Merit Medical Systems (MMSI) 10-Q 9 Aug 19 2019 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2019	Aug. 07, 2019
Cover page.
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2019
Document Transition Report	false
Entity File Number	0-18592
Entity Registrant Name	MERIT MEDICAL SYSTEMS INC
Entity Central Index Key	0000856982
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q2
Amendment Flag	false
Entity Incorporation, State or Country Code	UT
Entity Tax Identification Number	87-0447695
Entity Address, Address Line One	1600 West Merit Parkway
Entity Address, City or Town	South Jordan
Entity Address, State or Province	UT
Entity Address, Postal Zip Code	84095
City Area Code	801
Local Phone Number	253-1600
Title of 12(b) Security	Common Stock, no par
Trading Symbol	MMSI
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		55,174,922

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
CURRENT ASSETS:
Cash and cash equivalents	$ 35,182	$ 67,359
Trade receivables — net of allowance for uncollectible accounts — 2019 — $2,656 and 2018 — $2,355	156,444	137,174
Other receivables	11,520	11,879
Inventories	202,994	197,536
Prepaid expenses and current other assets	12,305	11,326
Prepaid income taxes	3,625	3,627
Income tax refund receivables	4,876	933
Total current assets	426,946	429,834
PROPERTY AND EQUIPMENT:
Land and land improvements	27,651	26,801
Buildings	153,502	151,251
Manufacturing equipment	230,315	221,029
Furniture and fixtures	57,565	54,765
Leasehold improvements	34,518	33,678
Construction-in-progress	69,370	53,491
Total property and equipment	572,921	541,015
Less accumulated depreciation	(222,402)	(209,563)
Property and equipment — net	350,519	331,452
OTHER ASSETS:
Intangible assets	74,419	79,566
Goodwill	352,133	335,433
Deferred income tax assets	3,038	3,001
Right-of-use operating lease assets	79,309
Other assets	58,255	57,579
Total other assets	958,805	858,726
TOTAL	1,736,270	1,620,012
CURRENT LIABILITIES:
Trade payables	52,601	54,024
Accrued expenses	97,176	96,173
Current portion of long-term debt	15,000	22,000
Short-term operating lease liabilities	11,732
Income taxes payable	42	3,146
Total current liabilities	176,551	175,343
LONG-TERM DEBT	385,221	373,152
DEFERRED INCOME TAX LIABILITIES	60,932	56,363
LONG-TERM INCOME TAXES PAYABLE	392	392
LIABILITIES RELATED TO UNRECOGNIZED TAX BENEFITS	3,013	3,013
DEFERRED COMPENSATION PAYABLE	12,739	11,219
DEFERRED CREDITS	2,192	2,261
LONG-TERM OPERATING LEASE LIABILITIES	71,272
OTHER LONG-TERM OBLIGATIONS	73,283	65,494
Total liabilities	785,595	687,237
COMMITMENTS AND CONTINGENCIES (Notes 5, 10, 11, 14 and 15)
STOCKHOLDERS’ EQUITY:
Preferred stock — 5,000 shares authorized as of June 30, 2019 and December 31, 2018; no shares issued	0	0
Common stock, no par value; shares authorized — 2019 and 2018 - 100,000; issued and outstanding as of June 30, 2019 - 55,079 and December 31, 2018 - 54,893	579,250	571,383
Retained earnings	376,572	363,425
Accumulated other comprehensive loss	(5,147)	(2,033)
Total stockholders’ equity	950,675	932,775
TOTAL	1,736,270	1,620,012
Developed technology — net of accumulated amortization — 2019 — $125,447 and 2018 — $102,357
OTHER ASSETS:
Intangible assets	391,651	383,147
Other — net of accumulated amortization — 2019 — $56,289 and 2018 — $49,136
OTHER ASSETS:
Intangible assets	$ 74,419	$ 79,566

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
CURRENT ASSETS:
Trade receivables, allowances	$ 2,656	$ 2,355
OTHER ASSETS:
Intangibles, accumulated amortization	$ 56,289	$ 49,136
STOCKHOLDERS’ EQUITY:
Preferred stock shares authorized (in shares)	5,000,000	5,000,000
Preferred stock shares issued (in shares)	0	0
Common stock shares authorized (in shares)	100,000,000	100,000,000
Common stock shares issued (in shares)	55,079,000	54,893,000
Common stock shares outstanding (in shares)	55,079,000	54,893,000
Developed technology
OTHER ASSETS:
Intangibles, accumulated amortization	$ 125,447	$ 102,357
Other
OTHER ASSETS:
Intangibles, accumulated amortization	$ 56,289	$ 49,136

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Income Statement [Abstract]
NET SALES	$ 255,532	$ 224,810	$ 493,881	$ 427,844
COST OF SALES	143,568	124,801	277,281	239,779
GROSS PROFIT	111,964	100,009	216,600	188,065
OPERATING EXPENSES:
Selling, general and administrative	79,977	69,095	158,247	134,007
Research and development	16,332	15,316	32,375	29,638
Intangible asset impairment charge	548	0	548	0
Contingent consideration expense	2,406	178	3,181	219
Acquired in-process research and development	500	306	525	306
Total operating expenses	99,763	84,895	194,876	164,170
INCOME FROM OPERATIONS	12,201	15,114	21,724	23,895
OTHER INCOME (EXPENSE):
Interest income	342	342	698	487
Interest expense	(3,115)	(3,338)	(5,879)	(5,736)
Other expense - net	(429)	(553)	(698)	(721)
Total other expense — net	(3,202)	(3,549)	(5,879)	(5,970)
INCOME BEFORE INCOME TAXES	8,999	11,565	15,845	17,925
INCOME TAX EXPENSE	2,140	624	2,791	1,715
NET INCOME	$ 6,859	$ 10,941	$ 13,054	$ 16,210
EARNINGS PER COMMON SHARE:
Basic (in dollars per share)	$ 0.12	$ 0.22	$ 0.24	$ 0.32
Diluted (in dollars per share)	$ 0.12	$ 0.21	$ 0.23	$ 0.31
AVERAGE COMMON SHARES:
Basic (in shares)	55,017	50,473	54,967	50,376
Diluted (in shares)	56,555	52,154	56,523	52,033

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Statement of Comprehensive Income [Abstract]
Net income	$ 6,859	$ 10,941	$ 13,054	$ 16,210
Other comprehensive income (loss):
Cash flow hedges	(1,154)	881	(3,731)	2,873
Income tax benefit (expense)	297	(226)	960	(738)
Foreign currency translation adjustment	274	(4,195)	(341)	(1,603)
Income tax benefit (expense)	(16)	0	(2)	0
Total other comprehensive income (loss)	(599)	(3,540)	(3,114)	532
Total comprehensive income	$ 6,260	$ 7,401	$ 9,940	$ 16,742

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Retained Earnings	Accumulated Other Comprehensive Income (Loss)
Beginning balance at Dec. 31, 2017	$ 676,334	$ 353,392	$ 321,408	$ 1,534
Beginning balance (in shares) at Dec. 31, 2017		50,248
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	5,269		5,269
Other comprehensive income/loss	4,072			4,072
Stock-based compensation expense	1,256	$ 1,256
Options exercised	1,286	$ 1,286
Options exercised (in shares)		91
Issuance of common stock under Employee Stock Purchase Plan	294	$ 294
Issuance of common stock under Employee Stock Purchase Plans (in shares)		7
Ending balance at Mar. 31, 2018	688,511	$ 356,228	326,677	5,606
Ending balance (in shares) at Mar. 31, 2018		50,346
Beginning balance at Dec. 31, 2017	676,334	$ 353,392	321,408	1,534
Beginning balance (in shares) at Dec. 31, 2017		50,248
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	16,210
Other comprehensive income/loss	532
Shares surrendered in exchange for exercise of stock options	$ (1,684)
Shares surrendered in exchange for exercise of stock options (in shares)	(32)
Ending balance at Jun. 30, 2018	$ 699,254	$ 359,570	337,618	2,066
Ending balance (in shares) at Jun. 30, 2018		50,635
Beginning balance at Mar. 31, 2018	688,511	$ 356,228	326,677	5,606
Beginning balance (in shares) at Mar. 31, 2018		50,346
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	10,941		10,941
Other comprehensive income/loss	(3,540)			(3,540)
Stock-based compensation expense	1,565	$ 1,565
Options exercised	5,307	$ 5,307
Options exercised (in shares)		357
Issuance of common stock under Employee Stock Purchase Plan	220	$ 220
Issuance of common stock under Employee Stock Purchase Plans (in shares)		4
Shares surrendered in exchange for payment of payroll tax liabilities	(2,065)	$ (2,065)
Shares surrendered in exchange for payment of payroll tax liabilities (in shares)		(40)
Shares surrendered in exchange for exercise of stock options	(1,685)	$ (1,685)
Shares surrendered in exchange for exercise of stock options (in shares)		(32)
Ending balance at Jun. 30, 2018	699,254	$ 359,570	337,618	2,066
Ending balance (in shares) at Jun. 30, 2018		50,635
Beginning balance at Dec. 31, 2018	$ 932,775	$ 571,383	363,425	(2,033)
Beginning balance (in shares) at Dec. 31, 2018	54,893	54,893
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 6,195		6,195
Other comprehensive income/loss	(2,515)			(2,515)
Stock-based compensation expense	1,766	$ 1,766
Options exercised	1,365	$ 1,365
Options exercised (in shares)		95
Issuance of common stock under Employee Stock Purchase Plan	432	$ 432
Issuance of common stock under Employee Stock Purchase Plans (in shares)		7
Ending balance at Mar. 31, 2019	940,111	$ 574,946	369,713	(4,548)
Ending balance (in shares) at Mar. 31, 2019		54,995
Beginning balance at Dec. 31, 2018	$ 932,775	$ 571,383	363,425	(2,033)
Beginning balance (in shares) at Dec. 31, 2018	54,893	54,893
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 13,054
Other comprehensive income/loss	(3,114)
Shares surrendered in exchange for exercise of stock options	$ 0
Shares surrendered in exchange for exercise of stock options (in shares)	0
Ending balance at Jun. 30, 2019	$ 950,675	$ 579,250	376,572	(5,147)
Ending balance (in shares) at Jun. 30, 2019	55,079	55,079
Beginning balance at Mar. 31, 2019	$ 940,111	$ 574,946	369,713	(4,548)
Beginning balance (in shares) at Mar. 31, 2019		54,995
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	6,859		6,859
Other comprehensive income/loss	(599)			(599)
Stock-based compensation expense	2,523	$ 2,523
Options exercised	1,441	$ 1,441
Options exercised (in shares)		78
Issuance of common stock under Employee Stock Purchase Plan	340	$ 340
Issuance of common stock under Employee Stock Purchase Plans (in shares)		6
Ending balance at Jun. 30, 2019	$ 950,675	$ 579,250	$ 376,572	$ (5,147)
Ending balance (in shares) at Jun. 30, 2019	55,079	55,079

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	$ 13,054	$ 16,210
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	45,010	32,779
Loss on sales and/or abandonment of property and equipment	803	371
Amortization of right-of-use operating lease assets	5,874
Write-off of patents and intangible assets	594	86
Acquired in-process research and development	525	306
Amortization of deferred credits	(70)	(71)
Amortization of long-term debt issuance costs	402	402
Stock-based compensation expense	4,289	2,821
Changes in operating assets and liabilities, net of effects from acquisitions:
Trade receivables	(21,206)	(27,947)
Other receivables	427	966
Inventories	(5,138)	(7,189)
Prepaid expenses and other current assets	(1,052)	(3,105)
Prepaid income taxes	(45)	(100)
Income tax refund receivables	(3,980)	(1,146)
Other assets	(2,845)	(751)
Trade payables	1,338	15,767
Accrued expenses	1,925	7,467
Income taxes payable	(2,059)	(2,076)
Deferred compensation payable	1,518	438
Operating lease liabilities	(5,882)
Other long-term obligations	2,208	(179)
Total adjustments	22,636	18,839
Net cash provided by operating activities	35,690	35,049
Capital expenditures for:
Property and equipment	(35,959)	(31,559)
Intangible assets	(1,607)	(1,755)
Proceeds from the sale of property and equipment	22	4
Issuance of note receivable	0	(10,500)
Cash paid in acquisitions, net of cash acquired	(37,256)	(118,654)
Net cash used in investing activities	(74,800)	(162,464)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock	3,374	3,251
Proceeds from issuance of long-term debt	125,746	320,827
Payments on long-term debt	(120,746)	(185,827)
Contingent payments related to acquisitions	(611)	(130)
Net cash provided by financing activities	7,763	138,121
EFFECT OF EXCHANGE RATES ON CASH	(830)	470
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS	(32,177)	11,176
CASH AND CASH EQUIVALENTS:
Beginning of period	67,359	32,336
End of period	35,182	43,512
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Interest (net of capitalized interest of $540 and $314, respectively)	5,794	5,714
Income taxes	8,856	5,141
SUPPLEMENTAL DISCLOSURES OF NON-CASH INVESTING AND FINANCING ACTIVITIES
Property and equipment purchases in accounts payable	3,331	3,943
Acquisition purchases in accrued expenses and other long-term obligations	8,400	0
Merit common stock surrendered (0 and 32 shares, respectively) in exchange for exercise of stock options	0	$ 1,684
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 2,927

CONSOLIDATED STATEMENTS OF CA_2

CONSOLIDATED STATEMENTS OF CASH FLOWS (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Statement of Cash Flows [Abstract]
Net capitalized interest	$ 540	$ 314
Shares surrendered in exchange for exercise of stock options (in shares)	0	32

Basis of Presentation

Basis of Presentation	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation. The interim consolidated financial statements of Merit Medical Systems, Inc. ("Merit," "we" or "us") for the three and six-month periods ended June 30, 2019 and 2018 are not audited. Our consolidated financial statements are prepared in accordance with the requirements for unaudited interim periods and, consequently, do not include all disclosures required to be made in conformity with accounting principles generally accepted in the United States of America. In the opinion of our management, the accompanying consolidated financial statements contain all adjustments, consisting of normal recurring accruals, necessary for a fair presentation of our financial position as of June 30, 2019 and December 31, 2018 , and our results of operations and cash flows for the three and six-month periods ended June 30, 2019 and 2018 . The results of operations for the three and six-month periods ended June 30, 2019 and 2018 are not necessarily indicative of the results for a full-year period. These interim consolidated financial statements should be read in conjunction with the financial statements included in our Annual Report on Form 10-K (the "2018 Form 10-K") for the year ended December 31, 2018 , which was filed with the Securities and Exchange Commission (the "SEC") on March 1, 2019 .

Inventories

Inventories	6 Months Ended
	Jun. 30, 2019
Inventory Disclosure [Abstract]
Inventories	Inventories. Inventories at June 30, 2019 and December 31, 2018 , consisted of the following (in thousands): June 30, December 31, 2019 2018 Finished goods $ 116,741 $ 117,703 Work-in-process 23,419 14,380 Raw materials 62,834 65,453 Total Inventories $ 202,994 $ 197,536

Stock-Based Compensation Expens

Stock-Based Compensation Expense	6 Months Ended
	Jun. 30, 2019
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation Expense	Stock-Based Compensation Expense. The stock-based compensation expense before income tax expense for the three and six months ended June 30, 2019 and 2018 consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Cost of sales $ 355 $ 232 $ 607 $ 416 Research and development 281 147 473 271 Selling, general and administrative 1,887 1,186 3,209 2,134 Stock-based compensation expense before taxes $ 2,523 $ 1,565 $ 4,289 $ 2,821 We recognize stock-based compensation expense (net of a forfeiture rate) for those awards which are expected to vest on a straight-line basis over the requisite service period. We estimate the forfeiture rate based on our historical experience and expectations about future forfeitures. As of June 30, 2019 , the total remaining unrecognized compensation cost related to non-vested stock options, net of expected forfeitures, was approximately $32.4 million and was expected to be recognized over a weighted average period of 3.32 years. During the three and six-month periods ended June 30, 2019 , we granted stock-based awards representing 190,000 and approximately 1.1 million shares of our common stock, respectively. During the three and six-month periods ended June 30, 2018 , we granted stock-based awards representing 200,000 and 692,002 shares of our common stock, respectively. We use the Black-Scholes methodology to value the stock-based compensation expense for options. In applying the Black-Scholes methodology to the option grants, the fair value of our stock-based awards granted was estimated using the following assumptions for the periods indicated below: Six Months Ended June 30, 2019 2018 Risk-free interest rate 1.90% - 2.56% 2.63% - 2.77% Expected option term 3.0 - 5.0 years 5.0 years Expected dividend yield — — Expected price volatility 28.66% - 33.69% 34.06% - 34.32%

Earnings Per Common Share (EPS)

Earnings Per Common Share (EPS)	6 Months Ended
	Jun. 30, 2019
Earnings Per Share, Basic and Diluted [Abstract]
Earnings Per Common Share (EPS)	Earnings Per Common Share (EPS). The computation of weighted average shares outstanding and the basic and diluted earnings per common share consisted of the following (in thousands, except per share amounts): Three Months Six Months Net Income Shares Per Share Amount Net Income Shares Per Share Amount Period ended June 30, 2019: Basic EPS $ 6,859 55,017 $ 0.12 $ 13,054 54,967 $ 0.24 Effect of dilutive stock options 1,538 1,556 Diluted EPS $ 6,859 56,555 $ 0.12 $ 13,054 56,523 $ 0.23 Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive 1,185 1,081 Period ended June 30, 2018: Basic EPS $ 10,941 50,473 $ 0.22 $ 16,210 50,376 $ 0.32 Effect of dilutive stock options 1,681 1,657 Diluted EPS $ 10,941 52,154 $ 0.21 $ 16,210 52,033 $ 0.31 Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive 535 359

Acquisitions

Acquisitions	6 Months Ended
	Jun. 30, 2019
Business Combinations [Abstract]
Acquisitions	Acquisitions. On June 14, 2019, we consummated an acquisition transaction contemplated by a merger agreement to acquire Brightwater Medical, Inc. ("Brightwater"). The purchase consideration consisted of an upfront payment of $35 million plus an initial working capital adjustment of approximately $104,000 in cash, with potential earn-out payments of up to an additional $5 million for achievement of CE certification with respect to the Brightwater device and up to an additional $10 million for the achievement of sales milestones specified in the merger agreement. Brightwater developed and commercialized the ConvertX®, a single-use device used to replace a series of devices and procedures used to treat severe obstructions of the ureter. The ConvertX system is designed to be implanted once and converted from a nephroureteral catheter to a nephroureteral stent without requiring sedation or local anesthesia. Brightwater recently received FDA clearance for the ConvertX biliary stent system. We accounted for this acquisition as a business combination. The sales and results of operations related to the acquisition have been included in our cardiovascular segment since the acquisition date and were not material. Acquisition-related costs associated with the Brightwater acquisition, which were included in selling, general and administrative expenses, were not material. The purchase price was preliminarily allocated as follows (in thousands): Assets Acquired Trade receivables $ 94 Inventories 349 Property and equipment 409 Other long-term assets 30 Intangibles Developed technology 31,680 Customer lists 83 Trademarks 250 Goodwill 16,950 Total assets acquired 49,845 Liabilities Assumed Trade payables (58 ) Accrued expenses (261 ) Other long-term obligations (1,522 ) Deferred income tax liabilities (4,590 ) Total liabilities assumed (6,431 ) Total net assets acquired $ 43,414 We are amortizing the developed technology intangible asset acquired from Brightwater over 13 years , the related trademarks over five years and the customer list on an accelerated basis over one year . The total weighted-average amortization period for these acquired intangible assets is approximately 12.9 years . On March 28, 2019, we paid $2 million to acquire convertible participating preferred shares of Fluidx Medical Technology, LLC ("Fluidx"), owner of certain technology proposed to be used in the development of embolic and adhesive agents for use in arterial, venous, vascular graft and cardiovascular applications inside and outside the heart and related appendages. Our investment in Fluidx has been recorded as an equity investment accounted for at cost and reflected within other assets in our accompanying consolidated balance sheet because we are not able to exercise significant influence over the operations of Fluidx. Our total current investment in Fluidx represents an ownership of approximately 12.7% of the outstanding equity interests of Fluidx. On December 14, 2018, we consummated an acquisition transaction contemplated by an asset purchase agreement with Vascular Insights, LLC and VI Management, Inc. (combined "Vascular Insights") and acquired Vascular Insight's intellectual property rights, inventory and certain other assets, including, the ClariVein® IC system and the ClariVein OC system. The ClariVein systems are specialty infusion and occlusion catheter systems with rotating wire tips designed for the controlled 360-degree dispersion of physician-specified agents to the targeted treatment area. We accounted for this acquisition as a business combination. The purchase consideration included an upfront payment of $40 million , and we are obligated to pay up to an additional $20 million based on achieving certain revenue milestones specified in the asset purchase agreement. The sales and results of operations related to this acquisition have been included in our cardiovascular segment. During the three and six-month periods ended June 30, 2019 , net sales of products acquired from Vascular Insights were approximately $1.7 million and $3.2 million , respectively. It is not practical to separately report earnings related to the products acquired from Vascular Insights, as we cannot split out sales costs related solely to the products we acquired from Vascular Insights, principally because our sales representatives sell multiple products (including the products we acquired from Vascular Insights) in our cardiovascular business segment. Acquisition-related costs associated with the Vascular Insights acquisition, which were included in selling, general and administrative expenses during the year ended December 31, 2018, were not material. The purchase price was preliminarily allocated as follows (in thousands): Inventories $ 1,353 Intangibles Developed technology 32,750 Customer list 840 Trademarks 1,410 Goodwill 21,847 Total net assets acquired $ 58,200 We are amortizing the developed technology intangible asset acquired from Vascular Insights over 12 years , the related trademarks over nine years and the customer list on an accelerated basis over eight years . The total weighted-average amortization period for these acquired intangible assets is approximately 11.8 years . On November 13, 2018, we consummated an acquisition transaction contemplated by a merger agreement to acquire Cianna Medical, Inc. ("Cianna Medical"). The purchase consideration consisted of an upfront payment of $135 million plus a final working capital adjustment of approximately $1.2 million in cash, with potential earn-out payments of up to an additional $15 million for achievement of supply chain and scalability metrics and up to an additional $50 million for the achievement of sales milestones specified in the merger agreement. Cianna Medical developed the first non-radioactive, wire-free breast cancer localization system. Its SCOUT® and SAVI® Brachy technologies are FDA-cleared and address unmet needs in the delivery of radiation therapy, tumor localization and surgical guidance. We accounted for this acquisition as a business combination. During the three and six-month periods ended June 30, 2019 , net sales of Cianna Medical products were approximately $11.2 million and $24.1 million , respectively. It is not practical to separately report earnings related to the products acquired from Cianna Medical, as we cannot split out sales costs related solely to the products we acquired from Cianna Medical, principally because our sales representatives sell multiple products (including the products we acquired from Cianna Medical) in our cardiovascular business segment. Acquisition-related costs associated with the Cianna Medical acquisition, which were included in selling, general and administrative expenses during the year ended December 31, 2018, were approximately $3.5 million . The following table summarizes the preliminary purchase price allocated to the net assets acquired from Cianna Medical (in thousands): Assets Acquired Trade receivables $ 6,151 Inventories 5,803 Prepaid expenses and other current assets 315 Property and equipment 1,047 Other long-term assets 14 Intangibles Developed technology 134,510 Customer lists 3,330 Trademarks 7,080 Goodwill 65,802 Total assets acquired 224,052 Liabilities Assumed Trade payables (1,497 ) Accrued expenses (2,384 ) Other long-term liabilities (1,527 ) Deferred income tax liabilities (30,363 ) Total liabilities assumed (35,771 ) Total net assets acquired $ 188,281 We are amortizing the developed technology intangible assets of Cianna Medical over 11 years , the related trademarks over ten years and the customer lists on an accelerated basis over eight years . The total weighted-average amortization period for these acquired intangible assets is approximately 10.7 years . On May 23, 2018, we entered into an asset purchase agreement with DirectACCESS Medical, LLC (“DirectACCESS”) to acquire its assets, including certain product distribution agreements for the FirstChoice™ Ultra High Pressure PTA Balloon Catheter. We accounted for this acquisition as a business combination. The purchase price for the assets was approximately $7.3 million . The sales and results of operations related to the acquisition have been included in our cardiovascular segment since the acquisition date and were not material. Acquisition-related costs associated with the DirectACCESS acquisition, which were included in selling, general and administrative expenses during the year ended December 31, 2018, were not material. The purchase price was allocated as follows (in thousands): Inventories $ 971 Intangibles Developed technology 4,840 Customer list 120 Trademarks 400 Goodwill 938 Total net assets acquired $ 7,269 We are amortizing the developed technology intangible asset of DirectACCESS over ten years , the related trademarks over ten years and the customer list on an accelerated basis over five years . The total weighted-average amortization period for these acquired intangible assets is approximately 9.9 years . On February 14, 2018, we acquired certain divested assets from Becton, Dickinson and Company ("BD"), for an aggregate purchase price of $100.3 million . The assets acquired include the soft tissue core needle biopsy products sold under the tradenames of Achieve® Programmable Automatic Biopsy System, Temno® Biopsy System and Tru-Cut® Biopsy Needles, as well as the Aspira® Pleural Effusion Drainage Kits, and the Aspira® Peritoneal Drainage System. We accounted for this acquisition as a business combination. During the three and six-month periods ended June 30, 2019 , our net sales of BD products were approximately $11.8 million and $23.4 million , respectively. It is not practical to separately report earnings related to the products acquired from BD, as we cannot split out sales costs related solely to the products we acquired from BD, principally because our sales representatives sell multiple products (including the products we acquired from BD) in our cardiovascular business segment. Acquisition-related costs associated with the BD acquisition, which were included in selling, general and administrative expenses during the year ended December 31, 2018, were approximately $1.8 million . The following table summarizes the purchase price allocated to the assets acquired from BD (in thousands): Inventories $ 5,804 Property and equipment 748 Intangibles Developed technology 74,000 Customer list 4,200 Trademarks 4,900 In-process technology 2,500 Goodwill 9,728 Total net assets acquired $ 101,880 We are amortizing the developed technology intangible assets acquired from BD over eight years , the related trademarks over nine years and the customer lists on an accelerated basis over seven years . The total weighted-average amortization period for these acquired intangible assets is eight years . The following table summarizes our consolidated results of operations for the three and six-month periods ended June 30, 2018, as well as unaudited pro forma consolidated results of operations as though the acquisition of Cianna Medical and Vascular Insights had occurred on January 1, 2017 (in thousands, except per common share amounts): Three Months Ended Six Months Ended June 30, 2018 June 30, 2018 As Reported Pro Forma As Reported Pro Forma Net sales $ 224,810 $ 238,272 $ 427,844 $ 452,451 Net income 10,941 6,842 16,210 5,016 Earnings per common share: Basic $ 0.22 $ 0.14 $ 0.32 $ 0.10 Diluted $ 0.21 $ 0.13 $ 0.31 $ 0.10 * The pro forma results for the three and six-month periods ended June 30, 2019 are not included in the table above because the operating results for the Cianna Medical and Vascular Insights acquisitions were included in our consolidated statements of income for these periods. The unaudited pro forma information set forth above is for informational purposes only and includes adjustments related to the step-up of acquired inventories, amortization expense of acquired intangible assets and interest expense on long-term debt. The pro forma information should not be considered indicative of actual results that would have been achieved if the acquisition of Cianna Medical and Vascular Insights had occurred on January 1, 2017, or results that may be obtained in any future period. The pro forma consolidated results of operations do not include the acquisition of assets from BD because it was deemed impracticable to obtain information to determine net income associated with the acquired product lines which represent a small product line of a large, consolidated company without standalone financial information. The pro forma consolidated results of operations do not include the Brightwater or DirectACCESS acquisitions, as we do not deem the pro forma effect of these transactions to be material. The goodwill arising from the acquisitions discussed above consists largely of the synergies and economies of scale we hope to achieve from combining the acquired assets and operations with our historical operations. The goodwill recognized from certain acquisitions is expected to be deductible for income tax purposes.

Revenue from Contracts with Cus

Revenue from Contracts with Customers.	6 Months Ended
	Jun. 30, 2019
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers.	Revenue from Contracts with Customers. In accordance with Accounting Standards Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606) ("ASC 606"), we recognize revenue when a customer obtains control of promised goods. The amount of revenue recognized reflects the consideration we expect to receive in exchange for these goods. Disaggregation of Revenue The disaggregation of revenue is based on type of product and geographical region. For descriptions of our product offerings and segments, see Note 13 in our 2018 Form 10-K. The following tables present revenue from contracts with customers for the three and six-month periods ended June 30, 2019 and 2018 (in thousands): Three Months Ended June 30, 2019 Three Months Ended June 30, 2018 United States International Total United States International Total Cardiovascular Stand-alone devices $ 55,906 $ 47,616 $ 103,522 $ 50,941 $ 41,555 $ 92,496 Cianna Medical 11,230 7 11,237 — — — Custom kits and procedure trays 23,124 11,219 34,343 23,667 10,325 33,992 Inflation devices 8,347 15,968 24,315 8,160 16,145 24,305 Catheters 20,696 24,648 45,344 16,704 22,670 39,374 Embolization devices 5,274 8,734 14,008 5,094 7,630 12,724 CRM/EP 11,536 2,361 13,897 11,758 1,738 13,496 Total 136,113 110,553 246,666 116,324 100,063 216,387 Endoscopy Endoscopy devices 8,549 317 8,866 8,121 302 8,423 Total $ 144,662 $ 110,870 $ 255,532 $ 124,445 $ 100,365 $ 224,810 Six Months Ended June 30, 2019 Six Months Ended June 30, 2018 United States International Total United States International Total Cardiovascular Stand-alone devices $ 109,305 $ 89,643 $ 198,948 $ 94,953 $ 80,789 $ 175,742 Cianna Medical 24,078 7 24,085 — — — Custom kits and procedure trays 45,179 22,107 67,286 45,984 21,280 67,264 Inflation devices 16,320 30,013 46,333 15,828 30,896 46,724 Catheters 40,108 48,275 88,383 31,974 41,265 73,239 Embolization devices 9,980 15,855 25,835 10,126 15,184 25,310 CRM/EP 21,635 4,641 26,276 20,596 3,366 23,962 Total 266,605 210,541 477,146 219,461 192,780 412,241 Endoscopy Endoscopy devices 16,117 618 16,735 15,040 563 15,603 Total $ 282,722 $ 211,159 $ 493,881 $ 234,501 $ 193,343 $ 427,844

Segment Reporting

Segment Reporting	6 Months Ended
	Jun. 30, 2019
Segment Reporting [Abstract]
Segment Reporting	Segment Reporting. We report our operations in two operating segments: cardiovascular and endoscopy. Our cardiovascular segment consists of cardiology and radiology medical device products which assist in diagnosing and treating coronary artery disease, peripheral vascular disease and other non-vascular diseases and includes embolotherapeutic, cardiac rhythm management ("CRM"), electrophysiology ("EP"), critical care, interventional oncology and spine devices, and our Cianna Medical product line. Our endoscopy segment focuses on the gastroenterology, pulmonary and thoracic surgery specialties, with a portfolio consisting primarily of stents, dilation balloons, certain inflation devices, guide wires, and other disposable products. We evaluate the performance of our operating segments based on net sales and operating income. Financial information relating to our reportable operating segments and reconciliations to the consolidated totals for the three and six-month periods ended June 30, 2019 and 2018 , are as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net Sales Cardiovascular $ 246,666 $ 216,387 $ 477,146 $ 412,241 Endoscopy 8,866 8,423 16,735 15,603 Total net sales 255,532 224,810 493,881 427,844 Operating Income Cardiovascular 9,855 12,663 17,474 19,060 Endoscopy 2,346 2,451 4,250 4,835 Total operating income 12,201 15,114 21,724 23,895 Total other expense - net (3,202 ) (3,549 ) (5,879 ) (5,970 ) Income tax expense 2,140 624 2,791 1,715 Net income $ 6,859 $ 10,941 $ 13,054 $ 16,210

Recently Issued Financial Accou

Recently Issued Financial Accounting Standards	6 Months Ended
	Jun. 30, 2019
Accounting Policies [Abstract]
Recently Issued Financial Accounting Standards	Recently Issued Financial Accounting Standards. Recently Adopted In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, Leases (Topic 842) ("ASC 842"), which requires lessees to recognize right-of-use ("ROU") assets and related lease liabilities on the balance sheet for all leases greater than one year in duration. We adopted ASC 842 on January 1, 2019 using a modified retrospective transition approach for leases existing at, or entered into after, the beginning of the earliest comparative period presented in the financial statements. The modified retrospective approach did not require any transition accounting for leases that expired before the earliest comparative period presented. The adoption of this standard resulted in the recording of ROU assets and lease liabilities for all of our lease agreements with original terms of greater than one year. The adoption of ASC 842 did not have a significant impact on our consolidated statements of operations or cash flows. See Note 14 for the required disclosures relating to our lease agreements. In June 2018, the FASB issued ASU 2018-07, Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting , which simplifies the accounting for nonemployee share-based payment transactions by expanding the scope of ASC Topic 718, Compensation - Stock Compensation , to include share-based payment transactions for acquiring goods and services from nonemployees. Under the new standard, most of the guidance on stock compensation payments to nonemployees would be aligned with the requirements for share-based payments granted to employees. This standard became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. In February 2018, the FASB issued ASU 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from U.S. federal tax legislation commonly referred to as the Tax Cuts and Jobs Act, which was enacted in December 2017 (the "2017 Tax Act"). ASU 2018-02 became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities , which expands and refines hedge accounting for both financial and non-financial risk components, aligns the recognition and presentation of the effects of hedging instruments and hedge items in the financial statements, and includes certain targeted improvements to ease the application of current guidance related to the assessment of hedge effectiveness. ASU 2017-12 became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. Not Yet Adopted In August 2018, the FASB issued ASU 2018-15, Intangibles – Goodwill and Other – Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract, which aligns the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software (and hosting arrangements that include an internal-use software license). ASU 2018-15 is effective for annual periods beginning after December 15, 2019, including interim periods within those annual periods. Early adoption is permitted. We are currently assessing the impact of this standard on our consolidated financial statements. In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820) , which removes, modifies and adds various disclosure requirements related to fair value disclosures. Disclosures related to transfers between fair value hierarchy levels will be removed and further detail around changes in unrealized gains and losses for the period and unobservable inputs used in determining level 3 fair value measurements will be added, among other changes. ASU 2018-13 is effective for interim and annual reporting periods beginning after December 15, 2019, and early adoption is permitted. We are currently assessing the impact of this standard on our consolidated financial statements. In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, which replaces the current incurred loss impairment methodology for financial assets measured at amortized cost with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information, including forecasted information, to develop credit loss estimates. ASU 2016-13 is effective for annual periods beginning after December 15, 2019, including interim periods within those annual periods. Early adoption is permitted for annual periods beginning after December 15, 2018. We are currently assessing the impact of this standard on our consolidated financial statements. We do not believe any other issued and not yet effective accounting standards will be relevant to our consolidated financial statements.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2019
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes. Our overall effective tax rate for the three months ended June 30, 2019 and 2018 was 23.8% and 5.4% , respectively, which resulted in a provision for income taxes of approximately $2.1 million and $0.6 million , respectively. Our overall effective tax rate for the six months ended June 30, 2019 and 2018 was 17.6% and 9.6% , respectively, which resulted in a provision for income taxes of approximately $2.8 million and $1.7 million , respectively. The increase in the effective tax rate for both periods, when compared to the prior-year periods, was primarily due to a lower discrete tax benefit for share-based payment awards and a discrete expense related to the fair value adjustment of the contingent liability of a recent equity acquisition, Cianna Medical.

Revolving Credit Facility and L

Revolving Credit Facility and Long-Term Debt	6 Months Ended
	Jun. 30, 2019
Debt Disclosure [Abstract]
Revolving Credit Facility and Long-Term Debt	Revolving Credit Facility and Long-Term Debt. Principal balances outstanding under our long-term debt obligations as of June 30, 2019 and December 31, 2018 , consisted of the following (in thousands): June 30, 2019 December 31, 2018 2016 Term loan $ 65,000 $ 72,500 2016 Revolving credit loans 335,500 316,000 Collateralized debt facility — 7,000 Less unamortized debt issuance costs (279 ) (348 ) Total long-term debt 400,221 395,152 Less current portion 15,000 22,000 Long-term portion $ 385,221 $ 373,152 2016 Term Loan and Revolving Credit Loans On July 6, 2016, we entered into a Second Amended and Restated Credit Agreement (as amended to date, the “Second Amended Credit Agreement”), with Wells Fargo Bank, National Association, as administrative agent, swingline lender and a lender, and Wells Fargo Securities, LLC, as sole lead arranger and sole bookrunner. In addition to Wells Fargo Bank, National Association, Bank of America, N.A., U.S. Bank, National Association, and HSBC Bank USA, National Association, are parties to the Second Amended Credit Agreement as lenders. The Second Amended Credit Agreement amends and restates in its entirety our previously outstanding Amended and Restated Credit Agreement and all amendments thereto. The Second Amended Credit Agreement was amended on September 28, 2016 to allow for a new revolving credit loan to our wholly-owned subsidiary, on March 20, 2017 to allow flexibility in how we apply net proceeds received from equity issuances to prepay outstanding indebtedness, on December 13, 2017 to increase the revolving credit commitment by $100 million to $375 million , and on March 28, 2018 to amend certain debt covenants. The Second Amended Credit Agreement provides for a term loan of $150 million and a revolving credit commitment up to an aggregate amount of $375 million , which includes a reserve of $25 million to make swingline loans from time to time. The term loan is payable in quarterly installments in the amounts provided in the Second Amended Credit Agreement until the maturity date of July 6, 2021, at which time the term and revolving credit loans, together with accrued interest thereon, will be due and payable. At any time prior to the maturity date, we may repay any amounts owing under all revolving credit loans, term loans, and all swingline loans in whole or in part, subject to certain minimum thresholds, without premium or penalty, other than breakage costs. Revolving credit loans denominated in dollars and term loans made under the Second Amended Credit Agreement bear interest, at our election, at either a Base Rate or Eurocurrency Base Rate (as such terms are defined in the Second Amended Credit Agreement) plus the applicable margin, which increases as our Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) increases. Revolving credit loans denominated in an Alternative Currency (as defined in the Second Amended Credit Agreement) bear interest at the Eurocurrency rate plus the applicable margin. Swingline loans bear interest at the Base Rate plus the applicable margin. Upon an event of default, the interest rate may be increased by 2.0% . The revolving credit commitment also carries a commitment fee of 0.15% to 0.40% per annum on the unused portion. The Second Amended Credit Agreement is collateralized by substantially all our assets. The Second Amended Credit Agreement contains covenants, representations and warranties, and other terms customary for loans of this nature. The Second Amended Credit Agreement requires that we maintain certain financial covenants, as follows: Covenant Requirement Consolidated Total Leverage Ratio (1) January 1, 2018 and thereafter 3.5 to 1.0 Consolidated EBITDA (2) 1.25 to 1.0 Consolidated Net Income (3) $0 Facility Capital Expenditures (4) $30 million (1) Maximum Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) as of any fiscal quarter end. (2) Minimum ratio of Consolidated EBITDA (as defined in the Second Amended Credit Agreement and adjusted for certain expenditures) to Consolidated Fixed Charges (as defined in the Second Amended Credit Agreement) for any period of four consecutive fiscal quarters. (3) Minimum level of Consolidated Net Income (as defined in the Second Amended Credit Agreement) for certain periods, and subject to certain adjustments. (4) Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Second Amended Credit Agreement) in any fiscal year. Additionally, the Second Amended Credit Agreement contains customary events of default and affirmative and negative covenants for transactions of this type. As of June 30, 2019 , we believe we were in compliance with all covenants set forth in the Second Amended Credit Agreement. As of June 30, 2019 , we had outstanding borrowings of approximately $400.5 million under the Second Amended Credit Agreement, with additional available borrowings of approximately $38.7 million , based on the leverage ratio required pursuant to the Second Amended Credit Agreement. Our interest rate as of June 30, 2019 was a fixed rate of 2.37% on $175 million as a result an interest rate swap (see Note 11) and a variable floating rate of 3.65% on $225.5 million . Our interest rate as of December 31, 2018 was a fixed rate of 2.12% on $175 million as a result of an interest rate swap and a variable floating rate of 3.52% on $213.5 million . Future Payments Future minimum principal payments on our long-term debt as of June 30, 2019 , are as follows (in thousands): Years Ending Future Minimum December 31 Principal Payments Remaining 2019 $ 7,500 2020 17,500 2021 375,500 Total future minimum principal payments $ 400,500 Subsequent to June 30, 2019, the Second Amended and Restated Credit Agreement was amended and restated in its entirety. See Note 16 below.

Derivatives

Derivatives	6 Months Ended
	Jun. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivatives	Derivatives. General. Our earnings and cash flows are subject to fluctuations due to changes in interest rates and foreign currency exchange rates, and we seek to mitigate a portion of these risks by entering into derivative contracts. The derivatives we use are interest rate swaps and foreign currency forward contracts. We recognize derivatives as either assets or liabilities at fair value in the accompanying consolidated balance sheets, regardless of whether or not hedge accounting is applied. We report cash flows arising from our hedging instruments consistent with the classification of cash flows from the underlying hedged items. Accordingly, cash flows associated with our derivative instruments are classified as operating activities in the accompanying consolidated statements of cash flows. We formally document, designate and assess the effectiveness of transactions that receive hedge accounting initially and on an ongoing basis. Changes in the fair value of derivatives that qualify for hedge accounting treatment are recorded, net of applicable taxes, in accumulated other comprehensive income (loss), a component of stockholders’ equity in the accompanying consolidated balance sheets. When the hedged transaction occurs, gains or losses are reclassified into earnings in the same line item associated with the forecasted transaction and in the same period or periods during which the hedged transaction affects earnings. Changes in the fair value of derivatives not designated as hedging instruments are recorded in earnings throughout the term of the derivative. Interest Rate Risk. A portion of our debt bears interest at variable interest rates and, therefore, we are subject to variability in the cash paid for interest expense. In order to mitigate a portion of this risk, we use a hedging strategy to reduce the variability of cash flows in the interest payments associated with a portion of the variable-rate debt outstanding under our Second Amended Credit Agreement that is solely due to changes in the benchmark interest rate. Derivative Instruments Designated as Cash Flow Hedges On August 5, 2016, we entered into a pay-fixed, receive-variable interest rate swap with a current notional amount of $175 million with Wells Fargo to fix the one-month LIBOR rate at 1.12% . The variable portion of the interest rate swap is tied to the one-month LIBOR rate (the benchmark interest rate). On a monthly basis, the interest rates under both the interest rate swap and the underlying debt reset, the swap is settled with the counterparty, and interest is paid. The interest rate swap is scheduled to expire on July 6, 2021. At June 30, 2019 and December 31, 2018 , our interest rate swap qualified as a cash flow hedge. The fair value of our interest rate swap at June 30, 2019 was an asset of approximately $1.9 million , which was partially offset by approximately $0.5 million in deferred taxes. The fair value of our interest rate swap at December 31, 2018 was an asset of approximately $5.8 million , which was offset by approximately $1.5 million in deferred taxes. Foreign Currency Risk. We operate on a global basis and are exposed to the risk that our financial condition, results of operations, and cash flows could be adversely affected by changes in foreign currency exchange rates. To reduce the potential effects of foreign currency exchange rate movements on net earnings, we enter into derivative financial instruments in the form of foreign currency exchange forward contracts with major financial institutions. Our policy is to enter into foreign currency derivative contracts with maturities of up to two years. We are primarily exposed to foreign currency exchange rate risk with respect to transactions and balances denominated in Euros, British Pounds, Chinese Renminbi, Mexican Pesos, Brazilian Reals, Australian Dollars, Hong Kong Dollars, Swiss Francs, Swedish Krona, Canadian Dollars, Danish Krone, Japanese Yen, Korean Won, and Singapore Dollars. We do not use derivative financial instruments for trading or speculative purposes. We are not subject to any credit risk contingent features related to our derivative contracts, and counterparty risk is managed by allocating derivative contracts among several major financial institutions. Derivative Instruments Designated as Cash Flow Hedges We enter into forward contracts on various foreign currencies to manage the risk associated with forecasted exchange rates which impact revenues, cost of sales, and operating expenses in various international markets. The objective of the hedges is to reduce the variability of cash flows associated with the forecasted purchase or sale of the associated foreign currencies. We enter into approximately 150 cash flow foreign currency hedges every month. As of June 30, 2019 , we had entered into foreign currency forward contracts, which qualified as cash flow hedges, with the following notional amounts (in thousands and in local currencies): Currency Symbol Forward Notional Amount Australian Dollar AUD 3,430 Brazilian Real BRL 1,080 Canadian Dollar CAD 4,330 Swiss Franc CHF 1,970 Chinese Renminbi CNY 166,500 Danish Krone DKK 18,175 Euro EUR 22,600 British Pound GBP 4,820 Japanese Yen JPY 1,335,000 Korean Won KRW 4,475,000 Mexican Peso MXN 296,500 Norwegian Krone NOK 6,000 Swedish Krona SEK 29,210 Derivative Instruments Not Designated as Cash Flow Hedges We forecast our net exposure in various receivables and payables to fluctuations in the value of various currencies, and we enter into foreign currency forward contracts to mitigate that exposure. We enter into approximately 20 foreign currency fair value hedges every month. As of June 30, 2019 , we had entered into foreign currency forward contracts related to those balance sheet accounts, with the following notional amounts (in thousands and in local currencies): Currency Symbol Forward Notional Amount Australian Dollar AUD 13,788 Brazilian Real BRL 9,000 Canadian Dollar CAD 2,652 Swiss Franc CHF 643 Chinese Renminbi CNY 85,226 Danish Krone DKK 2,544 Euro EUR 11,717 British Pound GBP 5,653 Hong Kong Dollar HKD 11,000 Japanese Yen JPY 1,445,574 Korean Won KRW 6,000,000 Mexican Peso MXN 25,000 Norwegian Krone NOK 3,180 Swedish Krona SEK 17,154 Singapore Dollar SGD 1,676 South African Rand ZAR 37,800 Balance Sheet Presentation of Derivative Instruments. As of June 30, 2019 , and December 31, 2018 , all derivative instruments, both those designated as hedging instruments and those that were not designated as hedging instruments, were recorded gross at fair value on our consolidated balance sheets. We are not subject to any master netting agreements. The fair value of derivative instruments on a gross basis was as follows on the dates indicated (in thousands): Fair Value Balance Sheet Location June 30, 2019 December 31, 2018 Derivative instruments designated as hedging instruments Assets Interest rate swap Other assets (long-term) $ 1,907 $ 5,772 Foreign currency forward contracts Prepaid expenses and other assets 960 613 Foreign currency forward contracts Other assets (long-term) 244 151 Liabilities Foreign currency forward contracts Accrued expenses (778 ) (711 ) Foreign currency forward contracts Other long-term obligations (101 ) (101 ) Derivative instruments not designated as hedging instruments Assets Foreign currency forward contracts Prepaid expenses and other assets $ 229 $ 814 Liabilities Foreign currency forward contracts Accrued expenses (1,539 ) (796 ) Income Statement Presentation of Derivative Instruments. Derivative Instruments Designated as Cash Flow Hedges Derivative instruments designated as cash flow hedges had the following effects, before income taxes, on other comprehensive income and net earnings in our consolidated statements of income, consolidated statements of comprehensive income and consolidated balance sheets (in thousands): Amount of Gain/(Loss) recognized in OCI Consolidated Statements of Income Amount of Gain/(Loss) reclassified from AOCI Three Months Ended June 30, Three Months Ended June 30, Three Months Ended June 30, 2019 2018 2019 2018 2019 2018 Derivative instrument Location in statements of income Interest rate swaps $ (1,812 ) $ 748 Interest expense $ (3,115 ) $ (3,338 ) $ 602 $ 357 Foreign currency forward contracts 1,064 394 Revenue 255,532 224,810 (92 ) (234 ) Cost of sales (143,568 ) (124,801 ) (104 ) 138 Amount of Gain/(Loss) recognized in OCI Consolidated Statements of Income Amount of Gain/(Loss) reclassified from AOCI Six Months Ended June 30, Six Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 2019 2018 Derivative instrument Location in statements of income Interest rate swaps (2,669 ) $ 2,868 Interest expense (5,879 ) (5,736 ) $ 1,196 $ 570 Foreign currency forward contracts 51 568 Revenue 493,881 427,844 102 (385 ) Cost of sales (277,281 ) (239,779 ) (185 ) 378 As of June 30, 2019 , approximately $6,200 , or $4,600 after taxes, was expected to be reclassified from accumulated other comprehensive income to earnings in revenue and cost of sales over the succeeding twelve months. As of June 30, 2019 , approximately $1.3 million , or $1.0 million after taxes, was expected to be reclassified from accumulated other comprehensive income to earnings in interest expense over the succeeding twelve months. Derivative Instruments Not Designated as Hedging Instruments The following gains/(losses) from these derivative instruments were recognized in our consolidated statements of income for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, Derivative Instrument Location in statements of income 2019 2018 2019 2018 Foreign currency forward contracts Other expense $ (489 ) $ 3,153 $ (755 ) $ 2,038

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2019
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements. Our financial assets and (liabilities) carried at fair value measured on a recurring basis as of June 30, 2019 and December 31, 2018 , consisted of the following (in thousands): Fair Value Measurements Using Total Fair Quoted prices in Significant other Significant Value at active markets observable inputs unobservable inputs Description June 30, 2019 (Level 1) (Level 2) (Level 3) Interest rate contracts (1) $ 1,907 $ — $ 1,907 $ — Foreign currency contract assets, current and long-term (2) $ 1,433 $ — $ 1,433 $ — Foreign currency contract liabilities, current and long-term (3) $ (2,418 ) $ — $ (2,418 ) $ — Contingent receivable asset $ 625 $ — $ — $ 625 Contingent consideration liabilities $ (93,204 ) $ — $ — $ (93,204 ) Fair Value Measurements Using Total Fair Quoted prices in Significant other Significant Value at active markets observable inputs unobservable inputs Description December 31, 2018 (Level 1) (Level 2) (Level 3) Interest rate contracts (1) $ 5,772 $ — $ 5,772 $ — Foreign currency contract assets, current and long-term (2) $ 1,578 $ — $ 1,578 $ — Foreign currency contract liabilities, current and long-term (3) $ (1,608 ) $ — $ (1,608 ) $ — Contingent receivable asset $ 607 $ — $ — $ 607 Contingent consideration liabilities $ (82,236 ) $ — $ — $ (82,236 ) (1) The fair value of the interest rate contracts is determined using Level 2 fair value inputs and is recorded as other assets or other long-term obligations in the consolidated balance sheets. (2) The fair value of the foreign currency contract assets (including those designated as hedging instruments and those not designated as hedging instruments) is determined using Level 2 fair value inputs and is recorded as prepaid expenses and other assets or other long-term assets in the consolidated balance sheets. (3) The fair value of the foreign currency contract liabilities (including those designated as hedging instruments and those not designated as hedging instruments) is determined using Level 2 fair value inputs and is recorded as accrued expenses or other long-term obligations in the consolidated balance sheets. Certain of our business combinations involve the potential for the payment of future contingent consideration, generally based on a percentage of future product sales or upon attaining specified future revenue milestones. See Note 5 for further information regarding these acquisitions. The contingent consideration liability is re-measured at the estimated fair value at the end of each reporting period with the change in fair value recognized within operating expenses in the accompanying consolidated statements of income for such period. We measure the initial liability and re-measure the liability on a recurring basis using Level 3 inputs as defined under authoritative guidance for fair value measurements. Changes in the fair value of our contingent consideration liabilities during the three and six-month periods ended June 30, 2019 and 2018 , consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Beginning balance $ 82,457 $ 10,928 $ 82,236 $ 10,956 Contingent consideration liability recorded as the result of acquisitions (see Note 5) 8,400 — 8,380 — Fair value adjustments recorded to income 2,404 99 3,199 86 Contingent payments made (57 ) (115 ) (611 ) (130 ) Ending balance $ 93,204 $ 10,912 $ 93,204 $ 10,912 As of June 30, 2019 , approximately $68.6 million in contingent consideration liability was included in other long-term obligations and approximately $24.6 million was included in accrued expenses in our consolidated balance sheet. As of December 31, 2018 , approximately $58.5 million in contingent consideration liability was included in other long-term obligations and $23.8 million was included in accrued expenses in our consolidated balance sheet. Cash paid to settle the contingent consideration liability recognized at fair value as of the acquisition date (including measurement-period adjustments) has been reflected as a cash outflow from financing activities in the accompanying consolidated statements of cash flows. During the year ended December 31, 2016, we sold a cost method investment for cash and for the right to receive additional payments based on various contingent milestones. We determined the fair value of the contingent payments using Level 3 inputs defined under authoritative guidance for fair value measurements, and we recorded a contingent receivable asset, which as of June 30, 2019 and December 31, 2018 had a value of approximately $625,000 and $607,000 , respectively, recorded as a current asset in other receivables in our consolidated balance sheets. We record any changes in fair value to operating expenses as part of our cardiovascular segment in our consolidated statements of income. During the three and six-month periods ended June 30, 2019 , we recorded a gain (loss) on the contingent receivable of approximately $(2,000) and $18,000 , respectively. During the three and six-month periods ended June 30, 2018 , we recorded a loss of approximately $79,000 and $132,000 , respectively and received payments of approximately $0 and $153,000 , respectively related to the contingent receivable. The recurring Level 3 measurement of our contingent consideration liability and contingent receivable included the following significant unobservable inputs at June 30, 2019 and December 31, 2018 (amounts in thousands): Contingent consideration asset or liability Fair value at June 30, 2019 Valuation technique Unobservable inputs Range Revenue-based royalty $ 9,843 Discounted cash flow Discount rate 14% - 25% payments contingent liability Projected year of payments 2019-2034 Supply chain milestone $ 15,000 Scenario-based method Discount rate 3.9% contingent liability Probability of milestone payment 100% Projected year of payments 2019 Revenue milestones $ 65,661 Monte Carlo simulation Discount rate 3.1% - 19.5% contingent liability Projected year of payments 2019-2022 Regulatory approval $ 2,700 Scenario-based method Discount rate 5.3% contingent liability Probability of milestone payment 65% Projected year of payment 2022 Contingent receivable $ 625 Discounted cash flow Discount rate 10% asset Probability of milestone payment 54% Projected year of payments 2019 Contingent consideration asset or liability Fair value at December 31, 2018 Valuation technique Unobservable inputs Range Revenue-based royalty $ 10,661 Discounted cash flow Discount rate 9.9% - 25% payments contingent liability Projected year of payments 2018-2037 Supply chain milestone $ 13,593 Discounted cash flow Discount rate 5.3% contingent liability Probability of milestone payment 95% Projected year of payments 2019 Revenue milestones $ 57,982 Discounted cash flow Discount rate 3.3% - 13% contingent liability Projected year of payments 2019-2023 Contingent receivable $ 607 Discounted cash flow Discount rate 10% asset Probability of milestone payment 67% Projected year of payments 2019 The contingent consideration liability and contingent receivable are re-measured to fair value each reporting period using projected revenues, discount rates, probabilities of payment, and projected payment dates. Projected revenues are based on our most recent internal operational budgets and long-range strategic plans. An increase (decrease) in either the discount rate or the time to payment, in isolation, may result in a significantly lower (higher) fair value measurement. A decrease in the probability of any milestone payment may result in lower fair value measurements. Our determination of the fair value of the contingent consideration liability and contingent receivable could change in future periods based upon our ongoing evaluation of these significant unobservable inputs. We intend to record any such change in fair value to operating expenses in our consolidated statements of income. During the three and six-month periods ended June 30, 2019 , we had losses of approximately $594,000 and $805,000 , compared to losses of approximately $29,000 and $86,000 , respectively for the three and six-month periods ended June 30, 2018 , related to the measurement of non-financial assets at fair value on a nonrecurring basis subsequent to their initial recognition. We believe the carrying amount of cash and cash equivalents, receivables, and trade payables approximate fair value because of the immediate, short-term maturity of these financial instruments. Our long-term debt re-prices frequently due to variable rates and entails no significant changes in credit risk and, as a result, we believe the fair value of long-term debt approximates carrying value. The fair value of assets and liabilities whose carrying value approximates fair value is determined using Level 2 inputs, with the exception of cash and cash equivalents, which are Level 1 inputs.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	6 Months Ended
	Jun. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets. The changes in the carrying amount of goodwill for the six-month period ended June 30, 2019 were as follows (in thousands): 2019 Goodwill balance at January 1 $ 335,433 Effect of foreign exchange (181 ) Additions and adjustments as the result of acquisitions 16,881 Goodwill balance at June 30 $ 352,133 Total accumulated goodwill impairment losses aggregated to approximately $8.3 million as of June 30, 2019 and December 31, 2018 . We did not have any goodwill impairments for the six-month periods ended June 30, 2019 and 2018. The total goodwill balance as of June 30, 2019 and December 31, 2018 , was related to our cardiovascular segment. Other intangible assets at June 30, 2019 and December 31, 2018 , consisted of the following (in thousands): June 30, 2019 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Patents $ 20,985 $ (5,850 ) $ 15,135 Distribution agreements 8,012 (6,280 ) 1,732 License agreements 27,008 (9,016 ) 17,992 Trademarks 30,246 (8,035 ) 22,211 Covenants not to compete 1,028 (1,016 ) 12 Customer lists 40,009 (26,092 ) 13,917 In-process technology 3,420 — 3,420 Total $ 130,708 $ (56,289 ) $ 74,419 December 31, 2018 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Patents $ 19,378 $ (5,012 ) $ 14,366 Distribution agreements 8,012 (5,766 ) 2,246 License agreements 26,930 (7,411 ) 19,519 Trademarks 29,998 (6,586 ) 23,412 Covenants not to compete 1,028 (1,000 ) 28 Customer lists 39,936 (23,361 ) 16,575 In-process technology 3,420 — 3,420 Total $ 128,702 $ (49,136 ) $ 79,566 Aggregate amortization expense for the three and six-month periods ended June 30, 2019 was approximately $14.9 million and $29.7 million , respectively. Aggregate amortization expense for the three and six-month periods ended June 30, 2018 was approximately $10.4 million and $18.9 million , respectively. During the three months ended June 30, 2019 we recorded an impairment charge of $548,000 for the discontinuation of our product associated with the assets acquired in our June 2017 acquisition of patent rights and other intellectual property related to the Repositionable Chest Tube and related devices from Lazarus Medical Technologies, LLC. We did not record any impairment charges during the three and six months ended June 30, 2018 . Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of June 30, 2019 (in thousands): Year Ending December 31 Remaining 2019 $ 30,817 2020 58,907 2021 51,550 2022 50,129 2023 48,830

Leases

Leases	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
Leases	Leases. We adopted ASC 842 using the modified retrospective approach, electing the practical expedient that allows us not to restate our comparative periods prior to the adoption of the standard on January 1, 2019. As such, the disclosures required under ASC 842 are not presented for periods before the date of adoption. For the comparative periods prior to adoption, we present the disclosures which were required under ASC 840. We have operating leases for facilities used for manufacturing, research and development, sales and distribution, and office space, as well as leases for manufacturing and office equipment, vehicles, and land. Our leases have remaining terms of less than one year to approximately 19 years . A number of our lease agreements contain options to renew at our discretion for periods of up to 30 years and options to terminate the leases within one year . The lease term used to calculate right-of-use ("ROU") assets and lease liabilities includes renewal and termination options that are deemed reasonably certain to be exercised. Lease agreements with lease and non-lease components are generally accounted for as a single lease component. We do not have any bargain purchase options in our leases. For leases with an initial term of one year or less, we do not record a ROU asset or lease liability on our consolidated balance sheet. Substantially all of the ROU assets and lease liabilities as of June 30, 2019 recorded on our consolidated balance sheet are related to our cardiovascular segment. We sublease a portion of one of our facilities to a third party. We also lease certain hardware consoles to customers and record rental revenue as a component of net sales. Rental revenue under such console leasing arrangements for the three and six months ended June 30, 2019 and 2018 was not significant. The following was included in our consolidated balance sheet as of June 30, 2019 (in thousands): Leases As of June 30, 2019 Assets ROU operating lease assets $ 79,309 Liabilities Short-term operating lease liabilities $ 11,732 Long-term operating lease liabilities 71,272 Total operating lease liabilities $ 83,004 During the year ended December 31, 2015, we entered into sale and leaseback transactions to finance certain production equipment for approximately $2.0 million . At that time, we deferred the gain from the sale and leaseback transaction, of which approximately $93,000 remained as of December 31, 2018. As part of the adoption of ASC 842, we wrote-off the deferred gain as an adjustment to equity through retained earnings during the three months ended March 31, 2019. We recognize lease expense on a straight-line basis over the term of the lease. The components of lease costs for the three and six months ended June 30, 2019 are as follows, in thousands: Three months ended Six months ended Lease Cost Classification June 30, 2019 June 30, 2019 Operating lease cost (a) Selling, general and administrative expenses $ 4,172 $ 8,398 Sublease (income) (b) Selling, general and administrative expenses (146 ) (292 ) Net lease cost $ 4,026 $ 8,106 (a) Includes expense related to short-term leases and variable payments, which were not significant. (b) Does not include rental revenue from leases of hardware consoles to customers, which was not significant. Supplemental cash flow information for the six months ended June 30, 2019 is as follows: Six months ended June 30, 2019 Cash paid for amounts included in the measurement of lease liabilities $ 7,267 Right-of-use assets obtained in exchange for lease obligations $ 2,927 Generally, our lease agreements do not specify an implicit rate. Therefore, we estimate our incremental borrowing rate, which is defined as the interest rate we would pay to borrow on a collateralized basis, considering such factors as length of lease term and the risks of the economic environment in which the leased asset operates. As of June 30, 2019 , the following disclosures for remaining lease term and incremental borrowing rates were applicable: Supplemental disclosure June 30, 2019 Weighted average remaining lease term 12 years Weighted average discount rate 3.3% As of June 30, 2019 , maturities of operating lease liabilities were as follows, in thousands: Year ended December 31, Amounts due under Operating Leases Remaining 2019 $ 7,064 2020 12,789 2021 11,762 2022 9,361 2023 7,381 Thereafter 53,588 Total lease payments 101,945 Less: Imputed interest (18,941 ) Total $ 83,004 As previously disclosed in our 2018 Form 10-K under the prior guidance of ASC 840, minimum payments under operating lease agreements as of December 31, 2018 were as follows, in thousands: Year ended December 31, Operating Leases 2019 $ 13,421 2020 11,319 2021 9,995 2022 8,053 2023 6,953 Thereafter 52,754 Total minimum lease payments $ 102,495 As of June 30, 2019, we had additional operating leases for office space that had not yet commenced. These leases will commence during 2019 and are not deemed material.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies. In the ordinary course of business, we are involved in various claims and litigation matters. These claims and litigation matters may include actions involving product liability, intellectual property, contract disputes, and employment or other matters that are significant to our business. Based upon our review of currently available information, we do not believe any such actions are likely to be, individually or in the aggregate, materially adverse to our business, financial condition, results of operations or liquidity. In addition to the foregoing matters, in October 2016, we received a subpoena from the U.S. Department of Justice seeking information on certain of our marketing and promotional practices. We are in the process of responding to the subpoena, which we anticipate will continue during 2019. We have incurred, and anticipate that we will continue to incur, substantial costs in connection with the matter. The investigation is ongoing and at this stage we are unable to predict its scope, duration or outcome. Investigations such as this may result in the imposition of, among other things, significant damages, injunctions, fines or civil or criminal claims or penalties against our company or individuals. Legal expenses we incurred in responding to the U.S. Department of Justice subpoena for the three and six-month periods ended June 30, 2019 were approximately $1.0 million and $2.7 million , respectively. In the event of unexpected further developments, it is possible that the ultimate resolution of any of the foregoing matters, or other similar matters, if resolved in a manner unfavorable to us, may be materially adverse to our business, financial condition, results of operations or liquidity. Legal costs for these matters, such as outside counsel fees and expenses, are charged to expense in the period incurred.

Subsequent Events

Subsequent Events	6 Months Ended
	Jun. 30, 2019
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events. We have evaluated whether any subsequent events have occurred from June 30, 2019 to the time of filing of this report that would require disclosure in the consolidated financial statements. We note the following events below. Third Amended and Restated Credit Agreement On July 31, 2019, we entered into a Third Amended and Restated Credit Agreement (as amended to date, the "Third Amended Credit Agreement"), with Wells Fargo Bank, National Association, as administrative agent, swingline lender and a lender, and Wells Fargo Securities, LLC, BOFA Securities, Inc. and HSBC Bank USA, National Association, as joint lead arrangers and joint bookrunners. In addition, Bank of America, N.A., U.S. Bank, National Association, and HSBC Bank USA, National Association, are parties to the Third Amended Credit Agreement as lenders. The Third Amended Credit Agreement amends and restates in its entirety our previously outstanding Second Amended and Restated Credit Agreement and all amendments thereto. The Third Amended Credit Agreement provides for a term loan of $150 million and a revolving credit commitment up to an aggregate amount of $600 million , inclusive of sub-facilities of $40 million for multicurrency borrowings, $40 million for standby letters of credit and $30 million for swingline loans from time to time. On July 31, 2024, all principal, interest and other amounts outstanding under the Third Amended Credit Agreement are payable in full. At any time prior to the maturity date, we may repay any amounts owing under all revolving credit loans and all swingline loans in whole or in part, without premium or penalty, other than breakage fees payable of Eurocurrency Rate Loans (as defined in the Third Amended Credit Agreement). Revolving credit loans denominated in dollars and term loans made under the Third Amended Credit Agreement bear interest, at our election, at either the Base Rate or the Eurocurrency Rate (as such terms are defined in the Third Amended Credit Agreement) plus the Applicable Margin (as defined in the Third Amended Credit Agreement). Revolving credit loans denominated in an Alternative Currency (as defined in the Third Amended Credit Agreement) bear interest at the Eurocurrency Rate plus the Applicable Margin. Swingline loans bear interest at the Base Rate plus the Applicable Margin. Interest on each loan featuring the Base Rate is due and payable on the last business day of each calendar quarter commencing September 30, 2019; interest on each loan featuring the Eurocurrency Rate is due and payable on the last day of each interest period applicable thereto, and if such interest period extends over three months, at the end of each three-month interval during such interest period. The Third Amended Credit Agreement is collateralized by substantially all our assets. The Third Amended Credit Agreement contains affirmative and negative covenants, representations and warranties, events of default and other terms customary for loans of this nature. In particular, the Third Amended Credit Agreement requires that we maintain certain financial covenants, as follows: Covenant Requirement Consolidated Total Net Leverage Ratio (1) 4.0 to 1.0 Consolidated Interest Coverage Ratio (2) 3.0 to 1.0 Facility Capital Expenditures (3) $50,000,000 (1) Maximum Consolidated Net Total Leverage Ratio (as defined in the Third Amended Credit Agreement) as of any fiscal quarter end. (2) Minimum ratio of Consolidated EBITDA (as defined in the Third Amended Credit Agreement and adjusted for certain expenditures) to Consolidated interest expense (as defined in the Third Amended Credit Agreement) for any period of four consecutive fiscal quarters. (3) Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Third Amended Credit Agreement) in any fiscal year. Acquisition On August 1, 2019, we entered into a share purchase agreement to acquire Fibrovein Holdings Limited, which is the owner of 100% of the capital stock of STD Pharmaceutical Products Limited, a UK-based company engaged in the manufacture, distribution and sale of pharmaceutical sclerotherapy products. The total purchase price was approximately £11.2 million . As of the date of this report, we are currently evaluating the accounting treatment of this acquisition.

Basis of Presentation (Policies

Basis of Presentation (Policies)	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	The interim consolidated financial statements of Merit Medical Systems, Inc. ("Merit," "we" or "us") for the three and six-month periods ended June 30, 2019 and 2018 are not audited. Our consolidated financial statements are prepared in accordance with the requirements for unaudited interim periods and, consequently, do not include all disclosures required to be made in conformity with accounting principles generally accepted in the United States of America. In the opinion of our management, the accompanying consolidated financial statements contain all adjustments, consisting of normal recurring accruals, necessary for a fair presentation of our financial position as of June 30, 2019 and December 31, 2018 , and our results of operations and cash flows for the three and six-month periods ended June 30, 2019 and 2018 . The results of operations for the three and six-month periods ended June 30, 2019 and 2018 are not necessarily indicative of the results for a full-year period. These interim consolidated financial statements should be read in conjunction with the financial statements included in our Annual Report on Form 10-K (the "2018 Form 10-K") for the year ended December 31, 2018 , which was filed with the Securities and Exchange Commission (the "SEC") on March 1, 2019 .
Revenue from Contracts with Customers	Revenue from Contracts with Customers. In accordance with Accounting Standards Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606) ("ASC 606"), we recognize revenue when a customer obtains control of promised goods. The amount of revenue recognized reflects the consideration we expect to receive in exchange for these goods.
Recently Issued Financial Accounting Standards	Recently Issued Financial Accounting Standards. Recently Adopted In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, Leases (Topic 842) ("ASC 842"), which requires lessees to recognize right-of-use ("ROU") assets and related lease liabilities on the balance sheet for all leases greater than one year in duration. We adopted ASC 842 on January 1, 2019 using a modified retrospective transition approach for leases existing at, or entered into after, the beginning of the earliest comparative period presented in the financial statements. The modified retrospective approach did not require any transition accounting for leases that expired before the earliest comparative period presented. The adoption of this standard resulted in the recording of ROU assets and lease liabilities for all of our lease agreements with original terms of greater than one year. The adoption of ASC 842 did not have a significant impact on our consolidated statements of operations or cash flows. See Note 14 for the required disclosures relating to our lease agreements. In June 2018, the FASB issued ASU 2018-07, Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting , which simplifies the accounting for nonemployee share-based payment transactions by expanding the scope of ASC Topic 718, Compensation - Stock Compensation , to include share-based payment transactions for acquiring goods and services from nonemployees. Under the new standard, most of the guidance on stock compensation payments to nonemployees would be aligned with the requirements for share-based payments granted to employees. This standard became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. In February 2018, the FASB issued ASU 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from U.S. federal tax legislation commonly referred to as the Tax Cuts and Jobs Act, which was enacted in December 2017 (the "2017 Tax Act"). ASU 2018-02 became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities , which expands and refines hedge accounting for both financial and non-financial risk components, aligns the recognition and presentation of the effects of hedging instruments and hedge items in the financial statements, and includes certain targeted improvements to ease the application of current guidance related to the assessment of hedge effectiveness. ASU 2017-12 became effective for us on January 1, 2019. The adoption of this standard did not have a material impact on our consolidated financial statements. Not Yet Adopted In August 2018, the FASB issued ASU 2018-15, Intangibles – Goodwill and Other – Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract, which aligns the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software (and hosting arrangements that include an internal-use software license). ASU 2018-15 is effective for annual periods beginning after December 15, 2019, including interim periods within those annual periods. Early adoption is permitted. We are currently assessing the impact of this standard on our consolidated financial statements. In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820) , which removes, modifies and adds various disclosure requirements related to fair value disclosures. Disclosures related to transfers between fair value hierarchy levels will be removed and further detail around changes in unrealized gains and losses for the period and unobservable inputs used in determining level 3 fair value measurements will be added, among other changes. ASU 2018-13 is effective for interim and annual reporting periods beginning after December 15, 2019, and early adoption is permitted. We are currently assessing the impact of this standard on our consolidated financial statements. In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, which replaces the current incurred loss impairment methodology for financial assets measured at amortized cost with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information, including forecasted information, to develop credit loss estimates. ASU 2016-13 is effective for annual periods beginning after December 15, 2019, including interim periods within those annual periods. Early adoption is permitted for annual periods beginning after December 15, 2018. We are currently assessing the impact of this standard on our consolidated financial statements. We do not believe any other issued and not yet effective accounting standards will be relevant to our consolidated financial statements.
Derivatives	Derivative Instruments Not Designated as Cash Flow Hedges Foreign Currency Risk. We operate on a global basis and are exposed to the risk that our financial condition, results of operations, and cash flows could be adversely affected by changes in foreign currency exchange rates. To reduce the potential effects of foreign currency exchange rate movements on net earnings, we enter into derivative financial instruments in the form of foreign currency exchange forward contracts with major financial institutions. Our policy is to enter into foreign currency derivative contracts with maturities of up to two years. We are primarily exposed to foreign currency exchange rate risk with respect to transactions and balances denominated in Euros, British Pounds, Chinese Renminbi, Mexican Pesos, Brazilian Reals, Australian Dollars, Hong Kong Dollars, Swiss Francs, Swedish Krona, Canadian Dollars, Danish Krone, Japanese Yen, Korean Won, and Singapore Dollars. We do not use derivative financial instruments for trading or speculative purposes. We are not subject to any credit risk contingent features related to our derivative contracts, and counterparty risk is managed by allocating derivative contracts among several major financial institutions. Derivative Instruments Designated as Cash Flow Hedges Balance Sheet Presentation of Derivative Instruments. As of June 30, 2019 , and December 31, 2018 , all derivative instruments, both those designated as hedging instruments and those that were not designated as hedging instruments, were recorded gross at fair value on our consolidated balance sheets. We are not subject to any master netting agreements. General. Our earnings and cash flows are subject to fluctuations due to changes in interest rates and foreign currency exchange rates, and we seek to mitigate a portion of these risks by entering into derivative contracts. The derivatives we use are interest rate swaps and foreign currency forward contracts. We recognize derivatives as either assets or liabilities at fair value in the accompanying consolidated balance sheets, regardless of whether or not hedge accounting is applied. We report cash flows arising from our hedging instruments consistent with the classification of cash flows from the underlying hedged items. Accordingly, cash flows associated with our derivative instruments are classified as operating activities in the accompanying consolidated statements of cash flows. We formally document, designate and assess the effectiveness of transactions that receive hedge accounting initially and on an ongoing basis. Changes in the fair value of derivatives that qualify for hedge accounting treatment are recorded, net of applicable taxes, in accumulated other comprehensive income (loss), a component of stockholders’ equity in the accompanying consolidated balance sheets. When the hedged transaction occurs, gains or losses are reclassified into earnings in the same line item associated with the forecasted transaction and in the same period or periods during which the hedged transaction affects earnings. Changes in the fair value of derivatives not designated as hedging instruments are recorded in earnings throughout the term of the derivative. Interest Rate Risk.

Inventories (Tables)

Inventories (Tables)	6 Months Ended
	Jun. 30, 2019
Inventory Disclosure [Abstract]
Schedule of Inventory	Inventories at June 30, 2019 and December 31, 2018 , consisted of the following (in thousands): June 30, December 31, 2019 2018 Finished goods $ 116,741 $ 117,703 Work-in-process 23,419 14,380 Raw materials 62,834 65,453 Total Inventories $ 202,994 $ 197,536

Stock-Based Compensation Expe_2

Stock-Based Compensation Expense (Tables)	6 Months Ended
	Jun. 30, 2019
Share-based Payment Arrangement [Abstract]
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs	The stock-based compensation expense before income tax expense for the three and six months ended June 30, 2019 and 2018 consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Cost of sales $ 355 $ 232 $ 607 $ 416 Research and development 281 147 473 271 Selling, general and administrative 1,887 1,186 3,209 2,134 Stock-based compensation expense before taxes $ 2,523 $ 1,565 $ 4,289 $ 2,821
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions	In applying the Black-Scholes methodology to the option grants, the fair value of our stock-based awards granted was estimated using the following assumptions for the periods indicated below: Six Months Ended June 30, 2019 2018 Risk-free interest rate 1.90% - 2.56% 2.63% - 2.77% Expected option term 3.0 - 5.0 years 5.0 years Expected dividend yield — — Expected price volatility 28.66% - 33.69% 34.06% - 34.32%

Earnings Per Common Share (EP_2

Earnings Per Common Share (EPS) (Tables)	6 Months Ended
	Jun. 30, 2019
Earnings Per Share, Basic and Diluted [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	The computation of weighted average shares outstanding and the basic and diluted earnings per common share consisted of the following (in thousands, except per share amounts): Three Months Six Months Net Income Shares Per Share Amount Net Income Shares Per Share Amount Period ended June 30, 2019: Basic EPS $ 6,859 55,017 $ 0.12 $ 13,054 54,967 $ 0.24 Effect of dilutive stock options 1,538 1,556 Diluted EPS $ 6,859 56,555 $ 0.12 $ 13,054 56,523 $ 0.23 Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive 1,185 1,081 Period ended June 30, 2018: Basic EPS $ 10,941 50,473 $ 0.22 $ 16,210 50,376 $ 0.32 Effect of dilutive stock options 1,681 1,657 Diluted EPS $ 10,941 52,154 $ 0.21 $ 16,210 52,033 $ 0.31 Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive 535 359

Acquisitions (Tables)

Acquisitions (Tables)	6 Months Ended
	Jun. 30, 2019
Business Combinations [Abstract]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The purchase price was allocated as follows (in thousands): Inventories $ 971 Intangibles Developed technology 4,840 Customer list 120 Trademarks 400 Goodwill 938 Total net assets acquired $ 7,269 Inventories $ 5,804 Property and equipment 748 Intangibles Developed technology 74,000 Customer list 4,200 Trademarks 4,900 In-process technology 2,500 Goodwill 9,728 Total net assets acquired $ 101,880 Assets Acquired Trade receivables $ 6,151 Inventories 5,803 Prepaid expenses and other current assets 315 Property and equipment 1,047 Other long-term assets 14 Intangibles Developed technology 134,510 Customer lists 3,330 Trademarks 7,080 Goodwill 65,802 Total assets acquired 224,052 Liabilities Assumed Trade payables (1,497 ) Accrued expenses (2,384 ) Other long-term liabilities (1,527 ) Deferred income tax liabilities (30,363 ) Total liabilities assumed (35,771 ) Total net assets acquired $ 188,281 Assets Acquired Trade receivables $ 94 Inventories 349 Property and equipment 409 Other long-term assets 30 Intangibles Developed technology 31,680 Customer lists 83 Trademarks 250 Goodwill 16,950 Total assets acquired 49,845 Liabilities Assumed Trade payables (58 ) Accrued expenses (261 ) Other long-term obligations (1,522 ) Deferred income tax liabilities (4,590 ) Total liabilities assumed (6,431 ) Total net assets acquired $ 43,414 Inventories $ 1,353 Intangibles Developed technology 32,750 Customer list 840 Trademarks 1,410 Goodwill 21,847 Total net assets acquired $ 58,200
Business Acquisition, Pro Forma Information	The following table summarizes our consolidated results of operations for the three and six-month periods ended June 30, 2018, as well as unaudited pro forma consolidated results of operations as though the acquisition of Cianna Medical and Vascular Insights had occurred on January 1, 2017 (in thousands, except per common share amounts): Three Months Ended Six Months Ended June 30, 2018 June 30, 2018 As Reported Pro Forma As Reported Pro Forma Net sales $ 224,810 $ 238,272 $ 427,844 $ 452,451 Net income 10,941 6,842 16,210 5,016 Earnings per common share: Basic $ 0.22 $ 0.14 $ 0.32 $ 0.10 Diluted $ 0.21 $ 0.13 $ 0.31 $ 0.10 * The pro forma results for the three and six-month periods ended June 30, 2019 are not included in the table above because the operating results for the Cianna Medical and Vascular Insights acquisitions were included in our consolidated statements of income for these periods.

Revenue from Contracts with C_2

Revenue from Contracts with Customers. (Tables)	6 Months Ended
	Jun. 30, 2019
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The following tables present revenue from contracts with customers for the three and six-month periods ended June 30, 2019 and 2018 (in thousands): Three Months Ended June 30, 2019 Three Months Ended June 30, 2018 United States International Total United States International Total Cardiovascular Stand-alone devices $ 55,906 $ 47,616 $ 103,522 $ 50,941 $ 41,555 $ 92,496 Cianna Medical 11,230 7 11,237 — — — Custom kits and procedure trays 23,124 11,219 34,343 23,667 10,325 33,992 Inflation devices 8,347 15,968 24,315 8,160 16,145 24,305 Catheters 20,696 24,648 45,344 16,704 22,670 39,374 Embolization devices 5,274 8,734 14,008 5,094 7,630 12,724 CRM/EP 11,536 2,361 13,897 11,758 1,738 13,496 Total 136,113 110,553 246,666 116,324 100,063 216,387 Endoscopy Endoscopy devices 8,549 317 8,866 8,121 302 8,423 Total $ 144,662 $ 110,870 $ 255,532 $ 124,445 $ 100,365 $ 224,810 Six Months Ended June 30, 2019 Six Months Ended June 30, 2018 United States International Total United States International Total Cardiovascular Stand-alone devices $ 109,305 $ 89,643 $ 198,948 $ 94,953 $ 80,789 $ 175,742 Cianna Medical 24,078 7 24,085 — — — Custom kits and procedure trays 45,179 22,107 67,286 45,984 21,280 67,264 Inflation devices 16,320 30,013 46,333 15,828 30,896 46,724 Catheters 40,108 48,275 88,383 31,974 41,265 73,239 Embolization devices 9,980 15,855 25,835 10,126 15,184 25,310 CRM/EP 21,635 4,641 26,276 20,596 3,366 23,962 Total 266,605 210,541 477,146 219,461 192,780 412,241 Endoscopy Endoscopy devices 16,117 618 16,735 15,040 563 15,603 Total $ 282,722 $ 211,159 $ 493,881 $ 234,501 $ 193,343 $ 427,844

Segment Reporting (Tables)

Segment Reporting (Tables)	6 Months Ended
	Jun. 30, 2019
Segment Reporting [Abstract]
Schedule of Segment Reporting Information, by Segment	Financial information relating to our reportable operating segments and reconciliations to the consolidated totals for the three and six-month periods ended June 30, 2019 and 2018 , are as follows (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net Sales Cardiovascular $ 246,666 $ 216,387 $ 477,146 $ 412,241 Endoscopy 8,866 8,423 16,735 15,603 Total net sales 255,532 224,810 493,881 427,844 Operating Income Cardiovascular 9,855 12,663 17,474 19,060 Endoscopy 2,346 2,451 4,250 4,835 Total operating income 12,201 15,114 21,724 23,895 Total other expense - net (3,202 ) (3,549 ) (5,879 ) (5,970 ) Income tax expense 2,140 624 2,791 1,715 Net income $ 6,859 $ 10,941 $ 13,054 $ 16,210

Revolving Credit Facility and_2

Revolving Credit Facility and Long-Term Debt (Tables)	6 Months Ended
	Jun. 30, 2019
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Principal balances outstanding under our long-term debt obligations as of June 30, 2019 and December 31, 2018 , consisted of the following (in thousands): June 30, 2019 December 31, 2018 2016 Term loan $ 65,000 $ 72,500 2016 Revolving credit loans 335,500 316,000 Collateralized debt facility — 7,000 Less unamortized debt issuance costs (279 ) (348 ) Total long-term debt 400,221 395,152 Less current portion 15,000 22,000 Long-term portion $ 385,221 $ 373,152
Schedule of Long-term Debt Covenants	The Second Amended Credit Agreement requires that we maintain certain financial covenants, as follows: Covenant Requirement Consolidated Total Leverage Ratio (1) January 1, 2018 and thereafter 3.5 to 1.0 Consolidated EBITDA (2) 1.25 to 1.0 Consolidated Net Income (3) $0 Facility Capital Expenditures (4) $30 million (1) Maximum Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) as of any fiscal quarter end. (2) Minimum ratio of Consolidated EBITDA (as defined in the Second Amended Credit Agreement and adjusted for certain expenditures) to Consolidated Fixed Charges (as defined in the Second Amended Credit Agreement) for any period of four consecutive fiscal quarters. (3) Minimum level of Consolidated Net Income (as defined in the Second Amended Credit Agreement) for certain periods, and subject to certain adjustments. (4) Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Second Amended Credit Agreement) in any fiscal year. Covenant Requirement Consolidated Total Net Leverage Ratio (1) 4.0 to 1.0 Consolidated Interest Coverage Ratio (2) 3.0 to 1.0 Facility Capital Expenditures (3) $50,000,000 (1) Maximum Consolidated Net Total Leverage Ratio (as defined in the Third Amended Credit Agreement) as of any fiscal quarter end. (2) Minimum ratio of Consolidated EBITDA (as defined in the Third Amended Credit Agreement and adjusted for certain expenditures) to Consolidated interest expense (as defined in the Third Amended Credit Agreement) for any period of four consecutive fiscal quarters. (3) Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Third Amended Credit Agreement) in any fiscal year.
Schedule of Maturities of Long-term Debt	Future minimum principal payments on our long-term debt as of June 30, 2019 , are as follows (in thousands): Years Ending Future Minimum December 31 Principal Payments Remaining 2019 $ 7,500 2020 17,500 2021 375,500 Total future minimum principal payments $ 400,500

Derivatives (Tables)

Derivatives (Tables)	6 Months Ended
	Jun. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Notional Amounts of Outstanding Derivative Positions	We enter into approximately 150 cash flow foreign currency hedges every month. As of June 30, 2019 , we had entered into foreign currency forward contracts, which qualified as cash flow hedges, with the following notional amounts (in thousands and in local currencies): Currency Symbol Forward Notional Amount Australian Dollar AUD 3,430 Brazilian Real BRL 1,080 Canadian Dollar CAD 4,330 Swiss Franc CHF 1,970 Chinese Renminbi CNY 166,500 Danish Krone DKK 18,175 Euro EUR 22,600 British Pound GBP 4,820 Japanese Yen JPY 1,335,000 Korean Won KRW 4,475,000 Mexican Peso MXN 296,500 Norwegian Krone NOK 6,000 Swedish Krona SEK 29,210 We forecast our net exposure in various receivables and payables to fluctuations in the value of various currencies, and we enter into foreign currency forward contracts to mitigate that exposure. We enter into approximately 20 foreign currency fair value hedges every month. As of June 30, 2019 , we had entered into foreign currency forward contracts related to those balance sheet accounts, with the following notional amounts (in thousands and in local currencies): Currency Symbol Forward Notional Amount Australian Dollar AUD 13,788 Brazilian Real BRL 9,000 Canadian Dollar CAD 2,652 Swiss Franc CHF 643 Chinese Renminbi CNY 85,226 Danish Krone DKK 2,544 Euro EUR 11,717 British Pound GBP 5,653 Hong Kong Dollar HKD 11,000 Japanese Yen JPY 1,445,574 Korean Won KRW 6,000,000 Mexican Peso MXN 25,000 Norwegian Krone NOK 3,180 Swedish Krona SEK 17,154 Singapore Dollar SGD 1,676 South African Rand ZAR 37,800
Schedule of Derivative Instruments in Statement of Financial Position, Fair Value	The fair value of derivative instruments on a gross basis was as follows on the dates indicated (in thousands): Fair Value Balance Sheet Location June 30, 2019 December 31, 2018 Derivative instruments designated as hedging instruments Assets Interest rate swap Other assets (long-term) $ 1,907 $ 5,772 Foreign currency forward contracts Prepaid expenses and other assets 960 613 Foreign currency forward contracts Other assets (long-term) 244 151 Liabilities Foreign currency forward contracts Accrued expenses (778 ) (711 ) Foreign currency forward contracts Other long-term obligations (101 ) (101 ) Derivative instruments not designated as hedging instruments Assets Foreign currency forward contracts Prepaid expenses and other assets $ 229 $ 814 Liabilities Foreign currency forward contracts Accrued expenses (1,539 ) (796 )
Schedule of Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss)	Derivative instruments designated as cash flow hedges had the following effects, before income taxes, on other comprehensive income and net earnings in our consolidated statements of income, consolidated statements of comprehensive income and consolidated balance sheets (in thousands): Amount of Gain/(Loss) recognized in OCI Consolidated Statements of Income Amount of Gain/(Loss) reclassified from AOCI Three Months Ended June 30, Three Months Ended June 30, Three Months Ended June 30, 2019 2018 2019 2018 2019 2018 Derivative instrument Location in statements of income Interest rate swaps $ (1,812 ) $ 748 Interest expense $ (3,115 ) $ (3,338 ) $ 602 $ 357 Foreign currency forward contracts 1,064 394 Revenue 255,532 224,810 (92 ) (234 ) Cost of sales (143,568 ) (124,801 ) (104 ) 138 Amount of Gain/(Loss) recognized in OCI Consolidated Statements of Income Amount of Gain/(Loss) reclassified from AOCI Six Months Ended June 30, Six Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 2019 2018 Derivative instrument Location in statements of income Interest rate swaps (2,669 ) $ 2,868 Interest expense (5,879 ) (5,736 ) $ 1,196 $ 570 Foreign currency forward contracts 51 568 Revenue 493,881 427,844 102 (385 ) Cost of sales (277,281 ) (239,779 ) (185 ) 378
Derivative Instruments, Gain (Loss)	The following gains/(losses) from these derivative instruments were recognized in our consolidated statements of income for the periods presented (in thousands): Three Months Ended June 30, Six Months Ended June 30, Derivative Instrument Location in statements of income 2019 2018 2019 2018 Foreign currency forward contracts Other expense $ (489 ) $ 3,153 $ (755 ) $ 2,038

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2019
Fair Value Disclosures [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis	Our financial assets and (liabilities) carried at fair value measured on a recurring basis as of June 30, 2019 and December 31, 2018 , consisted of the following (in thousands): Fair Value Measurements Using Total Fair Quoted prices in Significant other Significant Value at active markets observable inputs unobservable inputs Description June 30, 2019 (Level 1) (Level 2) (Level 3) Interest rate contracts (1) $ 1,907 $ — $ 1,907 $ — Foreign currency contract assets, current and long-term (2) $ 1,433 $ — $ 1,433 $ — Foreign currency contract liabilities, current and long-term (3) $ (2,418 ) $ — $ (2,418 ) $ — Contingent receivable asset $ 625 $ — $ — $ 625 Contingent consideration liabilities $ (93,204 ) $ — $ — $ (93,204 ) Fair Value Measurements Using Total Fair Quoted prices in Significant other Significant Value at active markets observable inputs unobservable inputs Description December 31, 2018 (Level 1) (Level 2) (Level 3) Interest rate contracts (1) $ 5,772 $ — $ 5,772 $ — Foreign currency contract assets, current and long-term (2) $ 1,578 $ — $ 1,578 $ — Foreign currency contract liabilities, current and long-term (3) $ (1,608 ) $ — $ (1,608 ) $ — Contingent receivable asset $ 607 $ — $ — $ 607 Contingent consideration liabilities $ (82,236 ) $ — $ — $ (82,236 ) (1) The fair value of the interest rate contracts is determined using Level 2 fair value inputs and is recorded as other assets or other long-term obligations in the consolidated balance sheets. (2) The fair value of the foreign currency contract assets (including those designated as hedging instruments and those not designated as hedging instruments) is determined using Level 2 fair value inputs and is recorded as prepaid expenses and other assets or other long-term assets in the consolidated balance sheets. (3) The fair value of the foreign currency contract liabilities (including those designated as hedging instruments and those not designated as hedging instruments) is determined using Level 2 fair value inputs and is recorded as accrued expenses or other long-term obligations in the consolidated balance sheets.
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	Changes in the fair value of our contingent consideration liabilities during the three and six-month periods ended June 30, 2019 and 2018 , consisted of the following (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Beginning balance $ 82,457 $ 10,928 $ 82,236 $ 10,956 Contingent consideration liability recorded as the result of acquisitions (see Note 5) 8,400 — 8,380 — Fair value adjustments recorded to income 2,404 99 3,199 86 Contingent payments made (57 ) (115 ) (611 ) (130 ) Ending balance $ 93,204 $ 10,912 $ 93,204 $ 10,912
Fair Value Inputs, Liabilities, Quantitative Information	The recurring Level 3 measurement of our contingent consideration liability and contingent receivable included the following significant unobservable inputs at June 30, 2019 and December 31, 2018 (amounts in thousands): Contingent consideration asset or liability Fair value at June 30, 2019 Valuation technique Unobservable inputs Range Revenue-based royalty $ 9,843 Discounted cash flow Discount rate 14% - 25% payments contingent liability Projected year of payments 2019-2034 Supply chain milestone $ 15,000 Scenario-based method Discount rate 3.9% contingent liability Probability of milestone payment 100% Projected year of payments 2019 Revenue milestones $ 65,661 Monte Carlo simulation Discount rate 3.1% - 19.5% contingent liability Projected year of payments 2019-2022 Regulatory approval $ 2,700 Scenario-based method Discount rate 5.3% contingent liability Probability of milestone payment 65% Projected year of payment 2022 Contingent receivable $ 625 Discounted cash flow Discount rate 10% asset Probability of milestone payment 54% Projected year of payments 2019 Contingent consideration asset or liability Fair value at December 31, 2018 Valuation technique Unobservable inputs Range Revenue-based royalty $ 10,661 Discounted cash flow Discount rate 9.9% - 25% payments contingent liability Projected year of payments 2018-2037 Supply chain milestone $ 13,593 Discounted cash flow Discount rate 5.3% contingent liability Probability of milestone payment 95% Projected year of payments 2019 Revenue milestones $ 57,982 Discounted cash flow Discount rate 3.3% - 13% contingent liability Projected year of payments 2019-2023 Contingent receivable $ 607 Discounted cash flow Discount rate 10% asset Probability of milestone payment 67% Projected year of payments 2019

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	6 Months Ended
	Jun. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Changes in carrying amount of goodwill	The changes in the carrying amount of goodwill for the six-month period ended June 30, 2019 were as follows (in thousands): 2019 Goodwill balance at January 1 $ 335,433 Effect of foreign exchange (181 ) Additions and adjustments as the result of acquisitions 16,881 Goodwill balance at June 30 $ 352,133
Other intangible assets	Other intangible assets at June 30, 2019 and December 31, 2018 , consisted of the following (in thousands): June 30, 2019 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Patents $ 20,985 $ (5,850 ) $ 15,135 Distribution agreements 8,012 (6,280 ) 1,732 License agreements 27,008 (9,016 ) 17,992 Trademarks 30,246 (8,035 ) 22,211 Covenants not to compete 1,028 (1,016 ) 12 Customer lists 40,009 (26,092 ) 13,917 In-process technology 3,420 — 3,420 Total $ 130,708 $ (56,289 ) $ 74,419 December 31, 2018 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Patents $ 19,378 $ (5,012 ) $ 14,366 Distribution agreements 8,012 (5,766 ) 2,246 License agreements 26,930 (7,411 ) 19,519 Trademarks 29,998 (6,586 ) 23,412 Covenants not to compete 1,028 (1,000 ) 28 Customer lists 39,936 (23,361 ) 16,575 In-process technology 3,420 — 3,420 Total $ 128,702 $ (49,136 ) $ 79,566
Estimated amortization expense	Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of June 30, 2019 (in thousands): Year Ending December 31 Remaining 2019 $ 30,817 2020 58,907 2021 51,550 2022 50,129 2023 48,830

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
Schedule of Consolidated Balance Sheet Information and Supplemental Information	As of June 30, 2019 , the following disclosures for remaining lease term and incremental borrowing rates were applicable: Supplemental disclosure June 30, 2019 Weighted average remaining lease term 12 years Weighted average discount rate 3.3% The following was included in our consolidated balance sheet as of June 30, 2019 (in thousands): Leases As of June 30, 2019 Assets ROU operating lease assets $ 79,309 Liabilities Short-term operating lease liabilities $ 11,732 Long-term operating lease liabilities 71,272 Total operating lease liabilities $ 83,004
Components of Lease Costs	We recognize lease expense on a straight-line basis over the term of the lease. The components of lease costs for the three and six months ended June 30, 2019 are as follows, in thousands: Three months ended Six months ended Lease Cost Classification June 30, 2019 June 30, 2019 Operating lease cost (a) Selling, general and administrative expenses $ 4,172 $ 8,398 Sublease (income) (b) Selling, general and administrative expenses (146 ) (292 ) Net lease cost $ 4,026 $ 8,106 (a) Includes expense related to short-term leases and variable payments, which were not significant. (b) Does not include rental revenue from leases of hardware consoles to customers, which was not significant. Supplemental cash flow information for the six months ended June 30, 2019 is as follows: Six months ended June 30, 2019 Cash paid for amounts included in the measurement of lease liabilities $ 7,267 Right-of-use assets obtained in exchange for lease obligations $ 2,927
Maturities of Operating Lease Liabilities	As of June 30, 2019 , maturities of operating lease liabilities were as follows, in thousands: Year ended December 31, Amounts due under Operating Leases Remaining 2019 $ 7,064 2020 12,789 2021 11,762 2022 9,361 2023 7,381 Thereafter 53,588 Total lease payments 101,945 Less: Imputed interest (18,941 ) Total $ 83,004
Schedule of Minimum Payments Under Operating Lease Agreements	As previously disclosed in our 2018 Form 10-K under the prior guidance of ASC 840, minimum payments under operating lease agreements as of December 31, 2018 were as follows, in thousands: Year ended December 31, Operating Leases 2019 $ 13,421 2020 11,319 2021 9,995 2022 8,053 2023 6,953 Thereafter 52,754 Total minimum lease payments $ 102,495

Subsequent Events (Tables)

Subsequent Events (Tables)	6 Months Ended
	Jun. 30, 2019
Subsequent Events [Abstract]
Schedule of Long-term Debt Covenants	The Second Amended Credit Agreement requires that we maintain certain financial covenants, as follows: Covenant Requirement Consolidated Total Leverage Ratio (1) January 1, 2018 and thereafter 3.5 to 1.0 Consolidated EBITDA (2) 1.25 to 1.0 Consolidated Net Income (3) $0 Facility Capital Expenditures (4) $30 million (1) Maximum Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) as of any fiscal quarter end. (2) Minimum ratio of Consolidated EBITDA (as defined in the Second Amended Credit Agreement and adjusted for certain expenditures) to Consolidated Fixed Charges (as defined in the Second Amended Credit Agreement) for any period of four consecutive fiscal quarters. (3) Minimum level of Consolidated Net Income (as defined in the Second Amended Credit Agreement) for certain periods, and subject to certain adjustments. (4) Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Second Amended Credit Agreement) in any fiscal year. Covenant Requirement Consolidated Total Net Leverage Ratio (1) 4.0 to 1.0 Consolidated Interest Coverage Ratio (2) 3.0 to 1.0 Facility Capital Expenditures (3) $50,000,000 (1) Maximum Consolidated Net Total Leverage Ratio (as defined in the Third Amended Credit Agreement) as of any fiscal quarter end. (2) Minimum ratio of Consolidated EBITDA (as defined in the Third Amended Credit Agreement and adjusted for certain expenditures) to Consolidated interest expense (as defined in the Third Amended Credit Agreement) for any period of four consecutive fiscal quarters. (3) Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Third Amended Credit Agreement) in any fiscal year.

Inventories (Details)

Inventories (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Finished goods	$ 116,741	$ 117,703
Work-in-process	23,419	14,380
Raw materials	62,834	65,453
Total Inventories	$ 202,994	$ 197,536

Stock-Based Compensation Expe_3

Stock-Based Compensation Expense - Allocation of Recognized Period Costs (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	$ 2,523	$ 1,565	$ 4,289	$ 2,821
Cost of sales
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	355	232	607	416
Research and development
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	281	147	473	271
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	$ 1,887	$ 1,186	$ 3,209	$ 2,134

Stock-Based Compensation Expe_4

Stock-Based Compensation Expense - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Share-based Payment Arrangement [Abstract]
Compensation cost not yet recognized	$ 32.4		$ 32.4
Compensation cost not yet recognized, period of recognition			3 years 3 months 26 days
Options granted in period (in shares)	190,000	200,000	1,100,000	692,002

Stock-Based Compensation Expe_5

Stock-Based Compensation Expense - Fair Value Calculation Assumptions (Details)	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate		5 years
Expected option term	0.00%	0.00%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	1.90%	2.63%
Risk-free interest rate	3 years
Expected price volatility	28.66%	34.06%
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	2.56%	2.77%
Risk-free interest rate	5 years
Expected price volatility	33.69%	34.32%

Earnings Per Common Share (EP_3

Earnings Per Common Share (EPS) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Earnings Per Share, Basic and Diluted [Abstract]
Net income, Basic EPS	$ 6,859	$ 10,941		$ 16,210
Basic EPS (in shares)	55,017	50,473	54,967	50,376
Basic EPS (in dollars per share)	$ 0.12	$ 0.22	$ 0.24	$ 0.32
Effect of dilutive stock options (in shares)	1,538	1,681	1,556	1,657
Net income, Diluted EPS	$ 6,859	$ 10,941	$ 13,054	$ 16,210
Diluted EPS (in shares)	56,555	52,154	56,523	52,033
Diluted EPS (in dollars per share)	$ 0.12	$ 0.21	$ 0.23	$ 0.31
Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive (in shares)	1,185	535	1,081	359

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) - USD ($) $ in Thousands	Jun. 14, 2019	Mar. 28, 2019	Dec. 14, 2018	Nov. 13, 2018	May 23, 2018	Feb. 14, 2018	Jun. 30, 2019	Jun. 30, 2019	Dec. 31, 2018
Fluidx
Business Acquisition [Line Items]
Payments to acquire shares		$ 2,000
Ownership percentage							12.70%	12.70%
Brightwater
Business Acquisition [Line Items]
Purchase consideration, upfront payment	$ 35,000
Working capital adjustment	$ 104
Weighted average useful life	12 years 10 months 24 days
Brightwater | Achievement of CE Certification
Business Acquisition [Line Items]
Earn-out payments	$ 5,000
Brightwater | Achievement of Sales Milestones
Business Acquisition [Line Items]
Earn-out payments	$ 10,000
Brightwater | Developed technology
Business Acquisition [Line Items]
Useful life	13 years
Brightwater | Trademarks
Business Acquisition [Line Items]
Useful life	5 years
Brightwater | Customer Lists
Business Acquisition [Line Items]
Useful life	1 year
Vascular Insights
Business Acquisition [Line Items]
Purchase consideration, upfront payment			$ 40,000
Weighted average useful life			11 years 9 months 18 days
Contingent liability			$ 20,000
Net sales related to acquisition							$ 1,700	$ 3,200
Vascular Insights | Developed technology
Business Acquisition [Line Items]
Useful life			12 years
Vascular Insights | Trademarks
Business Acquisition [Line Items]
Useful life			9 years
Vascular Insights | Customer Lists
Business Acquisition [Line Items]
Useful life			8 years
Cianna Medical
Business Acquisition [Line Items]
Purchase consideration, upfront payment				$ 135,000
Working capital adjustment				$ 1,200
Weighted average useful life				10 years 8 months 12 days
Net sales related to acquisition							11,200	24,100
Acquisition-related costs									$ 3,500
Cianna Medical | Achievement of Supply Chain and Scalability Metrics
Business Acquisition [Line Items]
Earn-out payments				$ 15,000
Cianna Medical | Annual Net Sales Milestone
Business Acquisition [Line Items]
Earn-out payments				$ 50,000
Cianna Medical | Developed technology
Business Acquisition [Line Items]
Useful life				11 years
Cianna Medical | Trademarks
Business Acquisition [Line Items]
Useful life				10 years
Cianna Medical | Customer Lists
Business Acquisition [Line Items]
Useful life				8 years
DirectACCESS Medical, LLC
Business Acquisition [Line Items]
Weighted average useful life					9 years 10 months 24 days
Total purchase price					$ 7,300
DirectACCESS Medical, LLC | Developed technology
Business Acquisition [Line Items]
Useful life					10 years
DirectACCESS Medical, LLC | Trademarks
Business Acquisition [Line Items]
Useful life					10 years
DirectACCESS Medical, LLC | Customer Lists
Business Acquisition [Line Items]
Useful life					5 years
Becton, Dickinson and Company
Business Acquisition [Line Items]
Weighted average useful life						8 years
Net sales related to acquisition							$ 11,800	$ 23,400
Acquisition-related costs									$ 1,800
Total purchase price						$ 100,300
Becton, Dickinson and Company | Developed technology
Business Acquisition [Line Items]
Useful life						8 years
Becton, Dickinson and Company | Trademarks
Business Acquisition [Line Items]
Useful life						9 years
Becton, Dickinson and Company | Customer Lists
Business Acquisition [Line Items]
Useful life						7 years

Acquisitions - Purchase Price A

Acquisitions - Purchase Price Allocation (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Jun. 14, 2019	Dec. 31, 2018	Dec. 14, 2018	Nov. 13, 2018	May 23, 2018	Feb. 14, 2018
Assets Acquired
Goodwill	$ 352,133		$ 335,433
Brightwater
Assets Acquired
Trade receivables		$ 94
Inventories		349
Property and equipment		409
Other long-term assets		30
Goodwill		16,950
Total assets acquired		49,845
Liabilities Assumed
Trade payables		(58)
Accrued expenses		(261)
Other long-term liabilities		(1,522)
Deferred income tax liabilities		(4,590)
Total liabilities assumed		(6,431)
Total net assets acquired		43,414
Brightwater | Developed technology
Assets Acquired
Intangibles		31,680
Brightwater | Customer lists
Assets Acquired
Intangibles		83
Brightwater | Trademarks
Assets Acquired
Intangibles		$ 250
Vascular Insights
Assets Acquired
Inventories				$ 1,353
Goodwill				21,847
Total assets acquired				58,200
Vascular Insights | Developed technology
Assets Acquired
Intangibles				32,750
Vascular Insights | Customer lists
Assets Acquired
Intangibles				840
Vascular Insights | Trademarks
Assets Acquired
Intangibles				$ 1,410
Cianna Medical
Assets Acquired
Trade receivables					$ 6,151
Inventories					5,803
Prepaid expenses and other assets					315
Property and equipment					1,047
Other long-term assets					14
Goodwill					65,802
Total assets acquired					224,052
Liabilities Assumed
Trade payables					(1,497)
Accrued expenses					(2,384)
Other long-term liabilities					(1,527)
Deferred income tax liabilities					(30,363)
Total liabilities assumed					(35,771)
Total net assets acquired					188,281
Cianna Medical | Developed technology
Assets Acquired
Intangibles					134,510
Cianna Medical | Customer lists
Assets Acquired
Intangibles					3,330
Cianna Medical | Trademarks
Assets Acquired
Intangibles					$ 7,080
DirectACCESS Medical, LLC
Assets Acquired
Inventories						$ 971
Goodwill						938
Total assets acquired						7,269
DirectACCESS Medical, LLC | Developed technology
Assets Acquired
Intangibles						4,840
DirectACCESS Medical, LLC | Customer lists
Assets Acquired
Intangibles						120
DirectACCESS Medical, LLC | Trademarks
Assets Acquired
Intangibles						$ 400
Becton, Dickinson and Company
Assets Acquired
Inventories							$ 5,804
Property and equipment							748
Goodwill							9,728
Total assets acquired							101,880
Becton, Dickinson and Company | Developed technology
Assets Acquired
Intangibles							74,000
Becton, Dickinson and Company | Customer lists
Assets Acquired
Intangibles							4,200
Becton, Dickinson and Company | Trademarks
Assets Acquired
Intangibles							4,900
Becton, Dickinson and Company | In-process technology
Assets Acquired
Intangibles							$ 2,500

Acquisitions - Summary of Unaud

Acquisitions - Summary of Unaudited Consolidated Results of Operations, Including Proforma Results (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Jun. 30, 2018
As Reported
Net sales	$ 255,532		$ 224,810		$ 493,881	$ 427,844
Net income	$ 6,859	$ 6,195	$ 10,941	$ 5,269	$ 13,054	$ 16,210
Basic (in dollars per share)	$ 0.12		$ 0.22		$ 0.24	$ 0.32
Diluted (in dollars per share)	$ 0.12		$ 0.21		$ 0.23	$ 0.31
Pro Forma
Net sales			$ 238,272			$ 452,451
Net income			$ 6,842			$ 5,016
Basic, Pro Forma (in dollars per share)			$ 0.14			$ 0.10
Diluted, Pro Forma (in dollars per share)			$ 0.13			$ 0.10

Revenue from Contracts with C_3

Revenue from Contracts with Customers. - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Disaggregation of Revenue [Line Items]
Net sales	$ 255,532	$ 224,810	$ 493,881	$ 427,844
United States
Disaggregation of Revenue [Line Items]
Net sales	144,662	124,445	282,722	234,501
International
Disaggregation of Revenue [Line Items]
Net sales	110,870	100,365	211,159	193,343
Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	246,666	216,387	477,146	412,241
Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	136,113	116,324	266,605	219,461
Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	110,553	100,063	210,541	192,780
Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	8,866	8,423	16,735	15,603
Stand-alone devices | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	103,522	92,496	198,948	175,742
Stand-alone devices | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	55,906	50,941	109,305	94,953
Stand-alone devices | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	47,616	41,555	89,643	80,789
Cianna Medical | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	11,237	0	24,085	0
Cianna Medical | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	11,230	0	24,078	0
Cianna Medical | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	7	0	7	0
Custom kits and procedure trays | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	34,343	33,992	67,286	67,264
Custom kits and procedure trays | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	23,124	23,667	45,179	45,984
Custom kits and procedure trays | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	11,219	10,325	22,107	21,280
Inflation devices | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	24,315	24,305	46,333	46,724
Inflation devices | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	8,347	8,160	16,320	15,828
Inflation devices | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	15,968	16,145	30,013	30,896
Catheters | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	45,344	39,374	88,383	73,239
Catheters | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	20,696	16,704	40,108	31,974
Catheters | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	24,648	22,670	48,275	41,265
Embolization devices | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	14,008	12,724	25,835	25,310
Embolization devices | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	5,274	5,094	9,980	10,126
Embolization devices | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	8,734	7,630	15,855	15,184
CRM/EP | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	13,897	13,496	26,276	23,962
CRM/EP | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	11,536	11,758	21,635	20,596
CRM/EP | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	2,361	1,738	4,641	3,366
Endoscopy devices | Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	8,866	8,423	16,735	15,603
Endoscopy devices | Endoscopy | United States
Disaggregation of Revenue [Line Items]
Net sales	8,549	8,121	16,117	15,040
Endoscopy devices | Endoscopy | International
Disaggregation of Revenue [Line Items]
Net sales	$ 317	$ 302	$ 618	$ 563

Segment Reporting - Narrative (

Segment Reporting - Narrative (Details)	6 Months Ended
	Jun. 30, 2019segment
Segment Reporting [Abstract]
Number of operating segments	2

Segment Reporting - Operating I

Segment Reporting - Operating Income (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Jun. 30, 2018
Segment Reporting Information [Line Items]
Net sales	$ 255,532		$ 224,810		$ 493,881	$ 427,844
Operating income	12,201		15,114		21,724	23,895
Total other expense - net	(3,202)		(3,549)		(5,879)	(5,970)
Income tax expense	2,140		624		2,791	1,715
Net income	6,859	$ 6,195	10,941	$ 5,269	13,054	16,210
Cardiovascular
Segment Reporting Information [Line Items]
Net sales	246,666		216,387		477,146	412,241
Operating income	9,855		12,663		17,474	19,060
Endoscopy
Segment Reporting Information [Line Items]
Net sales	8,866		8,423		16,735	15,603
Operating income	$ 2,346		$ 2,451		$ 4,250	$ 4,835

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Income Tax Disclosure [Abstract]
Income tax expense	$ 2,140	$ 624	$ 2,791	$ 1,715
Effective tax rate	23.80%	5.40%	17.60%	9.60%

Revolving Credit Facility and_3

Revolving Credit Facility and Long-Term Debt - Principal Balances under Long-term Debt (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Line of Credit Facility [Line Items]
Total long-term debt	$ 400,221	$ 395,152
Collateralized debt facility	0	7,000
Less unamortized debt issuance costs	(279)	(348)
Less current portion	15,000	22,000
Long-term portion	385,221	373,152
Term Loan
Line of Credit Facility [Line Items]
Total long-term debt	65,000	72,500
Revolving Credit Facility
Line of Credit Facility [Line Items]
Total long-term debt	$ 335,500	$ 316,000

Revolving Credit Facility and_4

Revolving Credit Facility and Long-Term Debt - Narrative (Details) - USD ($)	6 Months Ended
	Jun. 30, 2019	Dec. 31, 2018	Dec. 13, 2017	Jul. 06, 2016
Line of Credit Facility [Line Items]
Outstanding borrowings	$ 400,500,000
Collateralized debt facility	0	$ 7,000,000
Credit Agreement
Line of Credit Facility [Line Items]
Outstanding borrowings	400,500,000
Remaining borrowing capacity on line of credit	$ 38,700,000
Fixed interest rate percent		2.12%
Debt subject to fixed interest rate		$ 175,000,000
Credit Agreement | Variable Rate 1
Line of Credit Facility [Line Items]
Variable interest rate percent	3.65%	3.52%
Debt subject to variable interest rate	$ 225,500,000	$ 213,500,000
Credit Agreement | Interest Rate Swap 2
Line of Credit Facility [Line Items]
Fixed interest rate percent	2.37%
Debt subject to fixed interest rate	$ 175,000,000
Credit Agreement | Revolving Credit Facility
Line of Credit Facility [Line Items]
Increase to revolving credit commitment			$ 100,000,000
Maximum borrowing capacity			$ 375,000,000
Interest rate increase if in event of default	2.00%
Credit Agreement | Revolving Credit Facility | Minimum
Line of Credit Facility [Line Items]
Commitment fee percentage	0.15%
Credit Agreement | Revolving Credit Facility | Maximum
Line of Credit Facility [Line Items]
Commitment fee percentage	0.40%
Credit Agreement | Term Loan
Line of Credit Facility [Line Items]
Debt instrument, face amount				$ 150,000,000
Credit Agreement | Bridge Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity				$ 25,000,000

Revolving Credit Facility and_5

Revolving Credit Facility and Long-Term Debt - Financial Covenants (Details) - Credit Agreement	6 Months Ended
	Jun. 30, 2019USD ($)
Debt Instrument [Line Items]
Consolidated EBITDA	1.25
Consolidated Net Income	$ 0
Facility Capital Expenditures	$ 30,000,000
January 1, 2018 and thereafter
Debt Instrument [Line Items]
Consolidated Total Leverage Ratio	3.5

Revolving Credit Facility and_6

Revolving Credit Facility and Long-Term Debt - Future Minimum Payments on Long-term Debt (Details) $ in Thousands	Jun. 30, 2019USD ($)
Debt Disclosure [Abstract]
Remaining 2019	$ 7,500
2020	17,500
2021	375,500
Total future minimum principal payments	$ 400,500

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) € in Thousands, ₩ in Thousands, ¥ in Thousands, ¥ in Thousands, £ in Thousands, kr in Thousands, kr in Thousands, kr in Thousands, SFr in Thousands, R$ in Thousands, R in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)derivative_instrument	Jun. 30, 2019CNY (¥)derivative_instrument	Jun. 30, 2019CHF (SFr)derivative_instrument	Jun. 30, 2019NOK (kr)derivative_instrument	Jun. 30, 2019DKK (kr)derivative_instrument	Jun. 30, 2019MXN ($)derivative_instrument	Jun. 30, 2019HKD ($)derivative_instrument	Jun. 30, 2019KRW (₩)derivative_instrument	Jun. 30, 2019CAD ($)derivative_instrument	Jun. 30, 2019ZAR (R)derivative_instrument	Jun. 30, 2019GBP (£)derivative_instrument	Jun. 30, 2019JPY (¥)derivative_instrument	Jun. 30, 2019SGD ($)derivative_instrument	Jun. 30, 2019SEK (kr)derivative_instrument	Jun. 30, 2019EUR (€)derivative_instrument	Jun. 30, 2019BRL (R$)derivative_instrument	Jun. 30, 2019AUD ($)derivative_instrument	Dec. 31, 2018USD ($)	Aug. 05, 2016USD ($)
Derivative [Line Items]
Deferred taxes used to offset fair value of interest rate swap	$ 500,000																	$ 1,500,000
Maturity of derivative contract (up to)	2 years
Revenue and cost of sales
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, gross	$ 6,200
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, net of tax	4,600
Interest expense
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, gross	1,300,000
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, net of tax	$ 1,000,000
Interest rate swap
Derivative [Line Items]
Notional amount of derivative																			$ 175,000,000
Fixed rate																			1.12%
Foreign currency forward contracts | Designated as hedging instrument
Derivative [Line Items]
Average number of contracts entered into per month | derivative_instrument	150	150	150	150	150	150	150	150	150	150	150	150	150	150	150	150	150
Foreign currency forward contracts | Not designated as hedging instrument
Derivative [Line Items]
Notional amount of derivative		¥ 85,226	SFr 643	kr 3,180	kr 2,544	$ 25,000	$ 11,000	₩ 6,000,000	$ 2,652	R 37,800	£ 5,653	¥ 1,445,574	$ 1,676	kr 17,154	€ 11,717	R$ 9000	$ 13,788
Average number of contracts entered into per month | derivative_instrument	20	20	20	20	20	20	20	20	20	20	20	20	20	20	20	20	20
Other assets (long-term) | Interest rate swap | Designated as hedging instrument
Derivative [Line Items]
Total Asset Derivatives	$ 1,907,000																	5,772,000
Other assets (long-term) | Foreign currency forward contracts | Designated as hedging instrument
Derivative [Line Items]
Total Asset Derivatives	$ 244,000																	$ 151,000

Derivatives - Forward Notional

Derivatives - Forward Notional Contracts (Details) - Jun. 30, 2019 - Foreign currency forward contracts € in Thousands, ₩ in Thousands, ¥ in Thousands, ¥ in Thousands, £ in Thousands, kr in Thousands, kr in Thousands, kr in Thousands, SFr in Thousands, R$ in Thousands, R in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands

CNY (¥)

CHF (SFr)

NOK (kr)

DKK (kr)

MXN ($)

HKD ($)

KRW (₩)

CAD ($)

ZAR (R)

GBP (£)

JPY (¥)

SGD ($)

SEK (kr)

EUR (€)

BRL (R$)

AUD ($)

Designated as hedging instrument | Derivatives designated as cash flow hedges

Derivative [Line Items]

Notional amount of derivative

¥ 166,500

SFr 1,970

kr 6,000

kr 18,175

$ 296,500

₩ 4,475,000

$ 4,330

£ 4,820

¥ 1,335,000

kr 29,210

€ 22,600

R$ 1080

$ 3,430

Not designated as hedging instrument

Derivative [Line Items]

Notional amount of derivative

¥ 85,226

SFr 643

kr 3,180

kr 2,544

$ 25,000

$ 11,000

₩ 6,000,000

$ 2,652

R 37,800

£ 5,653

¥ 1,445,574

$ 1,676

kr 17,154

€ 11,717

R$ 9000

$ 13,788

Derivatives - Fair Value of Der

Derivatives - Fair Value of Derivative Instruments (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Designated as hedging instrument | Interest rate swap | Other assets (long-term)
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	$ 1,907	$ 5,772
Designated as hedging instrument | Foreign currency forward contracts | Other assets (long-term)
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	244	151
Designated as hedging instrument | Foreign currency forward contracts | Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	960	613
Designated as hedging instrument | Foreign currency forward contracts | Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(778)	(711)
Designated as hedging instrument | Foreign currency forward contracts | Other long-term obligations
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(101)	(101)
Not designated as hedging instrument | Foreign currency forward contracts | Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	229	814
Not designated as hedging instrument | Foreign currency forward contracts | Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	$ (1,539)	$ (796)

Derivatives - Amount of Gain (L

Derivatives - Amount of Gain (Loss) Recognized in OCI and Income Statement (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	$ (1,154)	$ 881	$ (3,731)	$ 2,873
Derivatives designated as cash flow hedges | Interest rate swap
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	(1,812)	748	(2,669)	2,868
Derivatives designated as cash flow hedges | Interest rate swap | Interest expense
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	(3,115)	(3,338)	(5,879)	(5,736)
Amount of Gain/(Loss) reclassified from AOCI	602		1,196
Amount of Gain/(Loss) reclassified from AOCI		357		570
Derivatives designated as cash flow hedges | Foreign currency forward contracts
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	1,064	394	51	568
Derivatives designated as cash flow hedges | Foreign currency forward contracts | Revenue
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	255,532	224,810	493,881	427,844
Amount of Gain/(Loss) reclassified from AOCI	(92)		102
Amount of Gain/(Loss) reclassified from AOCI		(234)		(385)
Derivatives designated as cash flow hedges | Foreign currency forward contracts | Cost of sales
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	(143,568)	(124,801)	(277,281)	(239,779)
Amount of Gain/(Loss) reclassified from AOCI	$ (104)		$ (185)
Amount of Gain/(Loss) reclassified from AOCI		$ 138		$ 378

Derivatives - Gain (Loss) in th

Derivatives - Gain (Loss) in the Consolidated Statements of Income (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Not designated as hedging instrument | Foreign currency forward contracts | Other expense
Derivative [Line Items]
Gain (loss) on derivative	$ (489)	$ 3,153	$ (755)	$ 2,038

Fair Value Measurements - Finan

Fair Value Measurements - Financial Assets and (Liabilities) Carried at Fair Value (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Fair Value, Inputs, Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	$ 0	$ 0
Foreign currency contract liabilities, current and long-term	0	0
Foreign currency contract liabilities, current and long-term	0	0
Contingent receivable asset	0	0
Contingent consideration liabilities	0	0
Fair Value, Inputs, Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	1,907	5,772
Foreign currency contract liabilities, current and long-term	1,433	1,578
Foreign currency contract liabilities, current and long-term	(2,418)	(1,608)
Contingent receivable asset	0	0
Contingent consideration liabilities	0	0
Fair Value, Inputs, Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	0	0
Foreign currency contract liabilities, current and long-term	0	0
Foreign currency contract liabilities, current and long-term	0	0
Contingent receivable asset	625	607
Contingent consideration liabilities	(93,204)	(82,236)
Estimate of Fair Value, Fair Value Disclosure
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	1,907	5,772
Foreign currency contract liabilities, current and long-term	1,433	1,578
Foreign currency contract liabilities, current and long-term	(2,418)	(1,608)
Contingent receivable asset	625	607
Contingent consideration liabilities	$ (93,204)	$ (82,236)

Fair Value Measurements - Liabi

Fair Value Measurements - Liability Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - Contingent Consideration - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 82,457	$ 10,928	$ 82,236	$ 10,956
Contingent consideration liability recorded as the result of acquisitions	8,400	0	8,380	0
Fair value adjustments recorded to income	2,404	99	3,199	86
Contingent payments made	(57)	(115)	(611)	(130)
Ending balance	$ 93,204	$ 10,912	$ 93,204	$ 10,912

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	Dec. 31, 2018
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment of other assets	$ 594	$ 29	$ 805	$ 86
Contingent Receivable | Contingent Consideration
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Gain (loss) on contingent receivable	(2)	(79)	18	(132)
Payment received on contingent receivable		$ 0		$ 153
Other long-term obligations
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, noncurrent	68,600		68,600		$ 58,500
Accrued expenses
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, current	$ 24,600		$ 24,600		$ 23,800

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value Inputs, Liabilities, Quantitative Information (Details) - Fair Value, Inputs, Level 3 $ in Thousands	Jun. 30, 2019USD ($)	Dec. 31, 2018USD ($)
Revenue-based royalty
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	$ 9,843	$ 10,661
Supply chain milestone
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	15,000	13,593
Revenue milestones
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	65,661	57,982
Regulatory approval
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	2,700
Contingent receivable
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration asset	$ 625	$ 607
Discount rate | Revenue-based royalty | Minimum | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.14	0.099
Discount rate | Revenue-based royalty | Maximum | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.25	0.25
Discount rate | Supply chain milestone | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.039	0.053
Discount rate | Revenue milestones | Minimum | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.031	0.033
Discount rate | Revenue milestones | Maximum | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.195	0.13
Discount rate | Regulatory approval | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.053
Discount rate | Contingent receivable | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent receivable asset	0.10	0.10
Probability of milestone payment | Supply chain milestone | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	1	0.95
Probability of milestone payment | Regulatory approval | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability		0.65
Probability of milestone payment | Contingent receivable | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent receivable asset	0.54	0.67

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Goodwill (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Goodwill [Roll Forward]
Goodwill balance at January 1	$ 335,433
Effect of foreign exchange	(181)
Additions and adjustments as the result of acquisitions	16,881
Goodwill balance at June 30	$ 352,133

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Other Intangible Assets (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 130,708	$ 128,702
Accumulated Amortization	(56,289)	(49,136)
Net Carrying Amount	74,419	79,566
Patents
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	20,985	19,378
Accumulated Amortization	(5,850)	(5,012)
Net Carrying Amount	15,135	14,366
Distribution agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	8,012	8,012
Accumulated Amortization	(6,280)	(5,766)
Net Carrying Amount	1,732	2,246
License agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	27,008	26,930
Accumulated Amortization	(9,016)	(7,411)
Net Carrying Amount	17,992	19,519
Trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	30,246	29,998
Accumulated Amortization	(8,035)	(6,586)
Net Carrying Amount	22,211	23,412
Covenants not to compete
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	1,028	1,028
Accumulated Amortization	(1,016)	(1,000)
Net Carrying Amount	12	28
Customer lists
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	40,009	39,936
Accumulated Amortization	(26,092)	(23,361)
Net Carrying Amount	13,917	16,575
In-process technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	3,420	3,420
Accumulated Amortization	0	0
Net Carrying Amount	$ 3,420	$ 3,420

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Accumulated impairment loss	$ 8,300		$ 8,300		$ 8,300
Aggregate amortization expense	14,900	$ 10,400	29,700	$ 18,900
Intangible asset impairment charge	$ 548	$ 0	$ 548	$ 0

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Future Amortization Expense (Details) $ in Thousands	Jun. 30, 2019USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remaining 2019	$ 30,817
2020	58,907
2021	51,550
2022	50,129
2023	$ 48,830

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Dec. 31, 2018	Dec. 31, 2015
Lessee, Lease, Description [Line Items]
Renewal term (up to)	30 years
Termination option (within)	1 year
Sale and leaseback transaction			$ 2,000
Deferred gain from sale and leaseback transaction		$ 93
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease term	1 year
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease term	19 years

Leases - Schedule of Consolidat

Leases - Schedule of Consolidated Balance Sheet Information (Details) $ in Thousands	Jun. 30, 2019USD ($)
Leases [Abstract]
ROU operating lease assets	$ 79,309
Short-term operating lease liabilities	11,732
Long-term operating lease liabilities	71,272
Total operating lease liabilities	$ 83,004

Leases - Components of Lease Co

Leases - Components of Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019
Leases [Abstract]
Operating lease cost	$ 4,172	$ 8,398
Sublease (income)	(146)	(292)
Net lease cost	$ 4,026	$ 8,106

Leases - Supplemental Cash Flow

Leases - Supplemental Cash Flow Information (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 7,267
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 2,927

Leases - Supplemental Disclosur

Leases - Supplemental Disclosure (Details)	Jun. 30, 2019
Leases [Abstract]
Weighted average remaining lease term	12 years
Weighted average discount rate	3.30%

Leases - Maturities of Operatin

Leases - Maturities of Operating Lease Liabilities (Details) $ in Thousands	Jun. 30, 2019USD ($)
Leases [Abstract]
Remaining 2019	$ 7,064
2020	12,789
2021	11,762
2022	9,361
2023	7,381
Thereafter	53,588
Total lease payments	101,945
Less: Imputed interest	(18,941)
Less: Imputed interest	$ 83,004

Leases - Schedule of Minimum Pa

Leases - Schedule of Minimum Payments Under Operating Lease Agreements (Details) $ in Thousands	Dec. 31, 2018USD ($)
Leases [Abstract]
2019	$ 13,421
2020	11,319
2021	9,995
2022	8,053
2023	6,953
Thereafter	52,754
Total minimum lease payments	$ 102,495

Commitments and Contingencies (

Commitments and Contingencies (Details) - USD ($) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019
U.S. Department of Justice Matter
Loss Contingencies [Line Items]
Legal expenses	$ 1	$ 2.7

Subsequent Events (Details)

Subsequent Events (Details) - Subsequent Event £ in Millions	Aug. 01, 2019GBP (£)	Jul. 31, 2019USD ($)
Fibrovein Holdings Limited
Subsequent Event [Line Items]
Total purchase price | £	£ 11.2
Third Amended Credit Agreement
Subsequent Event [Line Items]
Consolidated Total Leverage Ratio		4
Consolidated Interest Coverage Ratio		3
Facility Capital Expenditures		$ 50,000,000
Third Amended Credit Agreement | Term Loan
Subsequent Event [Line Items]
Debt instrument, face amount		150,000,000
Third Amended Credit Agreement | Revolving Credit Facility
Subsequent Event [Line Items]
Maximum borrowing capacity		600,000,000
Third Amended Credit Agreement | Multicurrency Borrowings
Subsequent Event [Line Items]
Maximum borrowing capacity		40,000,000
Third Amended Credit Agreement | Standby Letters of Credit
Subsequent Event [Line Items]
Maximum borrowing capacity		40,000,000
Third Amended Credit Agreement | Bridge Loan
Subsequent Event [Line Items]
Maximum borrowing capacity		$ 30,000,000

Uncategorized Items - mmsi-6302

Label	Element	Value
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 93,000
Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 93,000