Of Revenue [Line Items]
Product revenue	$ 180,165	$ 120,746	$ 341,231	$ 214,377
Coronary
Disaggregation Of Revenue [Line Items]
Product revenue	125,777	87,828	239,652	158,165
Peripheral
Disaggregation Of Revenue [Line Items]
Product revenue	52,262	31,886	98,392	54,738
Other
Disaggregation Of Revenue [Line Items]
Product revenue	895	1,032	1,956	1,474
Reducer
Disaggregation Of Revenue [Line Items]
Product revenue	$ 1,231	$ 0	$ 1,231	$ 0

Revenue - Schedule of Product_2

Revenue - Schedule of Product Revenue Based on Location (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Disaggregation Of Revenue [Line Items]
Product revenue	$ 180,165	$ 120,746	$ 341,231	$ 214,377
United States
Disaggregation Of Revenue [Line Items]
Product revenue	144,941	100,096	276,564	178,615
Europe
Disaggregation Of Revenue [Line Items]
Product revenue	18,915	13,394	35,149	25,461
All other countries
Disaggregation Of Revenue [Line Items]
Product revenue	$ 16,309	$ 7,256	$ 29,518	$ 10,301

Equity Method Investments - Add

Equity Method Investments - Additional Information (Details) - USD ($) $ in Thousands		3 Months Ended		6 Months Ended
	Mar. 19, 2021	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022	[1]
Schedule Of Equity Method Investments [Line Items]
Equity method investment		$ 2,543		$ 2,543		$ 3,512
Loss from equity method investment		146	$ 1,464	969	$ 1,511
Related party contract liability, noncurrent portion		12,273		12,273		$ 12,273
Joint Venture
Schedule Of Equity Method Investments [Line Items]
Percentage of equity stake received	45%
Related party transaction. transaction price	$ 12,300
Joint Venture
Schedule Of Equity Method Investments [Line Items]
Related party contract liability, noncurrent portion		12,300		12,300
JV Agreement with Genesis MedTech
Schedule Of Equity Method Investments [Line Items]
Equity method investment		$ 2,500		$ 2,500
JV Agreement with Genesis MedTech | Share Subscription Agreement
Schedule Of Equity Method Investments [Line Items]
Ordinary shares issued (in shares)	54,900
Equity percentage	55%
Cash contribution from exchange of equity	$ 15,000
Percentage of cash contribution received from exchange of equity upon signing of agreement	50%
Percentage of cash contribution receivable from exchange of equity within one year	50%
JV Agreement with Genesis MedTech | License Agreement
Schedule Of Equity Method Investments [Line Items]
Ordinary shares issued (in shares)	45,000
Equity percentage	45%
[1]The condensed consolidated balance sheet as of December 31, 2022 is derived from the audited consolidated financial statements as of that date.

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Income Tax Disclosure [Abstract]
Income tax expense	$ 4,142	$ 774	$ 5,754	$ 971
Federal statutory income tax rate	12.55%	2.94%	7.80%	2.37%

Business Combination - Narrativ

Business Combination - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands		3 Months Ended	6 Months Ended
	Apr. 11, 2023	Jun. 30, 2023	Jun. 30, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Goodwill		$ 39,789	$ 39,789	$ 0
Neovasc Inc.
Business Acquisition [Line Items]
Business Acquisition, Share Price	$ 27.25
Business Combination, Acquisition Related Costs		2,600	4,900
Business Combination, Consideration Transferred	$ 121,436
Cash transferred	112,129
Contingent consideration liability	9,307
Business Combination, Contingent Consideration Arrangements, Range of Outcomes, Value, High		47,000	47,000
Goodwill	39,789	39,789	39,789
Deferred tax liabilities	$ 11,185	$ 11,200	$ 11,200
Neovasc Inc. | June 30, 2026 Milestone
Business Acquisition [Line Items]
Business Combination, Contingent Consideration, Per Share	$ 12
Neovasc Inc. | December 31, 2026 Milestone
Business Acquisition [Line Items]
Business Combination, Contingent Consideration, Per Share	8
Neovasc Inc. | December 31, 2027 Milestone
Business Acquisition [Line Items]
Business Combination, Contingent Consideration, Per Share	$ 4

Business Combination - Calculat

Business Combination - Calculation of Consideration Transferred (Details) - Neovasc Inc. $ in Thousands	Apr. 11, 2023 USD ($)
Business Acquisition [Line Items]
Cash transferred	$ 112,129
Contingent consideration liability	9,307
Business Combination, Consideration Transferred	$ 121,436

Business Combination - Assets A

Business Combination - Assets Acquired, Liabilities Assumed (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Apr. 11, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Goodwill	$ 39,789		$ 0
Neovasc Inc.
Business Acquisition [Line Items]
Cash and cash equivalents		$ 17,273
Accounts receivable, net		1,345
Inventory		918
Prepaid expenses and other current assets		841
Operating lease right-of-use assets		310
Property and equipment		156
Intangible assets	95,500	95,500
Other assets		502
Total identifiable assets acquired		116,845
Accounts payable		3,334
Accrued liabilities		4,082
Lease liability, current portion		253
Lease liability, noncurrent portion		64
Deferred tax liabilities	11,200	11,185
Other liabilities		16,280
Total liabilities assumed		35,198
Net identifiable assets acquired		81,647
Goodwill	$ 39,789	39,789
Total purchase price		$ 121,436

Business Combination - Finite-L

Business Combination - Finite-Lived Intangible Assets (Details) - Neovasc Inc. - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Apr. 11, 2023
Business Acquisition [Line Items]
Intangible assets	$ 95,500	$ 95,500
Customer Relationships
Business Acquisition [Line Items]
Finite-Lived Intangibles	$ 2,900
Acquired Finite-Lived Intangible Assets, Weighted Average Useful Life	5 years
Developed technology
Business Acquisition [Line Items]
Finite-Lived Intangibles	$ 61,200
Acquired Finite-Lived Intangible Assets, Weighted Average Useful Life	20 years
In-process research and development
Business Acquisition [Line Items]
Indefinite-Lived Intangible Assets	$ 31,400

Business Combination - Pro Form

Business Combination - Pro Forma Information (Details) - Neovasc Inc. - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Business Acquisition [Line Items]
Net revenue	$ 180,193	$ 121,564	$ 342,700	$ 215,806
Net income	$ 34,383	$ 16,440	$ 69,199	$ 18,528

Goodwill and intangible asset_2

Goodwill and intangible assets - Changes in Carrying Amount of Goodwill (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Goodwill [Roll Forward]
Balance as of December 31, 2022	$ 0
Goodwill acquired - Neovasc	39,789
Goodwill deductions	0
Balance as of June 30, 2023	$ 39,789

Goodwill and intangible asset_3

Goodwill and intangible assets - Schedule of Finite and Indefinite-Lived Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Intangible assets, net	$ 94,692	$ 0
Neovasc Inc.
Finite-Lived Intangible Assets [Line Items]
Total intangibles, gross carrying amount	95,500
Accumulated Amortization	808
Impairment	0
Intangible Assets, Net	63,292
Intangible assets, net	$ 94,692
Useful Life	19 years 3 months 18 days
Estimated Remaining Useful Life	19 years 1 month 6 days
In-process research and development | Neovasc Inc.
Finite-Lived Intangible Assets [Line Items]
Indefinite-lived intangible assets	$ 31,400
Customer relationships | Neovasc Inc.
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	2,900
Accumulated Amortization	129
Impairment	0
Intangible Assets, Net	$ 2,771
Useful Life	5 years
Estimated Remaining Useful Life	4 years 9 months 18 days
Developed technology | Neovasc Inc.
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 61,200
Accumulated Amortization	679
Impairment	0
Intangible Assets, Net	$ 60,521
Useful Life	20 years
Estimated Remaining Useful Life	19 years 9 months 18 days

Goodwill and intangible asset_4

Goodwill and intangible assets - Future Amortization Expense (Details) - Neovasc Inc. $ in Thousands	Jun. 30, 2023 USD ($)
Finite-Lived Intangible Assets [Line Items]
2023 (remainder)	$ 1,820
2024	3,640
2025	3,640
2026	3,640
2027	3,640
Thereafter	46,912
Intangible Assets, Net	$ 63,292