Artivion (AORT) 10-Q 8 Nov 24 2024 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2024	Nov. 01, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	1-13165
Entity Registrant Name	ARTIVION, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	59-2417093
Entity Address, Address Line One	1655 Roberts Boulevard, NW
Entity Address, City or Town	Kennesaw
Entity Address, State or Province	GA
Entity Address, Postal Zip Code	30144
City Area Code	770
Local Phone Number	419-3355
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	AORT
Security Exchange Name	NYSE
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		41,919,896
Entity Central Index Key	0000784199
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Amendment Flag	false

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues:
Total revenues	$ 95,779	$ 87,854	$ 291,229	$ 260,334
Cost of products and preservation services:
Total cost of products and preservation services	34,770	31,584	103,950	92,253
Gross margin	61,009	56,270	187,279	168,081
Operating expenses:
General, administrative, and marketing	50,017	51,093	130,026	158,699
Research and development	6,605	6,421	21,048	21,062
Total operating expenses	56,622	57,514	151,074	179,761
Gain from sale of non-financial assets	0	0	0	(14,250)
Operating income (loss)	4,387	(1,244)	36,205	2,570
Interest expense	8,405	6,603	24,535	19,055
Interest income	(366)	(339)	(1,093)	(679)
Loss on extinguishment of debt	0	0	3,669	0
Other (income) expense, net	(2,386)	1,911	6	5,189
(Loss) income before income taxes	(1,266)	(9,419)	9,088	(20,995)
Income tax expense	1,022	382	5,964	5,720
Net (loss) income	$ (2,288)	$ (9,801)	$ 3,124	$ (26,715)
(Loss) income per share:
Basic (in usd per share)	$ (0.05)	$ (0.24)	$ 0.07	$ (0.65)
Diluted (in usd per share)	$ (0.05)	$ (0.24)	$ 0.07	$ (0.65)
Weighted-average common shares outstanding:
Basic (in shares)	41,844	40,881	41,607	40,691
Diluted (in shares)	41,844	40,881	42,621	40,691
Net (loss) income	$ (2,288)	$ (9,801)	$ 3,124	$ (26,715)
Other comprehensive income (loss):
Foreign currency translation adjustments	8,393	(7,070)	2,529	(1,423)
Unrealized (loss) gain from foreign currency intra-entity loans, net of tax	(2,060)	2,060	(47)	1,855
Comprehensive income (loss)	4,045	(14,811)	5,606	(26,283)
Products
Revenues:
Total revenues	71,244	63,747	215,568	192,041
Cost of products and preservation services:
Total cost of products and preservation services	24,412	21,574	72,707	62,084
Preservation services
Revenues:
Total revenues	24,535	24,107	75,661	68,293
Cost of products and preservation services:
Total cost of products and preservation services	$ 10,358	$ 10,010	$ 31,243	$ 30,169

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 56,173	$ 58,940
Trade receivables, net	75,686	71,796
Other receivables	2,288	2,342
Inventories, net	84,123	81,976
Deferred preservation costs, net	50,421	49,804
Prepaid expenses and other	19,267	15,810
Total current assets	287,958	280,668
Goodwill	248,745	247,337
Acquired technology, net	135,052	142,593
Operating lease right-of-use assets, net	41,206	43,822
Property and equipment, net	38,262	38,358
Other intangibles, net	29,527	29,638
Deferred income taxes	1,458	1,087
Other long-term assets	20,936	8,894
Total assets	803,144	792,397
Current liabilities:
Accounts payable	11,146	13,318
Current portion of long-term debt	99,698	1,451
Accrued expenses	15,888	12,732
Accrued compensation	15,236	18,715
Current maturities of operating leases	4,513	3,395
Taxes payable	3,521	3,840
Accrued procurement fees	1,456	1,439
Other current liabilities	1,380	2,972
Total current liabilities	152,838	57,862
Long-term debt	214,270	305,531
Contingent consideration	51,720	63,890
Non-current maturities of operating leases	41,440	43,977
Deferred income taxes	18,538	21,851
Deferred compensation liability	7,930	6,760
Non-current finance lease obligation	3,194	3,405
Other long-term liabilities	8,475	7,341
Total liabilities	498,405	510,617
Commitments and contingencies
Stockholders’ equity:
Preferred stock	0	0
Common stock (75,000 shares authorized, 43,392 and 42,569 shares issued in 2024 and 2023, respectively)	434	426
Additional paid-in capital	373,264	355,919
Retained deficit	(44,783)	(47,907)
Accumulated other comprehensive loss	(9,528)	(12,010)
Treasury stock, at cost, 1,487 shares as of September 30, 2024 ‎and December 31, 2023	(14,648)	(14,648)
Total stockholders’ equity	304,739	281,780
Total liabilities and stockholders’ equity	$ 803,144	$ 792,397

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - shares shares in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Common stock, shares authorized (in shares)	75,000	75,000
Common stock, shares issued (in shares)	43,392	42,569
Treasury stock at cost, shares (in shares)	1,487	1,487

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Net cash flows from operating activities:
Net income (loss)	$ 3,124	$ (26,715)
Adjustments to reconcile net income (loss) to net cash from operating activities:
Depreciation and amortization	17,910	17,260
Change in fair value of contingent consideration	(12,170)	21,900
Non-cash compensation	11,499	10,466
Non-cash lease expense	5,860	5,467
Deferred income taxes	(4,187)	(7,250)
Non-cash debt extinguishment expense	3,669	0
Write-down of inventories and deferred preservation costs	2,911	3,726
Fair value adjustment of Endospan agreements	(195)	5,000
Gain from sale of non-financial assets	0	(14,250)
Other	1,818	2,325
Changes in operating assets and liabilities:
Accounts payable, accrued expenses, and other liabilities	(5,237)	412
Inventories and deferred preservation costs	(4,791)	(10,592)
Prepaid expenses and other assets	(4,758)	(527)
Receivables	(3,356)	765
Net cash flows provided by operating activities	12,097	7,987
Net cash flows from investing activities:
Capital expenditures	(9,763)	(7,083)
Payments for Endospan agreements	(7,000)	(5,000)
Proceeds from sale of non-financial assets, net	0	14,250
Net cash flows (used in) provided by investing activities	(16,763)	2,167
Net cash flows from financing activities:
Proceeds from issuance of debt	190,000	0
Proceeds from revolving credit facility	30,000	0
Proceeds from exercise of stock options and issuance of common stock	5,285	3,467
Proceeds from financing insurance premiums	0	3,558
Repayment of debt	(211,765)	(2,063)
Payment of debt issuance costs	(10,044)	0
Principal payments on short-term notes payable	(1,027)	(1,522)
Other	(420)	(945)
Net cash flows provided by financing activities	2,029	2,495
Effect of exchange rate changes on cash and cash equivalents	(130)	1,481
(Decrease) increase in cash and cash equivalents	(2,767)	14,130
Cash and cash equivalents beginning of period	58,940	39,351
Cash and cash equivalents end of period	$ 56,173	$ 53,481

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Retained Deficit	Accumulated Other Comprehensive Loss	Treasury Stock
Beginning balance (in shares) at Dec. 31, 2022		41,830
Beginning balance at Dec. 31, 2022	$ 284,329	$ 418	$ 337,385	$ (17,217)	$ (21,609)	$ (14,648)
Beginning balance, treasury stock (in shares) at Dec. 31, 2022						(1,487)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(26,715)			(26,715)
Other comprehensive income (loss), net of tax	432				432
Equity compensation (in shares)		409
Equity compensation	11,025	$ 4	11,021
Exercise of options (in shares)		196
Exercise of options	2,006	$ 2	2,004
Employee stock purchase plan (in shares)		142
Employee stock purchase plan	1,461	$ 2	1,459
Redemption and repurchase of stock to cover tax withholdings (in shares)		(40)
Redemption and repurchase of stock to cover tax withholdings	(563)	$ (1)	(562)
Ending balance (in shares) at Sep. 30, 2023		42,537
Ending balance at Sep. 30, 2023	271,975	$ 425	351,307	(43,932)	(21,177)	$ (14,648)
Ending balance, treasury stock (in shares) at Sep. 30, 2023						(1,487)
Beginning balance (in shares) at Jun. 30, 2023		42,443
Beginning balance at Jun. 30, 2023	282,508	$ 424	347,030	(34,131)	(16,167)	$ (14,648)
Beginning balance, treasury stock (in shares) at Jun. 30, 2023						(1,487)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(9,801)			(9,801)
Other comprehensive income (loss), net of tax	(5,010)				(5,010)
Equity compensation (in shares)		8
Equity compensation	3,392		3,392
Employee stock purchase plan (in shares)		86
Employee stock purchase plan	886	$ 1	885
Ending balance (in shares) at Sep. 30, 2023		42,537
Ending balance at Sep. 30, 2023	271,975	$ 425	351,307	(43,932)	(21,177)	$ (14,648)
Ending balance, treasury stock (in shares) at Sep. 30, 2023						(1,487)
Beginning balance (in shares) at Dec. 31, 2023		42,569
Beginning balance at Dec. 31, 2023	$ 281,780	$ 426	355,919	(47,907)	(12,010)	$ (14,648)
Beginning balance, treasury stock (in shares) at Dec. 31, 2023	(1,487)					(1,487)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	$ 3,124			3,124
Other comprehensive income (loss), net of tax	2,482				2,482
Equity compensation (in shares)		499
Equity compensation	12,068	$ 5	12,063
Exercise of options (in shares)		206
Exercise of options	3,524	$ 2	3,522
Employee stock purchase plan (in shares)		118
Employee stock purchase plan	1,761	$ 1	1,760
Ending balance (in shares) at Sep. 30, 2024		43,392
Ending balance at Sep. 30, 2024	$ 304,739	$ 434	373,264	(44,783)	(9,528)	$ (14,648)
Ending balance, treasury stock (in shares) at Sep. 30, 2024	(1,487)					(1,487)
Beginning balance (in shares) at Jun. 30, 2024		43,279
Beginning balance at Jun. 30, 2024	$ 295,056	$ 433	367,627	(42,495)	(15,861)	$ (14,648)
Beginning balance, treasury stock (in shares) at Jun. 30, 2024						(1,487)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(2,288)			(2,288)
Other comprehensive income (loss), net of tax	6,333				6,333
Equity compensation (in shares)		11
Equity compensation	3,940		3,940
Exercise of options (in shares)		35
Exercise of options	676		676
Employee stock purchase plan (in shares)		67
Employee stock purchase plan	1,022	$ 1	1,021
Ending balance (in shares) at Sep. 30, 2024		43,392
Ending balance at Sep. 30, 2024	$ 304,739	$ 434	$ 373,264	$ (44,783)	$ (9,528)	$ (14,648)
Ending balance, treasury stock (in shares) at Sep. 30, 2024	(1,487)					(1,487)

Basis of Presentation and Summa

Basis of Presentation and Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation and Summary of Significant Accounting Policies	Basis of Presentation and Summary of Significant Accounting Policies Overview The accompanying Condensed Consolidated Financial Statements include the accounts of Artivion, Inc. and its subsidiaries (“Artivion,” the “Company,” “we,” or “us”). All significant intercompany accounts and transactions have been eliminated in consolidation. The accompanying Consolidated Balance Sheet as of December 31, 2023 has been derived from audited financial statements. The accompanying unaudited Condensed Consolidated Financial Statements as of, and for the three and nine months ended, September 30, 2024 and 2023 have been prepared in accordance with (i) accounting principles generally accepted in the United States of America (“US GAAP”) for interim financial information and (ii) the instructions to Form 10-Q and Rule 10-01 of Regulation S-X of the US Securities and Exchange Commission (the “SEC”). Accordingly, such statements do not include all the information and disclosures that are required by US GAAP for a complete presentation of financial statements. In the opinion of management, all adjustments (including those of a normal, recurring nature) considered necessary for a fair presentation have been included. Certain prior-year amounts have been reclassified to conform to the current year presentation. Operating results for the three and nine months ended September 30, 2024 are not necessarily indicative of the results that may be expected for the year ending December 31, 2024. These Condensed Consolidated Financial Statements should be read in conjunction with the Consolidated Financial Statements and Notes included in Artivion’s Annual Report on Form 10-K for the year ended December 31, 2023 filed with the SEC on February 23, 2024. Significant Accounting Policies A summary of our significant accounting policies is included in Note 1 of the “Notes to Consolidated Financial Statements” contained in our Form 10-K for the year ended December 31, 2023. Management believes that the consistent application of these policies enables us to provide users of the financial statements with useful and reliable information about our operating results and financial condition. The Condensed Consolidated Financial Statements are prepared in accordance with US GAAP, which require us to make estimates and assumptions. We did not experience any significant changes during the three and nine months ended September 30, 2024 in any of our Significant Accounting Policies from those contained in our Form 10-K for the year ended December 31, 2023. New Accounting Standards Not Yet Effective In December 2023 the FASB issued ASU 2023-09, Income Taxes Topic 740 - Improvements to Income Tax Disclosures . This amendment is expected to enhance the transparency and decision usefulness of income tax disclosures by requiring public business entities, on an annual basis, to disclose specific categories in the rate reconciliation, additional information for reconciling items that meet a quantitative threshold, and certain information about income taxes paid. This revised guidance is effective for financial statements issued for fiscal years beginning after December 15, 2024. We are currently evaluating the impacts of the new standard. In November 2023 the FASB issued ASU 2023-07, Segment Reporting Topic 280 - Improvements to Reportable Segment Disclosures. This amendment requires disclosure of incremental segment information on an annual and interim basis. This ASU is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, and requires retrospective application to all prior periods presented in the financial statements. We are currently evaluating the impacts of the new standard.

Sale of PerClot

Sale of PerClot	9 Months Ended
	Sep. 30, 2024
Discontinued Operations and Disposal Groups [Abstract]
Sale of PerClot	Sale of PerClot Overview On July 28, 2021 we entered into an asset purchase agreement, Transitional Manufacturing and Supply Agreement (“TMSA”), and other ancillary agreements related to the sale of PerClot ® , a polysaccharide hemostatic agent used in surgery (“PerClot”), to a subsidiary of Baxter International, Inc. (“Baxter”) and an agreement to terminate all of our material agreements with Starch Medical, Inc. (“SMI”) related to PerClot (collectively the “Baxter Transaction”). Under the terms of the Baxter Transaction, Baxter will pay an aggregate of up to $54.5 million in consideration (we will receive up to $41.0 million and SMI will receive up to $13.5 million), consisting of (i) $25.0 million at closing, of which $6.0 million was paid to SMI; (ii) $18.8 million upon our receipt of Premarket Approval (“PMA”) from the US Food and Drug Administration (the “FDA”) for PerClot and our transfer of the PMA to Baxter, of which $4.5 million was paid to SMI; and (iii) up to $10.0 million upon Baxter’s achievement of certain cumulative worldwide net sales of PerClot prior to December 31, 2026 and December 31, 2027, of which up to $3.0 million is payable to SMI. In addition, at the conclusion of our manufacturing and supply services for Baxter, Baxter will pay $780,000 upon transfer of our PerClot manufacturing equipment. Under the terms of the Baxter Transaction, we will continue to provide to Baxter certain transition services relating to the sale of SMI PerClot outside of the US. Within the terms of the TMSA, we will manufacture and supply PerClot for Baxter post PMA for a contractual period of 21 months, subject to short-term renewal provisions. PerClot PMA On May 23, 2023 the FDA granted PMA of PerClot for use to control bleeding in certain open and laparoscopic surgical procedures. Pursuant to the terms of the TMSA of the Baxter Transaction, we transferred the ownership of the PMA to Baxter following approval. In May 2023 we received a payment of $18.8 million from Baxter, of which $4.5 million was paid to SMI. As a result, we recorded a pre-tax gain of $14.3 million as the assets were derecognized upon closing of the Baxter Transaction in fiscal year 2021, included as Gain from sale of non-financial assets within the Condensed Consolidated Statements of Operations and Comprehensive Loss for the nine months ended September 30, 2023. Following receipt of the PMA, under the terms of the TMSA, we began manufacturing and supplying PerClot for Baxter and recorded $994,000 and $2.3 million of PerClot revenues on the Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) during the three and nine months ended September 30, 2024, respectively. We recorded $2.0 million and $3.6 million of PerClot revenues on the Condensed Consolidated Statements of Operations and Comprehensive Loss during the three and nine months ended September 30, 2023, respectively. The Company accounted for this TMSA in accordance with the provision of ASU 2016-02, Leases Topic 842 (“ASC 842”) by bifurcating the lease and non-lease components and recognizing each component based on ASC 842 and ASU 2014-09, Revenue from Contracts with Customers Topic 606

Agreements with Endospan

Agreements with Endospan	9 Months Ended
	Sep. 30, 2024
Variable Interest Entity, Primary Beneficiary, Does Not Hold Majority Voting Interest, Disclosures [Abstract]
Agreements with Endospan	Agreements with Endospan Exclusive Distribution Agreement and Securities Purchase Option Agreement On September 11, 2019 Artivion’s wholly owned subsidiary, JOTEC GmbH (“JOTEC”), entered into an exclusive distribution agreement with Endospan Ltd. (“Endospan”), an Israeli corporation, pursuant to which JOTEC obtained exclusive distribution rights for NEXUS ® and related accessories in certain countries in Europe in exchange for a fixed distribution fee of $9.0 million paid in September 2019. We also entered into a securities purchase option agreement (“Endospan Option”) with Endospan for $1.0 million paid in September 2019. The Endospan Option provides Artivion the option to purchase all the outstanding securities of Endospan from Endospan’s securityholders at the time of acquisition, or the option to acquire all of Endospan’s assets, in each case, for a price between $350.0 and $450.0 million before, or within a certain period of time after FDA approval of NEXUS, with such option expiring if not exercised within 90 days after receiving notice that Endospan has received approval from the FDA for NEXUS. On July 1, 2024 Artivion and Endospan entered into an amendment to the Endospan Option ( “ Endospan Option Amendment ” ) which amended the terms of the previously existing Endospan Option. Under the terms of the Endospan Option Amendment, the price to acquire all of Endospan’s outstanding securities from Endospan’s securityholders at the time of acquisition, or the option to acquire all of Endospan’s assets under the Endospan Option was reduced from $250.0 million to $175.0 million, resulting in an upfront acquisition purchase price of $135.0 million, inclusive of the loan off-set. There is no longer a minimum earnout payment of $100.0 million and the maximum earnout payment of $200.0 million remains the same. The value of the Endospan Option was fully impaired during the fourth quarter of fiscal year 2021. We estimated the fair value of the Endospan Option after the Endospan Option Amendment utilizing the Monte Carlo simulation. Inputs in our valuation of the Endospan agreements included cash payments and anticipated payments based on the executed agreements with Endospan, projected discounted cash flows in connection with the Endospan transaction, our expected internal rate of return and discount rates, and our assessed probability and timing of receipt of certification of certain approvals and milestones in obtaining FDA approval. Based on this calculation, we recorded $3.1 million for the fair value of the Endospan Option as of the Endospan Option Amendment transaction date and as of September 30, 2024. Loan Agreement Artivion and Endospan also entered into a loan agreement (the “Endospan Loan”), dated September 11, 2019, in which Artivion agreed to provide Endospan a secured loan of up to $15.0 million to be funded in three tranches of $5.0 million each. The first tranche of the Endospan Loan was funded upon execution of the agreement in September 2019. In September 2020 we funded the second tranche payment of $5.0 million upon the certification of the NEXUS IDE from the FDA. In May 2023 we funded the third tranche payment of $5.0 million upon the certification of enrollment of 50% of the required number of patients in the primary arm of the FDA approved clinical trial for NEXUS. We elected the fair value option for recording the Endospan Loan. We assess the fair value of the Endospan Loan based on quantitative and qualitative characteristics and adjust the amount recorded to its current fair market value at each reporting period. We performed an assessment of the fair value of the Endospan Loan, including the funding of the third tranche payment in May 2023. We determined that the loan had no fair value as of June 30, 2023 and recorded a $5.0 million expense included in Other expense, net within the Condensed Consolidated Statements of Operations and Comprehensive Loss for the three and six months ended June 30, 2023. After entering into the Endospan Loan Amendment, defined below, we determined that the Endospan Loan had a fair value of $298,000 as of September 30, 2024. On July 1, 2024 Artivion and Endospan entered into an Amended and Restated Loan Agreement ( “ Endospan Loan Amendment ” ) which amended the terms of the previously existing Endospan Loan. As a part of the Endospan Loan Amendment, Artivion agreed to fund Endospan additional secured loans of up to $25.0 million . The additional loans are contracted to be funded in three tranches of $7.0 million, $10.0 million, and $8.0 million, subject to Endospan’s achievement of milestones related to its pursuit of regulatory approval for the NEXUS products that are specified in the Endospan Loan Amendment. The first tranche of $7.0 million was funded following execution of the agreement during the three months ended September 30, 2024. We elected the fair value option for recording the Endospan Loan and the additional secured loans as part of the Endospan Loan Amendment (collectively the “Endospan Loans”). We performed an assessment of the first tranche loan of $7.0 million and determined that the first tranche loan had a fair value of $3.8 million as of September 30, 2024 which is recorded in “Other long-term assets” on the Condensed Consolidated Balance Sheets as of September 30, 2024.

Financial Instruments

Financial Instruments	9 Months Ended
	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Financial Instruments	Financial Instruments The following is a summary of our financial instruments measured at fair value on a recurring basis (in thousands): September 30, 2024 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 21,487 $ — $ — $ 21,487 Certificates of deposit 3,490 — — 3,490 Endospan Loans — — 4,059 4,059 Total assets $ 24,977 $ — $ 4,059 $ 29,036 Long-term liabilities: Contingent consideration — — (51,720) (51,720) Total liabilities $ — $ — $ (51,720) $ (51,720) December 31, 2023 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 22,802 $ — $ — $ 22,802 Certificates of deposit 3,968 — — 3,968 Total assets $ 26,770 $ — $ — $ 26,770 Long-term liabilities: Contingent consideration — — (63,890) (63,890) Total liabilities $ — $ — $ (63,890) $ (63,890) We used prices quoted from our investment advisors to determine the Level 1 valuation of our investments in money market funds and certificates of deposit. The estimated market value of all cash equivalents is equal to cost basis as there were no gross realized gains or losses on cash equivalents for the three and nine months ended September 30, 2024 and 2023. We recorded the Endospan Loans, classified as Level 3, as a result of the Endospan Loan Amendment in July 2024. See Note 3 for further discussion of the Endospan Loan Amendment. On September 2, 2020 we entered into a Securities Purchase Agreement to acquire 100% of the outstanding equity interests of Ascyrus Medical LLC (“Ascyrus”). Ascyrus developed the Ascyrus Medical Dissection Stent (“AMDS”) hybrid prosthesis, the world’s first aortic arch remodeling device for use in the treatment of acute Type A aortic dissections. As part of the acquisition, we may be required to pay additional consideration in cash of up to $100.0 million to the former shareholders of Ascyrus upon the achievement of certain milestones and the sales-based additional earnout. The contingent consideration represents the estimated fair value of future potential payments. The fair value of the contingent consideration liability was estimated by discounting to present value the contingent payments expected to be made based on a probability-weighted scenario approach. We applied a discount rate based on our unsecured credit spread and the term commensurate risk-free rate to the additional consideration to be paid, and then applied a risk-based estimate of the probability of achieving each scenario to calculate the fair value of the contingent consideration. This fair value measurement was based on unobservable inputs, including management estimates and assumptions about the future achievement of milestones and future estimate of revenues, and is, therefore, classified as Level 3 within the fair value hierarchy. We used a discount rate of approximately 16% and estimated future achievement of milestone dates between 2025 and 2026 to calculate the fair value of contingent consideration as of September 30, 2024. We will remeasure this liability at each reporting date and will record changes in the fair value of the contingent consideration in General, administrative, and marketing expenses on the Condensed Consolidated Statements of Operations and Comprehensive Income (Loss). Increases or decreases in the fair value of the contingent consideration liability can result from changes in passage of time, discount rates, the timing and amount of our revenue estimates, and the timing and expectation of regulatory approvals. We performed an assessment of the fair value of the contingent consideration and recorded a fair value increase of $3.5 million and a fair value reduction of $12.2 million for the three and nine months ended September 30, 2024, respectively, as compared to a fair value increase of $6.2 million and $21.9 million for the three and nine months ended September 30, 2023, respectively, in General, administrative, and marketing expenses on the Condensed Consolidated Statements of Operations and Comprehensive Income (Loss), as a result of this assessment. The reduction in the fair value for the nine months ended September 30, 2024 was primarily due to an increase in the credit risk spread resulting from the change in the inputs related to the newly issued Credit Facilities in the first quarter of 2024, as further discussed in Note 9. The fair value of the contingent consideration component of the Ascyrus acquisition was updated using Level 3 inputs. Changes in fair value of Level 3 assets and liabilities are listed in the tables below (in thousands): Endospan Loans Balance as of December 31, 2023 — Initial value of Endospan Loans 3,517 Change in valuation 542 Balance as of September 30, 2024 $ 4,059 Contingent Consideration Balance as of December 31, 2023 $ (63,890) Change in valuation 12,170 Balance as of September 30, 2024 $ (51,720) The determination of fair value and the assessment of a measurement’s placement within the hierarchy requires judgment. Level 3 valuations often involve a higher degree of judgment and complexity. Although we believe that the recorded fair values of our financial instruments are appropriate, these fair values may not be reflective of future fair values. The contingent consideration liability of $51.7 million and $63.9 million was included in Long-term liabilities on the Condensed Consolidated Balance Sheets as of September 30, 2024 and the Consolidated Balance Sheets as of December 31, 2023, respectively.

Inventories, net and Deferred P

Inventories, net and Deferred Preservation Costs	9 Months Ended
	Sep. 30, 2024
Inventory Disclosure [Abstract]
Inventories, net and Deferred Preservation Costs	Inventories, net and Deferred Preservation Costs Inventories, net at September 30, 2024 and December 31, 2023 were comprised of the following (in thousands): September 30, December 31, Raw materials and supplies $ 36,037 $ 36,907 Work-in-process 15,602 12,687 Finished goods 32,484 32,382 Total inventories, net $ 84,123 $ 81,976 To facilitate product usage, we maintain consignment inventory of our On-X ® heart valves at domestic hospital locations and On-X heart valves and aortic stent grafts at international hospital locations. We retain title and control over this consignment inventory until we receive a notification of implantation, at which time we invoice the hospital and recognize revenue. As of September 30, 2024 we had $10.7 million in consignment inventory, with approximately 40% in domestic locations and 60% in international locations. As of December 31, 2023 we had $10.7 million in consignment inventory, with approximately 44% in domestic locations and 56% in international locations. Total deferred preservation costs were $50.4 million and $49.8 million as of September 30, 2024 and December 31, 2023, respectively. Inventory and deferred preservation costs obsolescence reserves were $3.7 million and $3.0 million

Goodwill and Other Intangible A

Goodwill and Other Intangible Assets	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Other Intangible Assets	Goodwill and Other Intangible Assets Indefinite Lived Intangible Assets As of September 30, 2024 and December 31, 2023 the carrying values of our indefinite lived intangible assets were as follows (in thousands): September 30, December 31, Goodwill $ 248,745 $ 247,337 In-process R&D 2,183 2,154 Procurement contracts and agreements 2,013 2,013 We monitor the phases of development of our acquired in-process research and development projects, including the risks associated with further development and the amount and timing of benefits expected to be derived from the completed projects. Incremental costs associated with development are charged to expense as incurred. Capitalized costs are amortized over the estimated useful life of the developed asset once completed. Our in-process research and development projects are reviewed for impairment annually, or more frequently, if events or changes in circumstances indicate that the asset might be impaired. We did not record any impairment of indefinite lived intangible assets during the three and nine months ended September 30, 2024. In-process research and development, procurement contracts and agreements were included in Other intangibles, net on the Condensed Consolidated Balance Sheets as of September 30, 2024 and the Consolidated Balance Sheets as of December 31, 2023. Based on our experience with similar agreements, we believe that our acquired procurement contracts and agreements have indefinite useful lives, as we expect to continue to renew these contracts for the foreseeable future. We evaluate our goodwill and non-amortizing intangible assets for impairment on an annual basis during the fourth quarter of the year, and, if necessary, during interim periods if factors indicate that an impairment review is warranted. As of September 30, 2024 we concluded that our assessment of current factors did not indicate that goodwill or non-amortizing intangible assets are more likely than not to be impaired. We will continue to evaluate the recoverability of these non-amortizing intangible assets in future periods as necessary. As of September 30, 2024 and December 31, 2023 the carrying value of goodwill, all of which is related to our Medical Devices segment, was as follows (in thousands): Medical Devices Segment Balance as of December 31, 2023 $ 247,337 Foreign currency translation 1,408 Balance as of September 30, 2024 $ 248,745 Definite Lived Intangible Assets The definite lived intangible assets balance includes balances related to acquired technology, customer relationships, distribution and manufacturing rights and know-how, patents, and other definite lived intangible assets. As of September 30, 2024 and December 31, 2023 the gross carrying values, accumulated amortization, and approximate amortization period of our definite lived intangible assets were as follows (in thousands, except weighted average useful life): September 30, 2024 Gross Carrying Accumulated Net Carrying Weighted Average Acquired technology $ 203,219 $ 68,167 $ 135,052 18.2 Other intangibles: Customer lists and relationships 28,754 11,342 17,412 21.6 Distribution and manufacturing rights and know-how 9,735 9,279 456 5.0 Patents 4,422 3,261 1,161 17.0 Other 11,541 5,239 6,302 5.0 Total other intangibles $ 54,452 $ 29,121 $ 25,331 9.3 December 31, 2023 Gross Carrying Accumulated Net Carrying Weighted Average Acquired technology $ 201,897 $ 59,304 $ 142,593 18.2 Other intangibles: Customer lists and relationships 28,729 10,334 18,395 21.6 Distribution and manufacturing rights and know-how 9,608 7,807 1,801 5.0 Patents 4,365 3,225 1,140 17.0 Other 7,815 3,680 4,135 5.0 Total other intangibles $ 50,517 $ 25,046 $ 25,471 10.0 Amortization Expense The following is a summary of amortization expense as recorded in General, administrative, and marketing expenses on our Condensed Consolidated Statement of Operations and Comprehensive Income (Loss) (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 Amortization expense $ 3,990 $ 3,766 $ 11,650 $ 11,453 As of September 30, 2024 scheduled amortization of intangible assets for the next five years is as follows (in thousands): Remainder 2025 2026 2027 2028 2029 Total Amortization expense $ 4,073 $ 13,634 $ 13,249 $ 13,140 $ 12,944 $ 12,745 $ 69,785

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes Income Tax Expense Our effective income tax rate was an expense of 81% and 66% for the three and nine months ended September 30, 2024, respectively, as compared to an expense of 4% and 27% for the three and nine months ended September 30, 2023, respectively. Our income tax rate for the three and nine months ended September 30, 2024 and 2023 was primarily impacted by changes in anticipated full year pre-tax operating results, profit mix among jurisdictions, our valuation allowance against our net deferred tax assets, non-deductible executive compensation, the foreign derived intangible income deduction, the research and development tax credit, changes in our uncertain tax position liabilities, and tax-effected impact of stock based compensation. Deferred Income Taxes We generate deferred tax assets primarily as a result of finance and operating leases, net operating losses, excess interest carryforward, change in contingent consideration, accrued compensation, and stock compensation. Our deferred tax liabilities are primarily comprised of intangible assets acquired in previous years, finance and operating leases, and unrealized gains and losses. We maintained a net deferred tax liability of $17.1 million and $20.8 million as of September 30, 2024 and December 31, 2023, respectively. Our valuation allowance against our deferred tax assets was $34.4 million and $32.9 million as of September 30, 2024 and December 31, 2023, respectively, primarily related to net operating loss carryforwards, disallowed excess interest carryforwards, change in contingent consideration, and capitalized research and development expenses.

Leases

Leases	9 Months Ended
	Sep. 30, 2024
Leases [Abstract]
Leases	Leases We have operating and finance lease obligations resulting from the lease of land and buildings that comprise our corporate headquarters and various manufacturing facilities; leases related to additional manufacturing, office, and warehouse space; leases on company vehicles; and leases on a variety of office and other equipment. Information related to leases included in the Condensed Consolidated Balance Sheets was as follows (in thousands, except lease term and discount rate): Operating leases: September 30, December 31, Operating lease right-of-use assets, net $ 41,206 $ 43,822 Current maturities of operating leases $ 4,513 $ 3,395 Non-current maturities of operating leases 41,440 43,977 Total operating lease liabilities $ 45,953 $ 47,372 Finance leases: Property and equipment, at cost $ 7,218 $ 6,862 Accumulated amortization (3,637) (3,136) Property and equipment, net $ 3,581 $ 3,726 Current maturities of finance leases $ 650 $ 582 Non-current maturities of finance leases 3,194 3,405 Total finance lease liabilities $ 3,844 $ 3,987 Weighted average remaining lease term (in years): Operating leases 9.8 10.4 Finance leases 5.9 6.8 Weighted average discount rate: Operating leases 6.3% 6.3% Finance leases 2.3% 2.2% Current maturities of finance leases are included as a component of Other current liabilities Three Months Ended Nine Months Ended 2024 2023 2024 2023 Amortization of property and equipment $ 159 $ 136 $ 468 $ 400 Interest expense on finance leases 22 20 67 62 Total finance lease expense 181 156 535 462 Operating lease expense 1,963 1,836 5,860 5,467 Sublease income (133) (87) (332) (101) Total lease expense $ 2,011 $ 1,905 $ 6,063 $ 5,828 A summary of our cash flow information related to leases was as follows (in thousands): Nine Months Ended Cash paid for amounts included in the measurement of lease liabilities: 2024 2023 Operating cash flows for operating leases $ 5,798 $ 5,422 Financing cash flows for finance leases 469 396 Operating cash flows for finance leases 67 62 Future minimum lease payments are as follows (in thousands): Finance Operating Remainder of 2024 $ 183 $ 1,546 2025 721 7,516 2026 700 6,976 2027 688 6,288 2028 652 5,934 Thereafter 1,155 34,021 Total minimum lease payments 4,099 62,281 Less amount representing interest (255) (16,328) Present value of net minimum lease payments 3,844 45,953 Less current maturities (650) (4,513) Lease liabilities, less current maturities $ 3,194 $ 41,440

Debt

Debt	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Debt	Debt Credit Facilities On January 18, 2024 we entered into a credit and guaranty agreement with Ares Management Credit funds for $350.0 million of senior secured, interest-only, credit facilities, consisting of a $190.0 million secured term loan facility (the “Initial Term Loan Facility”), a $100.0 million secured delayed draw term loan facility (the “Delayed Draw Term Loan Facility” and, together with the Initial Term Loan Facility, the “Term Loan Facilities”) and a $60.0 million “senior-priority” secured revolving credit facility which has a priority claim ahead of the other secured facilities (the “Revolving Credit Facility” and, together with the Term Loan Facilities, the “Credit Facilities”). The final scheduled maturity date of the Credit Facilities is January 18, 2030. There are no scheduled repayments of principal required to be made prior to the final maturity date. We have the right to prepay loans under the Ares Credit Agreement in whole or in part at any time, provided that any prepayment of loans under the Term Loan Facilities (or loans under the Revolving Credit Facility to the extent of reducing the balance of outstanding loans below $30.0 million) will be subject to a prepayment premium of 5.00% if the prepayment occurs prior to January 18, 2025 and 1.00% if the prepayment occurs thereafter and prior to January 18, 2026. Amounts repaid in respect of loans under the Initial Term Loan Facilities may not be reborrowed. The Credit Facilities are secured by a security interest in substantially all existing and after-acquired real and personal property (subject to certain exceptions and exclusions) of us and the Guarantors. Upon closing, we borrowed $190.0 million under the Initial Term Loan Facility and $30.0 million under the Revolving Credit Facility. The remaining $30.0 million of undrawn availability under the Revolving Credit Facility may be drawn for working capital, capital expenditures, and other general corporate purposes. The Delayed Draw Term Loan Facility remained undrawn as of September 30, 2024. We paid $6.5 million of debt issuance costs related to the Initial Term Loan Facility which are included in Long-term debt on the Condensed Consolidated Balance Sheets as of September 30, 2024 and amortized, thereafter, over the life of the Initial Term Loan Facility. We paid $3.7 million of debt issuance costs related to the Delayed Draw Term Loan Facility and Revolving Credit Facility which are included in Other long-term assets on the Condensed Consolidated Balance Sheets as of September 30, 2024. We recognized $7.1 million and $19.8 million of interest expense on the Credit Facilities for the three and nine months ended September 30, 2024, respectively, of which $358,000 and $997,000 represent non-cash amortization of debt issuance costs for the three and nine months ended September 30, 2024, respectively. There was approximately $5.7 million of unamortized debt issuance costs related to the Initial Term Loan Facility as of September 30, 2024. The proceeds of the initial borrowings were used along with cash on hand to pay off our previously existing credit agreement, dated as of December 1, 2017, and pay related fees and expenses. As a result of this transaction, we recorded a loss on extinguishment of our previously existing debt of $3.7 million during the nine months ended September 30, 2024 on our Condensed Consolidated Statements of Operations and Comprehensive Income (Loss). The proceeds of borrowings under the Delayed Draw Term Loan Facility may be used solely to repurchase or repay our outstanding 4.25% Convertible Senior Notes due July 1, 2025 and to pay related fees and expenses. Subject to the satisfaction of a specified maximum total net leverage ratio and other customary conditions, we may borrow under the Delayed Draw Term Loan Facility at any time and from time to time on or prior to the maturity date of the convertible bonds on July 1, 2025. Loans borrowed under the Delayed Draw Term Loan Facility generally have the same terms as the loans under the Initial Term Loan Facility. The Credit Facilities contain certain customary affirmative and negative covenants, including covenants that limit our ability and the ability of our subsidiaries to, among other things, grant liens, incur debt, dispose of assets, make loans and investments, make acquisitions, make certain restricted payments (including cash dividends), merge or consolidate, change business or accounting or reporting practices, in each case subject to customary exceptions for a credit facility of this size and type. The covenants include a financial maintenance covenant that requires the company’s total net leverage ratio, as defined in the agreement, to be not greater than 6.25x for the test periods from the second quarter of fiscal year 2024 through the fourth quarter of fiscal year 2024 and not greater than 5.75x from the first quarter of fiscal year 2025 and thereafter. As of September 30, 2024 we are in compliance with our debt covenants. The Revolving Credit Facility bears interest, at our option, at a floating annual rate equal to either the base rate plus a margin of 3.00%, or the Adjusted Term Secured Overnight Financing Rate (“Adjusted Term SOFR”) plus a margin of 4.00%. In addition, we will be required to pay fees of 0.50% per annum on the daily unused amount of the Revolving Credit Facility and 1.00% per annum on the daily unused amount of the Delayed Draw Term Loan Facility. The Term Loan Facilities initially bear interest, at our option, at a floating annual rate equal to either the base rate plus a margin of 5.50%, or the Adjusted Term SOFR plus a margin of 6.50%. If, after the second quarter of fiscal year 2025, the company reports total net leverage ratio, as defined in the Credit Facilities, of less than or equal to 3.75x the interest margins applicable to the Term Loan Facilities will be reduced by 25 basis points, to 5.25% and 6.25%, for base rate and Adjusted Term SOFR loans, respectively. As of September 30, 2024 the aggregate interest rate was 11.78% and 9.28% per annum for the Term Loan Facilities and Revolving Credit Facility, respectively. Convertible Senior Notes On June 18, 2020 we issued $100.0 million aggregate principal amount of 4.25% Convertible Senior Notes with a maturity date of July 1, 2025 (the “Convertible Senior Notes”). The net proceeds from this offering, after deducting initial purchasers’ discounts and costs directly related to this offering, were approximately $96.5 million. On January 1, 2021 we adopted ASU 2020-06 and adjusted the carrying balance of the Convertible Senior Notes to notional. The Convertible Senior Notes balance was $100.0 million recorded in Current portion of long-term debt on the Condensed Consolidated Balance Sheets as of September 30, 2024 and Long-term debt on the Consolidated Balance Sheets as of December 31, 2023. The Convertible Senior Notes are scheduled to mature on July 1, 2025. The Convertible Senior Notes may be settled in cash, stock, or a combination thereof, solely at our discretion. The initial conversion rate of the Convertible Senior Notes is 42.6203 shares per $1,000 principal amount, which is equivalent to a conversion price of approximately $23.46 per share, subject to adjustments. We use the if-converted method for assumed conversion of the Convertible Senior Notes for the diluted earnings per share calculation. The fair value and the effective interest rate of the Convertible Senior Notes as of September 30, 2024 was approximately $125.4 million and 5.05%, respectively. The fair value was based on market prices observable for similar instruments and is considered Level 2 in the fair value hierarchy. The interest expense recognized on the Convertible Senior Notes includes $1.2 million and $3.7 million for both the three and nine months ended September 30, 2024 and 2023, respectively , related to the aggregate of the contractual coupon interest and the amortization of the debt issuance costs . Interest on the Convertible Senior Notes began accruing upon issuance and is payable semi-annually. There were approximately $582,000 and $1.1 million of unamortized debt issuance costs related to the Convertible Senior Notes as of September 30, 2024 and December 31, 2023 , respectively. Holders of the Convertible Senior Notes may convert their notes at their option at any time prior to January 1, 2025, but only under the following circumstances: (i) during any calendar quarter commencing after the calendar quarter ending on September 30, 2020 (and only during such calendar quarter), if the last reported sale price of our common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (ii) during the five business day period after any five consecutive trading day period in which the trading price per $1,000 principal amount of notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of our common stock and the conversion rate on each such trading day; (iii) we give a notice of redemption with respect to any or all of the notes, at any time prior to the close of business on the second scheduled trading day immediately preceding the redemption date; or (iv) upon the occurrence of specified corporate events. On or after January 1, 2025 until the close of business on the second scheduled trading day immediately preceding the maturity date, holders may convert their notes at any time, regardless of the foregoing circumstances. We became eligible to redeem the Convertible Senior Notes beginning on July 5, 2023, following the expiration of their non-redemption period. We are able to redeem the Convertible Senior Notes in whole or in part, at our option, if the last reported sale price per share of our common stock has been at least 130% of the conversion price then in effect for at least 20 trading days (whether or not consecutive) during any 30 consecutive trading day period (including the last trading day of such period) ending on, and including, the trading day immediately preceding the date on which we provide notice of redemption. We may redeem for cash all or part of the Convertible Senior Notes at a redemption price equal to 100% of the principal amount of the redeemable Convertible Senior Notes, plus accrued and unpaid interest to, but excluding, the redemption date. No principal payments are due on the Convertible Senior Notes prior to maturity. Other than restrictions relating to certain fundamental changes and consolidations, mergers or asset sales and customary anti-dilution adjustments, the Convertible Senior Notes do not contain any financial covenants and do not restrict us from conducting significant restructuring transactions or issuing or repurchasing any of our other securities. As of September 30, 2024 and December 31, 2023 we are not aware of any current events or market conditions that would allow holders to convert the Convertible Senior Notes. Loan Balances The short-term and long-term balances of our Initial Term Loan Facility, Revolving Credit Facility, Convertible Senior Notes, and other long-term borrowings were as follows (in thousands): September 30, December 31, Initial Term Loan Facility $ 190,000 $ — Revolving Credit Facility 30,000 — Convertible Senior Notes 100,000 100,000 Term loan balance — 211,500 2.45% Sparkasse Zollernalb (KFW Loan 1) — 61 1.40% Sparkasse Zollernalb (KFW Loan 2) 280 484 Total loan balance 320,280 312,045 Less unamortized loan origination costs (6,312) (5,063) Net borrowings 313,968 306,982 Less short-term Convertible Senior Notes, net (99,418) — Less short-term loan balance, net (280) (1,451) Long-term loan balance, net $ 214,270 $ 305,531 Interest Expense Interest expense was $8.4 million and $24.5 million for the

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Liability Claims In the normal course of business, we are made aware of adverse events involving our products and tissues. Future adverse events could ultimately give rise to a lawsuit against us, and liability claims may be asserted against us in the future based on past events that we are not aware of at the present time. We maintain claims-made insurance policies to mitigate our financial exposure to product and tissue processing liability claims. Claims-made insurance policies generally cover only those asserted claims and incidents that are reported to the insurance carrier while the policy is in effect. The amounts recorded in these Condensed Consolidated Financial Statements as of September 30, 2024 and the Consolidated Financial Statements as of December 31, 2023 represent our estimate of the probable losses and anticipated recoveries for incurred but not reported claims related to products sold and services performed prior to the balance sheet date.

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2024
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition Disaggregation of Revenue Revenues are disaggregated by the following geographic regions: • North America: consists of the US and Canada. We market our approved medical device products and preservation services (predominantly in the US), primarily to physicians through our direct sales representatives who are managed by regional managers. • Europe, the Middle East, and Africa (“EMEA”): in certain countries, we market approved medical device products to physicians, hospitals, and distributors through our direct sales force. In countries where we have no direct sales forces, regional sales managers market to distributors who buy medical device products directly from us and sell to hospitals in their respective countries. • Asia Pacific (“APAC”): we market medical device products that are approved in each country to distributors in the region. • Latin America (“LATAM”): we market medical device products that are approved in each country to distributors in the region except for Brazil where we sell directly to end customers and distributors. Net revenues by geographic location based on the location of the customer for the three and nine months ended September 30, 2024 and 2023 were as follows (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 North America $ 49,089 $ 48,028 $ 148,679 $ 137,541 EMEA 30,423 26,536 98,156 84,608 APAC 10,366 8,402 27,628 24,655 LATAM 5,901 4,888 16,766 13,530 Total revenues $ 95,779 $ 87,854 $ 291,229 $ 260,334 Also see segment disaggregation information in Note 14 below. Contract Balances We may generate contract assets during the pre-delivery design and manufacturing stage of E-xtra Design Engineering product order fulfillment. We assess the balance related to any arrangements in process and determine if the enforceable right to payment creates a material contract asset requiring disclosure. No material arrangements in process existed as of September 30, 2024 and 2023. We also incur contract obligations on general customer purchase orders that have been accepted but unfulfilled. Due to the short duration of time between order acceptance and delivery of the related product or service, we have determined that the balance related to these contract obligations is generally immaterial at any point in time. We monitor the value of orders accepted but unfulfilled at the close of each reporting period to determine if disclosure is appropriate. The value of orders accepted but unfulfilled as of September 30, 2024 and 2023 was not material.

Stock Compensation

Stock Compensation	9 Months Ended
	Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]
Stock Compensation	Stock Compensation Overview We have stock option and stock incentive plans for employees and non-employee directors that provide for grants of restricted stock awards (“RSAs”), restricted stock units (“RSUs”), performance stock units (“PSUs”), and options to purchase shares of our common stock at exercise prices generally equal to the fair value of such stock at the dates of grant. We also maintain a stockholder-approved Employee Stock Purchase Plan (“ESPP”) for the benefit of our employees. The ESPP allows eligible employees to purchase common stock on a regular basis at the lower of 85% of the market price at the beginning or end of each offering period. Equity Grants During the nine months ended September 30, 2024 the Compensation Committee of our Board of Directors (the “Committee”) authoriz ed awards from approved stock incentive plans of RSAs to non-employee directors and RSUs and PSUs to certain employees and company officers, which, assuming that performance under the PSUs will be achieved at target levels, together totaled 778,000 shares and had an aggregate grant date fair value of $16.1 million. During the nine months ended September 30, 2023 the Committee authorized awards from approved stock incentive plans of RSAs to non-employee directors and RSUs and PSUs to certain employees and company officers, which, assuming that performance under the PSUs were to be achieved at target levels, together totaled 616,000 shares and had an aggregate grant date fair value of $8.5 million. The Committee did not authorize any grants of stock options during the nine months ended September 30, 2024. During the nine months ended September 30, 2023 the Committee authorized, from approved stock incentive plans, grants of stock options to purchase a total of 16,000 shares to certain company officers. The exercise prices of the options were equal to the closing stock prices on their respective grant dates. Employees purchased common stock totaling 67,000 and 118,000 shares in the three and nine months ended September 30, 2024, respectively, as compared to 86,000 and 142,000 shares in the three and nine months ended September 30, 2023, respectively, through the ESPP. Stock Compensation Expense The following weighted-average assumptions were used to determine the fair value of shares purchased under the ESPP: Three Months Ended Nine Months Ended ESPP ESPP Expected life 0.5 Years 0.5 Years Expected stock price volatility 0.36 0.48 Risk-free interest rate 5.37% 5.26% The following table summarizes total stock compensation expenses prior to the capitalization of amounts into Inventory and Deferred preservation costs (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 RSA, RSU, and PSU expense $ 3,364 $ 2,647 $ 10,222 $ 8,685 Stock option and ESPP expense 576 745 1,846 2,340 Total stock compensation expense $ 3,940 $ 3,392 $ 12,068 $ 11,025

(Loss) Income Per Common Share

(Loss) Income Per Common Share	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
(Loss) Income Per Common Share	(Loss) Income Per Common Share The following table sets forth the computation of basic and diluted (loss) income per common share (in thousands, except per share data): Three Months Ended Nine Months Ended Basic (loss) income per common share 2024 2023 2024 2023 Net (loss) income $ (2,288) $ (9,801) $ 3,124 $ (26,715) Net loss (income) allocated to participating securities 3 39 (6) 108 Net (loss) income allocated to common stockholders $ (2,285) $ (9,762) $ 3,118 $ (26,607) Basic weighted-average common shares outstanding 41,844 40,881 41,607 40,691 Basic (loss) income per common share $ (0.05) $ (0.24) $ 0.07 $ (0.65) Three Months Ended Nine Months Ended Diluted (loss) income per common share 2024 2023 2024 2023 Net (loss) income $ (2,288) $ (9,801) $ 3,124 $ (26,715) Net loss (income) allocated to participating securities 3 39 (6) 108 Net (loss) income allocated to common stockholders $ (2,285) $ (9,762) $ 3,118 $ (26,607) Basic weighted-average common shares outstanding 41,844 40,881 41,607 40,691 Effect of dilutive stock options and awards — — 1,014 — Diluted weighted-average common shares outstanding 41,844 40,881 42,621 40,691 Diluted (loss) income per common share $ (0.05) $ (0.24) $ 0.07 $ (0.65) We excluded stock options from the calculation of diluted weighted-average common shares outstanding if the per share value, including the sum of (i) the exercise price of the options and (ii) the amount of the compensation cost attributed to future services and not yet recognized, was greater than the average market price of the shares because the inclusion of these stock options would be antidilutive to loss per common share. For the three months ended September 30, 2024 all stock options and awards were excluded from the calculation of diluted weighted-average common shares outstanding as these would be antidilutive due to the net loss. For the nine months ended September 30, 2024 591,000 potential common shares related to stock options and awards were antidilutive and excluded from the calculation of diluted weighted-average common shares outstanding. For the three and nine months ended September 30, 2023

Segment Information

Segment Information	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Segment Information	Segment Information We have two reportable segments organized according to our products and services: Medical Devices and Preservation Services. The Medical Devices segment includes external revenues from product sales of aortic stent grafts, On-X, surgical sealants, and other product revenues. Aortic stent grafts include aortic arch stent grafts, abdominal stent grafts, and synthetic vascular grafts. Aortic arch stent grafts include our E-vita ® Open NEO, E-vita Open Plus, AMDS TM , NEXUS ® , NEXUS DUO TM , E-vita Thoracic 3G, and Artivex TM . Abdominal stent grafts include our E-xtra Design Engineering, E-nside TM , E-tegra TM , E-ventus TM BX, and E-liac TM products. Surgical sealants include BioGlue ® Surgical Adhesive products. The Preservation Services segment includes external services revenues from the preservation of cardiac and vascular tissues. There are no intersegment revenues. The primary measure of segment performance, as viewed by our management, is segment gross margin or net external revenues less cost of products and preservation services. We do not segregate assets by segment; therefore, asset information is excluded from the segment disclosures below. The following table summarizes revenues, cost of products and preservation services, and gross margins for our operating segments (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 Revenues: Medical devices $ 71,244 $ 63,747 $ 215,568 $ 192,041 Preservation services 24,535 24,107 75,661 68,293 Total revenues 95,779 87,854 291,229 260,334 Cost of products and preservation services: Medical devices 24,412 21,574 72,707 62,084 Preservation services 10,358 10,010 31,243 30,169 Total cost of products and preservation services 34,770 31,584 103,950 92,253 Gross margin: Medical devices 46,832 42,173 142,861 129,957 Preservation services 14,177 14,097 44,418 38,124 Total gross margin $ 61,009 $ 56,270 $ 187,279 $ 168,081 The following table summarizes net revenues by product and service (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 Products: Aortic stent grafts $ 28,643 $ 25,523 $ 92,936 $ 80,032 On-X 21,478 18,744 61,804 54,346 Surgical sealants 18,437 16,234 53,963 49,503 Other 2,686 3,246 6,865 8,160 Total products 71,244 63,747 215,568 192,041 Preservation services 24,535 24,107 75,661 68,293 Total revenues $ 95,779 $ 87,854 $ 291,229 $ 260,334

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2024
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events Endospan Loan Amendment Second Tranche Funding

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net income (loss)	$ (2,288)	$ (9,801)	$ 3,124	$ (26,715)

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended	9 Months Ended
	Sep. 30, 2024 shares	Sep. 30, 2024 shares
Trading Arrangements, by Individual
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Andrew M. Green [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		on August 13, 2024, Andrew M. Green, our Vice President, Regulatory Affairs, adopted a trading arrangement pursuant to which he may sell up to 10,000 shares of the Company’s common stock from November 12, 2024 to May 24, 2025;
Name	Andrew M. Green
Title	Vice President, Regulatory Affairs
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 13, 2024
Expiration Date	May 24, 2025
Arrangement Duration	193 days
Aggregate Available	10,000	10,000
J. Patrick Mackin [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		on August 30, 2024, J. Patrick Mackin, our Chairman, President, and Chief Executive Officer, adopted a trading arrangement pursuant to which he may sell up to 75,615 shares of the Company’s common stock from November 29, 2024 to March 12, 2025;
Name	J. Patrick Mackin
Title	Chairman, President, and Chief Executive Officer
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 30, 2024
Expiration Date	March 12, 2025
Arrangement Duration	103 days
Aggregate Available	75,615	75,615
Jean F. Holloway, Esq. [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		on August 30, 2024, Jean F. Holloway, Esq. our Senior Vice President, General Counsel, Chief Compliance Officer, and Corporate Secretary, adopted a trading arrangement pursuant to which she may sell up to 19,092 shares of the Company’s common stock from November 29, 2024 to March 12, 2025;
Name	Jean F. Holloway, Esq.
Title	Senior Vice President, General Counsel, Chief Compliance Officer, and Corporate Secretary
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 30, 2024
Expiration Date	March 12, 2025
Arrangement Duration	103 days
Aggregate Available	19,092	19,092
John E. Davis [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		on August 30, 2024, John E. Davis, our Chief Commercial Officer, adopted a trading arrangement pursuant to which he may sell up to 15,910 shares of the Company’s common stock from November 29, 2024 to March 12, 2025.
Name	John E. Davis
Title	Chief Commercial Officer
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 30, 2024
Expiration Date	March 12, 2025
Arrangement Duration	103 days
Aggregate Available	15,910	15,910

Basis of Presentation and Sum_2

Basis of Presentation and Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Accounting	The accompanying Condensed Consolidated Financial Statements include the accounts of Artivion, Inc. and its subsidiaries (“Artivion,” the “Company,” “we,” or “us”). All significant intercompany accounts and transactions have been eliminated in consolidation. The accompanying Consolidated Balance Sheet as of December 31, 2023 has been derived from audited financial statements. The accompanying unaudited Condensed Consolidated Financial Statements as of, and for the three and nine months ended, September 30, 2024 and 2023 have been prepared in accordance with (i) accounting principles generally accepted in the United States of America (“US GAAP”) for interim financial information and (ii) the instructions to Form 10-Q and Rule 10-01 of Regulation S-X of the US Securities and Exchange Commission (the “SEC”). Accordingly, such statements do not include all the information and disclosures that are required by US GAAP for a complete presentation of financial statements. In the opinion of management, all adjustments (including those of a normal, recurring nature) considered necessary for a fair presentation have been included. Certain prior-year amounts have been reclassified to conform to the current year presentation. Operating results for the three and nine months ended September 30, 2024 are not necessarily indicative of the results that may be expected for the year ending December 31, 2024. These Condensed Consolidated Financial Statements should be read in conjunction with the Consolidated Financial Statements and Notes included in Artivion’s Annual Report on Form 10-K for the year ended December 31, 2023 filed with the SEC on February 23, 2024.
New Accounting Standards	New Accounting Standards Not Yet Effective In December 2023 the FASB issued ASU 2023-09, Income Taxes Topic 740 - Improvements to Income Tax Disclosures . This amendment is expected to enhance the transparency and decision usefulness of income tax disclosures by requiring public business entities, on an annual basis, to disclose specific categories in the rate reconciliation, additional information for reconciling items that meet a quantitative threshold, and certain information about income taxes paid. This revised guidance is effective for financial statements issued for fiscal years beginning after December 15, 2024. We are currently evaluating the impacts of the new standard. In November 2023 the FASB issued ASU 2023-07, Segment Reporting Topic 280 - Improvements to Reportable Segment Disclosures. This amendment requires disclosure of incremental segment information on an annual and interim basis. This ASU is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, and requires retrospective application to all prior periods presented in the financial statements. We are currently evaluating the impacts of the new standard.

Financial Instruments (Tables)

Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2024
Fair Value Disclosures [Abstract]
Schedule of Financial Instruments Measured at Fair Value	The following is a summary of our financial instruments measured at fair value on a recurring basis (in thousands): September 30, 2024 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 21,487 $ — $ — $ 21,487 Certificates of deposit 3,490 — — 3,490 Endospan Loans — — 4,059 4,059 Total assets $ 24,977 $ — $ 4,059 $ 29,036 Long-term liabilities: Contingent consideration — — (51,720) (51,720) Total liabilities $ — $ — $ (51,720) $ (51,720) December 31, 2023 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 22,802 $ — $ — $ 22,802 Certificates of deposit 3,968 — — 3,968 Total assets $ 26,770 $ — $ — $ 26,770 Long-term liabilities: Contingent consideration — — (63,890) (63,890) Total liabilities $ — $ — $ (63,890) $ (63,890)
Schedule of Reconciliation of Changes in Fair Value of Level 3 Liabilities	Changes in fair value of Level 3 assets and liabilities are listed in the tables below (in thousands): Endospan Loans Balance as of December 31, 2023 — Initial value of Endospan Loans 3,517 Change in valuation 542 Balance as of September 30, 2024 $ 4,059 Contingent Consideration Balance as of December 31, 2023 $ (63,890) Change in valuation 12,170 Balance as of September 30, 2024 $ (51,720)

Inventories, Net And Deferred_2

Inventories, Net And Deferred Preservation Costs (Tables)	9 Months Ended
	Sep. 30, 2024
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories, net at September 30, 2024 and December 31, 2023 were comprised of the following (in thousands): September 30, December 31, Raw materials and supplies $ 36,037 $ 36,907 Work-in-process 15,602 12,687 Finished goods 32,484 32,382 Total inventories, net $ 84,123 $ 81,976

Goodwill and Other Intangible_2

Goodwill and Other Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Carrying Values of Indefinite Lived Intangible Assets	As of September 30, 2024 and December 31, 2023 the carrying values of our indefinite lived intangible assets were as follows (in thousands): September 30, December 31, Goodwill $ 248,745 $ 247,337 In-process R&D 2,183 2,154 Procurement contracts and agreements 2,013 2,013
Schedule of Goodwill by Reportable Segment	As of September 30, 2024 and December 31, 2023 the carrying value of goodwill, all of which is related to our Medical Devices segment, was as follows (in thousands): Medical Devices Segment Balance as of December 31, 2023 $ 247,337 Foreign currency translation 1,408 Balance as of September 30, 2024 $ 248,745
Schedule of Gross Carrying Values, Accumulated Amortization, and Approximate Amortization Period of Definite Lived Intangible Assets	As of September 30, 2024 and December 31, 2023 the gross carrying values, accumulated amortization, and approximate amortization period of our definite lived intangible assets were as follows (in thousands, except weighted average useful life): September 30, 2024 Gross Carrying Accumulated Net Carrying Weighted Average Acquired technology $ 203,219 $ 68,167 $ 135,052 18.2 Other intangibles: Customer lists and relationships 28,754 11,342 17,412 21.6 Distribution and manufacturing rights and know-how 9,735 9,279 456 5.0 Patents 4,422 3,261 1,161 17.0 Other 11,541 5,239 6,302 5.0 Total other intangibles $ 54,452 $ 29,121 $ 25,331 9.3 December 31, 2023 Gross Carrying Accumulated Net Carrying Weighted Average Acquired technology $ 201,897 $ 59,304 $ 142,593 18.2 Other intangibles: Customer lists and relationships 28,729 10,334 18,395 21.6 Distribution and manufacturing rights and know-how 9,608 7,807 1,801 5.0 Patents 4,365 3,225 1,140 17.0 Other 7,815 3,680 4,135 5.0 Total other intangibles $ 50,517 $ 25,046 $ 25,471 10.0
Schedule of Amortization Expense	The following is a summary of amortization expense as recorded in General, administrative, and marketing expenses on our Condensed Consolidated Statement of Operations and Comprehensive Income (Loss) (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 Amortization expense $ 3,990 $ 3,766 $ 11,650 $ 11,453
Schedule of Amortization of Intangible Assets for Next Five Years	As of September 30, 2024 scheduled amortization of intangible assets for the next five years is as follows (in thousands): Remainder 2025 2026 2027 2028 2029 Total Amortization expense $ 4,073 $ 13,634 $ 13,249 $ 13,140 $ 12,944 $ 12,745 $ 69,785

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2024
Leases [Abstract]
Schedule of Supplemental Balance Sheet Information Related to Leases	Information related to leases included in the Condensed Consolidated Balance Sheets was as follows (in thousands, except lease term and discount rate): Operating leases: September 30, December 31, Operating lease right-of-use assets, net $ 41,206 $ 43,822 Current maturities of operating leases $ 4,513 $ 3,395 Non-current maturities of operating leases 41,440 43,977 Total operating lease liabilities $ 45,953 $ 47,372 Finance leases: Property and equipment, at cost $ 7,218 $ 6,862 Accumulated amortization (3,637) (3,136) Property and equipment, net $ 3,581 $ 3,726 Current maturities of finance leases $ 650 $ 582 Non-current maturities of finance leases 3,194 3,405 Total finance lease liabilities $ 3,844 $ 3,987 Weighted average remaining lease term (in years): Operating leases 9.8 10.4 Finance leases 5.9 6.8 Weighted average discount rate: Operating leases 6.3% 6.3% Finance leases 2.3% 2.2%
Schedule of Lease Costs	A summary of lease expenses for our finance and operating leases included in General, administrative, and marketing expenses on our Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) was as follows (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 Amortization of property and equipment $ 159 $ 136 $ 468 $ 400 Interest expense on finance leases 22 20 67 62 Total finance lease expense 181 156 535 462 Operating lease expense 1,963 1,836 5,860 5,467 Sublease income (133) (87) (332) (101) Total lease expense $ 2,011 $ 1,905 $ 6,063 $ 5,828 A summary of our cash flow information related to leases was as follows (in thousands): Nine Months Ended Cash paid for amounts included in the measurement of lease liabilities: 2024 2023 Operating cash flows for operating leases $ 5,798 $ 5,422 Financing cash flows for finance leases 469 396 Operating cash flows for finance leases 67 62
Schedule of Lessee, Operating Lease, Liability, Maturity	Future minimum lease payments are as follows (in thousands): Finance Operating Remainder of 2024 $ 183 $ 1,546 2025 721 7,516 2026 700 6,976 2027 688 6,288 2028 652 5,934 Thereafter 1,155 34,021 Total minimum lease payments 4,099 62,281 Less amount representing interest (255) (16,328) Present value of net minimum lease payments 3,844 45,953 Less current maturities (650) (4,513) Lease liabilities, less current maturities $ 3,194 $ 41,440
Schedule of Finance Lease, Liability, Fiscal Year Maturity	Future minimum lease payments are as follows (in thousands): Finance Operating Remainder of 2024 $ 183 $ 1,546 2025 721 7,516 2026 700 6,976 2027 688 6,288 2028 652 5,934 Thereafter 1,155 34,021 Total minimum lease payments 4,099 62,281 Less amount representing interest (255) (16,328) Present value of net minimum lease payments 3,844 45,953 Less current maturities (650) (4,513) Lease liabilities, less current maturities $ 3,194 $ 41,440

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Schedule of Short-Term and Long-Term Balances of Term Loan	The short-term and long-term balances of our Initial Term Loan Facility, Revolving Credit Facility, Convertible Senior Notes, and other long-term borrowings were as follows (in thousands): September 30, December 31, Initial Term Loan Facility $ 190,000 $ — Revolving Credit Facility 30,000 — Convertible Senior Notes 100,000 100,000 Term loan balance — 211,500 2.45% Sparkasse Zollernalb (KFW Loan 1) — 61 1.40% Sparkasse Zollernalb (KFW Loan 2) 280 484 Total loan balance 320,280 312,045 Less unamortized loan origination costs (6,312) (5,063) Net borrowings 313,968 306,982 Less short-term Convertible Senior Notes, net (99,418) — Less short-term loan balance, net (280) (1,451) Long-term loan balance, net $ 214,270 $ 305,531

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2024
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	Net revenues by geographic location based on the location of the customer for the three and nine months ended September 30, 2024 and 2023 were as follows (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 North America $ 49,089 $ 48,028 $ 148,679 $ 137,541 EMEA 30,423 26,536 98,156 84,608 APAC 10,366 8,402 27,628 24,655 LATAM 5,901 4,888 16,766 13,530 Total revenues $ 95,779 $ 87,854 $ 291,229 $ 260,334

Stock Compensation (Tables)

Stock Compensation (Tables)	9 Months Ended
	Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]
Schedule of Weighted-Average Assumptions Used to Determine the Fair Value of Options	The following weighted-average assumptions were used to determine the fair value of shares purchased under the ESPP: Three Months Ended Nine Months Ended ESPP ESPP Expected life 0.5 Years 0.5 Years Expected stock price volatility 0.36 0.48 Risk-free interest rate 5.37% 5.26%
Schedule of Total Stock Compensation Expenses	The following table summarizes total stock compensation expenses prior to the capitalization of amounts into Inventory and Deferred preservation costs (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 RSA, RSU, and PSU expense $ 3,364 $ 2,647 $ 10,222 $ 8,685 Stock option and ESPP expense 576 745 1,846 2,340 Total stock compensation expense $ 3,940 $ 3,392 $ 12,068 $ 11,025

(Loss) Income Per Common Share

(Loss) Income Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Schedule of Computation of Basic and Diluted (Loss) Income Per Common Share	The following table sets forth the computation of basic and diluted (loss) income per common share (in thousands, except per share data): Three Months Ended Nine Months Ended Basic (loss) income per common share 2024 2023 2024 2023 Net (loss) income $ (2,288) $ (9,801) $ 3,124 $ (26,715) Net loss (income) allocated to participating securities 3 39 (6) 108 Net (loss) income allocated to common stockholders $ (2,285) $ (9,762) $ 3,118 $ (26,607) Basic weighted-average common shares outstanding 41,844 40,881 41,607 40,691 Basic (loss) income per common share $ (0.05) $ (0.24) $ 0.07 $ (0.65) Three Months Ended Nine Months Ended Diluted (loss) income per common share 2024 2023 2024 2023 Net (loss) income $ (2,288) $ (9,801) $ 3,124 $ (26,715) Net loss (income) allocated to participating securities 3 39 (6) 108 Net (loss) income allocated to common stockholders $ (2,285) $ (9,762) $ 3,118 $ (26,607) Basic weighted-average common shares outstanding 41,844 40,881 41,607 40,691 Effect of dilutive stock options and awards — — 1,014 — Diluted weighted-average common shares outstanding 41,844 40,881 42,621 40,691 Diluted (loss) income per common share $ (0.05) $ (0.24) $ 0.07 $ (0.65)

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Schedule of Revenues, Cost of Products and Services, and Gross Margins for Operating Segments	The following table summarizes revenues, cost of products and preservation services, and gross margins for our operating segments (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 Revenues: Medical devices $ 71,244 $ 63,747 $ 215,568 $ 192,041 Preservation services 24,535 24,107 75,661 68,293 Total revenues 95,779 87,854 291,229 260,334 Cost of products and preservation services: Medical devices 24,412 21,574 72,707 62,084 Preservation services 10,358 10,010 31,243 30,169 Total cost of products and preservation services 34,770 31,584 103,950 92,253 Gross margin: Medical devices 46,832 42,173 142,861 129,957 Preservation services 14,177 14,097 44,418 38,124 Total gross margin $ 61,009 $ 56,270 $ 187,279 $ 168,081
Schedule of Net Revenues by Product and Service	The following table summarizes net revenues by product and service (in thousands): Three Months Ended Nine Months Ended 2024 2023 2024 2023 Products: Aortic stent grafts $ 28,643 $ 25,523 $ 92,936 $ 80,032 On-X 21,478 18,744 61,804 54,346 Surgical sealants 18,437 16,234 53,963 49,503 Other 2,686 3,246 6,865 8,160 Total products 71,244 63,747 215,568 192,041 Preservation services 24,535 24,107 75,661 68,293 Total revenues $ 95,779 $ 87,854 $ 291,229 $ 260,334

Sale of PerClot (Details)

Sale of PerClot (Details) - USD ($) $ in Thousands			3 Months Ended		9 Months Ended
	May 23, 2023	Jul. 28, 2021	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of assets					$ 0	$ 14,250
Gain (loss) on disposition			$ 0	$ 0	0	14,250
Revenue			95,779	87,854	291,229	260,334
Per Clot
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration for sale of assets		$ 41,000
Gain (loss) on disposition						14,300
Revenue			$ 994	$ 2,000	$ 2,300	$ 3,600
Per Clot | Transfer Of Perclot Manufacturing Equipment
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent consideration receivable		780
Per Clot | SMI
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent liability payment	$ 4,500	4,500
Per Clot | Upon Our Receipt of Premarket Approval
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of assets		18,800
Per Clot | Artivion Inc. And Starch Medical Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration for sale of assets		54,500
Proceeds from sale of assets	$ 18,800	25,000
Per Clot | Artivion Inc. And Starch Medical Inc. | Baxter Achievement Of Worldwide Sales
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent consideration receivable		$ 10,000
Contractual period		21 months
Per Clot | SMI
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration for sale of assets		$ 13,500
Proceeds from sale of assets		6,000
Per Clot | SMI | Baxter Achievement Of Worldwide Sales
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent consideration receivable		$ 3,000

Agreements with Endospan (Detai

Agreements with Endospan (Details)

1 Months Ended

3 Months Ended

6 Months Ended

9 Months Ended

Jul. 01, 2024 USD ($) tranche

Jun. 30, 2024 USD ($)

Sep. 11, 2019 USD ($) tranche

May 31, 2023 USD ($)

Sep. 30, 2020 USD ($)

Sep. 30, 2019 USD ($)

Sep. 30, 2024 USD ($)

Sep. 30, 2023 USD ($)

Jun. 30, 2023 USD ($)

Jun. 30, 2023 USD ($)

Sep. 30, 2024 USD ($)

Sep. 30, 2023 USD ($)

Variable Interest Entity [Line Items]

Number of tranches | tranche

3

Expense

$ (2,386,000)

$ 1,911,000

$ 6,000

$ 5,189,000

Variable Interest Entity, Primary Beneficiary

Variable Interest Entity [Line Items]

Securities purchase option agreement

$ 1,000,000

Option to purchase outstanding securities

$ 175,000,000

$ 250,000,000

Securities purchase option agreement, expiration period

90 days

Minimum amount of future consideration payment

0

Securities purchase option agreement, payment

100,000,000

Maximum amount of future consideration payment

200,000,000

Securities purchase option agreement, fair value

3,100,000

Loan provided

$ 25,000,000

$ 15,000,000

Number of tranches | tranche

3

Funding of loan agreement per tranche

5,000,000

Funded second tranche payment

$ 5,000,000

$ 5,000,000

Required percentage of number of patients before tranche of loan funding can be acquired

50%

Loans at fair value

$ 0

$ 0

Expense

$ 5,000,000

$ 5,000,000

Variable Interest Entity, Primary Beneficiary | Upfront Acquisition Purchase Price

Variable Interest Entity [Line Items]

Option to purchase outstanding securities

$ 135,000,000

Variable Interest Entity, Primary Beneficiary | Tranche One

Variable Interest Entity [Line Items]

Funding of loan agreement per tranche

7,000,000

7,000,000

Variable Interest Entity, Primary Beneficiary | Tranche Two

Variable Interest Entity [Line Items]

Funding of loan agreement per tranche

10,000,000

Variable Interest Entity, Primary Beneficiary | Tranche Three

Variable Interest Entity [Line Items]

Funding of loan agreement per tranche

$ 8,000,000

Variable Interest Entity, Primary Beneficiary | Endospan Loan | After Funding of First Tranche Payment

Variable Interest Entity [Line Items]

Loans at fair value

298,000

298,000

Variable Interest Entity, Primary Beneficiary | Endospan Loans | Tranche One

Variable Interest Entity [Line Items]

Loans at fair value

$ 3,800,000

$ 3,800,000

Variable Interest Entity, Primary Beneficiary | Minimum

Variable Interest Entity [Line Items]

Option to purchase outstanding securities

$ 350,000,000

Variable Interest Entity, Primary Beneficiary | Maximum

Variable Interest Entity [Line Items]

Option to purchase outstanding securities

$ 450,000,000

Variable Interest Entity, Primary Beneficiary | JOTEC GmbH

Variable Interest Entity [Line Items]

Distribution fee

$ 9,000,000

Financial Instruments (Schedule

Financial Instruments (Schedule of Financial Instruments Measured at Fair Value) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Total assets	$ 29,036	$ 26,770
Contingent consideration	(51,720)	(63,890)
Total liabilities	(51,720)	(63,890)
Money market funds
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents:	21,487	22,802
Certificates of deposit
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents:	3,490	3,968
Endospan Loans
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Endospan Loans	4,059
Level 1
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Total assets	24,977	26,770
Contingent consideration	0	0
Total liabilities	0	0
Level 1 | Money market funds
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents:	21,487	22,802
Level 1 | Certificates of deposit
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents:	3,490	3,968
Level 1 | Endospan Loans
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Endospan Loans	0
Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Total assets	0	0
Contingent consideration	0	0
Total liabilities	0	0
Level 2 | Money market funds
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents:	0	0
Level 2 | Certificates of deposit
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents:	0	0
Level 2 | Endospan Loans
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Endospan Loans	0
Level 3
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Total assets	4,059	0
Contingent consideration	(51,720)	(63,890)
Total liabilities	(51,720)	(63,890)
Level 3 | Money market funds
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents:	0	0
Level 3 | Certificates of deposit
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents:	0	$ 0
Level 3 | Endospan Loans
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Endospan Loans	$ 4,059

Financial Instruments (Narrativ

Financial Instruments (Narrative) (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)	Sep. 02, 2020 USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Realized investment gains (losses)	$ 0	$ 0	$ 0	$ 0
Change in fair value of contingent consideration			(12,170,000)	21,900,000
Business combination, contingent consideration, liability	51,700,000		51,700,000		$ 63,900,000
Ascyrus Medical LLC
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Percentage of outstanding equity acquired						100%
Maximum amount of future consideration payment						$ 100,000,000
Change in fair value of contingent consideration	$ 3,500,000	$ 6,200,000	$ (12,200,000)	$ 21,900,000
Ascyrus Medical LLC | Measurement Input, Discount Rate
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration, measurement input	0.16		0.16

Financial Instruments (Schedu_2

Financial Instruments (Schedule of Endospan Loan Amendment) (Details) - Variable Interest Entity, Primary Beneficiary - Level 3 $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Contingent Consideration
Balance as of December 31, 2023	$ 0
Initial value of Endospan Loans	3,517
Change in valuation	542
Balance as of September 30, 2024	$ 4,059

Financial Instruments (Schedu_3

Financial Instruments (Schedule of Reconciliation of Contingent Consideration) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Contingent Consideration
Change in valuation			$ 12,170	$ (21,900)
Ascyrus Medical LLC
Contingent Consideration
Change in valuation	$ (3,500)	$ (6,200)	12,200	$ (21,900)
Ascyrus Medical LLC | Level 3
Contingent Consideration
Beginning balance			(63,890)
Change in valuation			12,170
Ending balance	$ (51,720)		$ (51,720)

Inventories, net and Deferred_3

Inventories, net and Deferred Preservation Costs (Schedule of Inventories) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Inventory Disclosure [Abstract]
Raw materials and supplies	$ 36,037	$ 36,907
Work-in-process	15,602	12,687
Finished goods	32,484	32,382
Total inventories, net	$ 84,123	$ 81,976

Inventories, net and Deferred_4

Inventories, net and Deferred Preservation Costs (Narrative) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Inventory [Line Items]
Consignment inventory	$ 10,700	$ 10,700
Deferred preservation costs, net	50,421	49,804
Inventory valuation reserve	$ 3,700	$ 3,000
Domestic
Inventory [Line Items]
Consignment inventory percentage	40%	44%
International
Inventory [Line Items]
Consignment inventory percentage	60%	56%

Goodwill and Other Intangible_3

Goodwill and Other Intangible Assets (Schedule of Carrying Values of Indefinite Lived Intangible Assets) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Indefinite-lived Intangible Assets [Line Items]
Goodwill	$ 248,745	$ 247,337
In-process R&D
Indefinite-lived Intangible Assets [Line Items]
Total indefinite-lived intangible assets	2,183	2,154
Procurement contracts and agreements
Indefinite-lived Intangible Assets [Line Items]
Total indefinite-lived intangible assets	$ 2,013	$ 2,013

Goodwill and Other Intangible_4

Goodwill and Other Intangible Assets (Narrative) (Details) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Impairment of indefinite lived intangible assets	$ 0	$ 0

Goodwill and Other Intangible_5

Goodwill and Other Intangible Assets (Schedule of Goodwill by Reportable Segment) (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Goodwill [Roll Forward]
Beginning balance	$ 247,337
Foreign currency translation	1,408
Ending balance	$ 248,745

Goodwill and Other Intangible_6

Goodwill and Other Intangible Assets (Schedule of Gross Carrying Values, Accumulated Amortization, and Approximate Amortization Period of Definite Lived Intangible Assets) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets [Line Items]
Net Carrying Value	$ 135,052	$ 142,593
Total other intangibles
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	54,452	50,517
Accumulated Amortization	29,121	25,046
Net Carrying Value	$ 25,331	$ 25,471
Weighted Average Useful Life (Years)	9 years 3 months 18 days	10 years
Acquired technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 203,219	$ 201,897
Accumulated Amortization	68,167	59,304
Net Carrying Value	$ 135,052	$ 142,593
Weighted Average Useful Life (Years)	18 years 2 months 12 days	18 years 2 months 12 days
Customer lists and relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 28,754	$ 28,729
Accumulated Amortization	11,342	10,334
Net Carrying Value	$ 17,412	$ 18,395
Weighted Average Useful Life (Years)	21 years 7 months 6 days	21 years 7 months 6 days
Distribution and manufacturing rights and know-how
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 9,735	$ 9,608
Accumulated Amortization	9,279	7,807
Net Carrying Value	$ 456	$ 1,801
Weighted Average Useful Life (Years)	5 years	5 years
Patents
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 4,422	$ 4,365
Accumulated Amortization	3,261	3,225
Net Carrying Value	$ 1,161	$ 1,140
Weighted Average Useful Life (Years)	17 years	17 years
Other
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 11,541	$ 7,815
Accumulated Amortization	5,239	3,680
Net Carrying Value	$ 6,302	$ 4,135
Weighted Average Useful Life (Years)	5 years	5 years

Goodwill and Other Intangible_7

Goodwill and Other Intangible Assets (Schedule of Amortization Expense) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 3,990	$ 3,766	$ 11,650	$ 11,453

Goodwill and Other Intangible_8

Goodwill and Other Intangible Assets (Schedule of Amortization of Intangible Assets for Next Five Years) (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2024	$ 4,073
2025	13,634
2026	13,249
2027	13,140
2028	12,944
2029	12,745
Total	$ 69,785

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Effective income tax rate expense	81%	4%	66%	27%
Net deferred tax liability	$ 17.1		$ 17.1		$ 20.8
Valuation allowances against deferred tax assets	$ 34.4		$ 34.4		$ 32.9

Leases (Schedule of Supplementa

Leases (Schedule of Supplemental Balance Sheet Information Related to Leases) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Operating leases:
Operating lease right-of-use assets, net	$ 41,206	$ 43,822
Current maturities of operating leases	4,513	3,395
Non-current maturities of operating leases	41,440	43,977
Total operating lease liabilities	45,953	47,372
Finance leases:
Property and equipment, at cost	7,218	6,862
Accumulated amortization	(3,637)	(3,136)
Property and equipment, net	3,581	3,726
Current maturities of finance leases	650	582
Non-current maturities of finance leases	3,194	3,405
Total finance lease liabilities	$ 3,844	$ 3,987
Weighted average remaining lease term (in years):
Operating leases	9 years 9 months 18 days	10 years 4 months 24 days
Finance leases	5 years 10 months 24 days	6 years 9 months 18 days
Weighted average discount rate:
Operating leases	6.30%	6.30%
Finance leases	2.30%	2.20%

Leases (Narrative) (Details)

Leases (Narrative) (Details)	Sep. 30, 2024	Dec. 31, 2023
Leases [Abstract]
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Other Liabilities, Current	Other Liabilities, Current

Leases (Schedule of Lease Costs

Leases (Schedule of Lease Costs) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Leases [Abstract]
Amortization of property and equipment	$ 159	$ 136	$ 468	$ 400
Interest expense on finance leases	22	20	67	62
Total finance lease expense	181	156	535	462
Operating lease expense	1,963	1,836	5,860	5,467
Sublease income	(133)	(87)	(332)	(101)
Total lease expense	$ 2,011	$ 1,905	$ 6,063	$ 5,828

Leases (Schedule of Supplemen_2

Leases (Schedule of Supplemental Cash Flow Information Related to Leases) (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Leases [Abstract]
Operating cash flows for operating leases	$ 5,798	$ 5,422
Financing cash flows for finance leases	469	396
Operating cash flows for finance leases	$ 67	$ 62

Leases (Schedule of Minimum Lea

Leases (Schedule of Minimum Lease Payments for Finance, Operating, and Sublease Income Leases) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Finance Leases
Remainder of 2024	$ 183
2025	721
2026	700
2027	688
2028	652
Thereafter	1,155
Total minimum lease payments	4,099
Less amount representing interest	(255)
Present value of net minimum lease payments	3,844	$ 3,987
Less current maturities	(650)	(582)
Lease liabilities, less current maturities	3,194	3,405
Operating Leases
Remainder of 2024	1,546
2025	7,516
2026	6,976
2027	6,288
2028	5,934
Thereafter	34,021
Total minimum lease payments	62,281
Less amount representing interest	(16,328)
Present value of net minimum lease payments	45,953	47,372
Less current maturities	(4,513)	(3,395)
Lease liabilities, less current maturities	$ 41,440	$ 43,977

Debt (Narrative) (Details)

Debt (Narrative) (Details)						3 Months Ended		9 Months Ended
	Jun. 30, 2025	Jan. 18, 2024 USD ($)	Jul. 05, 2023 day	Oct. 01, 2020 day	Jun. 18, 2020 USD ($) $ / shares	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)
Line of Credit Facility [Line Items]
Secured term loan facility						$ 320,280,000		$ 320,280,000		$ 312,045,000
Payments of debt issuance costs								10,044,000	$ 0
Interest expense						8,400,000	$ 6,600,000	24,500,000	19,100,000
Non-cash debt extinguishment expense						0	0	3,669,000	0
Current portion of long-term debt						99,698,000		99,698,000		1,451,000
Long-term debt						313,968,000		313,968,000		306,982,000
For Period from Second Quarter To Fourth Quarter of Fiscal Year 2024 | Secured Debt
Line of Credit Facility [Line Items]
Debt Instrument, net leverage ratio		6.25
From First Quarter of Fiscal Year 2025 and Thereafter | Secured Debt
Line of Credit Facility [Line Items]
Debt Instrument, net leverage ratio		5.75
Secured Debt
Line of Credit Facility [Line Items]
Secured term loan facility						0		0		211,500,000
Credit Facility
Line of Credit Facility [Line Items]
Interest expense						7,100,000		19,800,000
Credit Facility | Non-cash Amortization of Debt Issuance Costs
Line of Credit Facility [Line Items]
Interest expense						358,000		997,000
Convertible Senior Notes
Line of Credit Facility [Line Items]
Face value					$ 100,000,000
Secured term loan facility						100,000,000		100,000,000		100,000,000
Interest expense						1,200,000	$ 1,200,000	3,700,000	$ 3,700,000
Unamortized debt issuance costs						$ 582,000		$ 582,000		1,100,000
Interest rate on amounts borrowed		4.25%			4.25%
Effective interest rate						5.05%		5.05%
Proceeds from issuance of convertible debt					$ 96,500,000
Conversion ratio					0.0426203
Conversion price (in dollars per share) | $ / shares					$ 23.46
Debt fair value						$ 125,400,000		$ 125,400,000
Convertible Senior Notes | Cumulative Effect, Period of Adoption, Adjustment | Accounting Standards Update 2020-06
Line of Credit Facility [Line Items]
Current portion of long-term debt						100,000,000		100,000,000
Long-term debt										$ 100,000,000
Convertible Senior Notes | Circumstance I
Line of Credit Facility [Line Items]
Conversion trading day threshold | day				20
Conversion consecutive trading day threshold | day				30
Conversion percentage of stock price threshold				130%
Convertible Senior Notes | Circumstance II
Line of Credit Facility [Line Items]
Conversion trading day threshold | day				5
Conversion consecutive trading day threshold | day				5
Conversion percentage of stock price threshold				98%
Convertible Senior Notes | Circumstance After July 5, 2023
Line of Credit Facility [Line Items]
Conversion trading day threshold | day			20
Conversion consecutive trading day threshold | day			30
Conversion percentage of stock price threshold			130%
Conversion percentage of principal amount			100%
Convertible Senior Notes | Prior to Maturity
Line of Credit Facility [Line Items]
Periodic payment, principal								0
Credit and Guaranty Agreement | Secured Debt
Line of Credit Facility [Line Items]
Face value		$ 350,000,000
Initial Term Loan Facility | Secured Debt
Line of Credit Facility [Line Items]
Face value		190,000,000
Secured term loan facility		190,000,000
Payments of debt issuance costs								6,500,000
Unamortized debt issuance costs						5,700,000		5,700,000
Delayed Draw Term Loan Facility | Secured Debt
Line of Credit Facility [Line Items]
Face value		$ 100,000,000
Debt issuance costs, net						$ 3,700,000		$ 3,700,000
Commitment fee percentage		1%
Revolving Credit Facility | Secured Debt
Line of Credit Facility [Line Items]
Effective interest rate						9.28%		9.28%
Revolving Credit Facility | Secured Debt | Base Rate
Line of Credit Facility [Line Items]
Interest rate on amounts borrowed		3%
Revolving Credit Facility | Secured Debt | SOFR
Line of Credit Facility [Line Items]
Interest rate on amounts borrowed		4%
Revolving Credit Facility | Secured Debt
Line of Credit Facility [Line Items]
Face value		$ 60,000,000
Debt instrument, unused borrowing capacity, amount		30,000,000
Secured term loan facility		$ 30,000,000
Debt issuance costs, net						$ 3,700,000		$ 3,700,000
Commitment fee percentage		0.50%
Revolving Credit Facility | Secured Debt | If Prepayment Occurs Prior To January 18, 2025
Line of Credit Facility [Line Items]
Debt prepayment premium		5%
Revolving Credit Facility | Secured Debt | If Prepayment Occurs After January 18, 2025 And Prior To January 18, 2026
Line of Credit Facility [Line Items]
Debt prepayment premium		1%
Term Loan Facilities | Secured Debt | Base Rate
Line of Credit Facility [Line Items]
Credit facility margin		5.50%
Term Loan Facilities | Secured Debt | SOFR
Line of Credit Facility [Line Items]
Credit facility margin		6.50%
Term Loan Facilities | Secured Debt
Line of Credit Facility [Line Items]
Non-cash debt extinguishment expense								$ 3,700,000
Effective interest rate						11.78%		11.78%
Term Loan Facilities | Secured Debt | Forecast
Line of Credit Facility [Line Items]
Debt Instrument, net leverage ratio	3.75
Term Loan Facilities | Secured Debt | If Certain Conditions Are Met After Q2, 2025 | Forecast
Line of Credit Facility [Line Items]
Decrease in basis spread on variable rate	25
Term Loan Facilities | Secured Debt | If Certain Conditions Are Met After Q2, 2025 | Base Rate | Forecast
Line of Credit Facility [Line Items]
Credit facility margin	5.25%
Term Loan Facilities | Secured Debt | If Certain Conditions Are Met After Q2, 2025 | SOFR | Forecast
Line of Credit Facility [Line Items]
Credit facility margin	6.25%

Debt (Schedule of Short-Term an

Debt (Schedule of Short-Term and Long-Term Balances of Term Loan) (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Jan. 18, 2024	Dec. 31, 2023	Jun. 18, 2020
Debt Instrument [Line Items]
Total loan balance	$ 320,280		$ 312,045
Less unamortized loan origination costs	(6,312)		(5,063)
Net borrowings	313,968		306,982
Less short-term Convertible Senior Notes, net	(99,418)		0
Less short-term loan balance, net	(280)		(1,451)
Long-term loan balance, net	214,270		305,531
Convertible Senior Notes
Debt Instrument [Line Items]
Total loan balance	100,000		100,000
Interest rate on amounts borrowed		4.25%		4.25%
Secured Debt
Debt Instrument [Line Items]
Total loan balance	0		211,500
2.45% Sparkasse Zollernalb (KFW Loan 1)
Debt Instrument [Line Items]
Total loan balance	$ 0		61
Interest rate on amounts borrowed	2.45%
1.40% Sparkasse Zollernalb (KFW Loan 2)
Debt Instrument [Line Items]
Total loan balance	$ 280		484
Interest rate on amounts borrowed	1.40%
Initial Term Loan Facility
Debt Instrument [Line Items]
Total loan balance	$ 190,000		0
Revolving Credit Facility
Debt Instrument [Line Items]
Total loan balance	$ 30,000		$ 0

Revenue Recognition (Schedule o

Revenue Recognition (Schedule of Disaggregation of Revenue) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
Total revenues	$ 95,779	$ 87,854	$ 291,229	$ 260,334
North America
Disaggregation of Revenue [Line Items]
Total revenues	49,089	48,028	148,679	137,541
EMEA
Disaggregation of Revenue [Line Items]
Total revenues	30,423	26,536	98,156	84,608
APAC
Disaggregation of Revenue [Line Items]
Total revenues	10,366	8,402	27,628	24,655
LATAM
Disaggregation of Revenue [Line Items]
Total revenues	$ 5,901	$ 4,888	$ 16,766	$ 13,530

Stock Compensation (Narrative)

Stock Compensation (Narrative) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Capitalized stock compensation expense	$ 171	$ 205	$ 569	$ 559
ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
ESPP, percentage of market price for eligible employees			85%
Employee stock purchase plan (in shares)	67,000	86,000	118,000	142,000
RSAs, RSUs And PSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Authorized awards from approved stock incentive plans (in shares)			778,000	616,000
Aggregate grant date market value			$ 16,100	$ 8,500
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Authorized awards from approved stock incentive plans (in shares)			0	16,000

Stock Compensation (Schedule of

Stock Compensation (Schedule of Weighted-Average Assumptions Used to Determine the Fair Value of Options) (Details) - ESPP	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected life	6 months	6 months
Expected stock price volatility	36%	48%
Risk-free interest rate	5.37%	5.26%

Stock Compensation (Schedule _2

Stock Compensation (Schedule of Total Stock Compensation Expenses) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock compensation expense	$ 3,940	$ 3,392	$ 12,068	$ 11,025
RSA, RSU, and PSU expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock compensation expense	3,364	2,647	10,222	8,685
Stock option and ESPP expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock compensation expense	$ 576	$ 745	$ 1,846	$ 2,340

(Loss) Income Per Common Shar_2

(Loss) Income Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Basic (loss) income per common share
Net (loss) income	$ (2,288)	$ (9,801)	$ 3,124	$ (26,715)
Net loss (income) allocated to participating securities	3	39	(6)	108
Net (loss) income allocated to common stockholders	$ (2,285)	$ (9,762)	$ 3,118	$ (26,607)
Basic weighted-average common shares outstanding (in shares)	41,844,000	40,881,000	41,607,000	40,691,000
Basic (loss) income per common share (in usd per share)	$ (0.05)	$ (0.24)	$ 0.07	$ (0.65)
Diluted (loss) income per common share
Net (loss) income	$ (2,288)	$ (9,801)	$ 3,124	$ (26,715)
Net loss (income) allocated to participating securities	3	39	(6)	108
Net (loss) income allocated to common stockholders	$ (2,285)	$ (9,762)	$ 3,118	$ (26,607)
Basic weighted-average common shares outstanding (in shares)	41,844,000	40,881,000	41,607,000	40,691,000
Effect of dilutive stock options and awards (in shares)	0	0	1,014,000	0
Diluted weighted-average common shares outstanding (in shares)	41,844,000	40,881,000	42,621,000	40,691,000
Diluted (loss) income per common share (in usd per share)	$ (0.05)	$ (0.24)	$ 0.07	$ (0.65)
Antidilutive shares (in shares)			591,000

Segment Information (Narrative)

Segment Information (Narrative) (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) segment	Sep. 30, 2023 USD ($)
Segment Reporting Information [Line Items]
Number of reportable segments | segment			2
Total revenues	$ 95,779,000	$ 87,854,000	$ 291,229,000	$ 260,334,000
Intersegment Eliminations
Segment Reporting Information [Line Items]
Total revenues			$ 0

Segment Information (Schedule o

Segment Information (Schedule of Revenues, Cost of Products and Services, and Gross Margins for Operating Segments) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Segment Reporting Information [Line Items]
Total revenues	$ 95,779	$ 87,854	$ 291,229	$ 260,334
Total cost of products and preservation services	34,770	31,584	103,950	92,253
Gross margin	61,009	56,270	187,279	168,081
Medical devices
Segment Reporting Information [Line Items]
Total revenues			215,568	192,041
Total cost of products and preservation services			72,707	62,084
Gross margin	46,832	42,173	142,861	129,957
Preservation services
Segment Reporting Information [Line Items]
Total revenues			75,661	68,293
Total cost of products and preservation services			31,243	30,169
Gross margin	14,177	14,097	$ 44,418	$ 38,124
Operating Segments | Medical devices
Segment Reporting Information [Line Items]
Total revenues	71,244	63,747
Total cost of products and preservation services	24,412	21,574
Operating Segments | Preservation services
Segment Reporting Information [Line Items]
Total revenues	24,535	24,107
Total cost of products and preservation services	$ 10,358	$ 10,010

Segment Information (Schedule_2

Segment Information (Schedule of Net Revenues by Product and Service) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Product Information [Line Items]
Total revenues	$ 95,779	$ 87,854	$ 291,229	$ 260,334
Products
Product Information [Line Items]
Total revenues	71,244	63,747	215,568	192,041
Aortic stent grafts
Product Information [Line Items]
Total revenues	28,643	25,523	92,936	80,032
On-X
Product Information [Line Items]
Total revenues	21,478	18,744	61,804	54,346
Surgical sealants
Product Information [Line Items]
Total revenues	18,437	16,234	53,963	49,503
Other
Product Information [Line Items]
Total revenues	2,686	3,246	6,865	8,160
Preservation services
Product Information [Line Items]
Total revenues	$ 24,535	$ 24,107	$ 75,661	$ 68,293

Subsequent Events (Details)

Subsequent Events (Details) - Variable Interest Entity, Primary Beneficiary - USD ($) $ in Millions	Nov. 07, 2024	Jul. 01, 2024	Sep. 11, 2019
Subsequent Event [Line Items]
Funding of loan agreement per tranche			$ 5
Tranche Two
Subsequent Event [Line Items]
Funding of loan agreement per tranche		$ 10
Tranche Two | Subsequent Event
Subsequent Event [Line Items]
Funding of loan agreement per tranche	$ 10
Tranche Three
Subsequent Event [Line Items]
Funding of loan agreement per tranche		$ 8
Tranche Three | Subsequent Event
Subsequent Event [Line Items]
Funding of loan agreement per tranche	$ 8