Merit Medical Systems (MMSI) 10-Q 8 Nov 19 2019 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2019	Nov. 05, 2019
Cover page.
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 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	Q3
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		55,208,840

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
CURRENT ASSETS:
Cash and cash equivalents	$ 37,315	$ 67,359
Trade receivables - net of allowance for uncollectible accounts - 2019 - $2,848 and 2018 - $2,355	144,683	137,174
Other receivables	11,751	11,879
Inventories	216,766	197,536
Prepaid expenses and other current assets	17,610	11,326
Prepaid income taxes	3,611	3,627
Income tax refund receivables	9,566	933
Total current assets	441,302	429,834
PROPERTY AND EQUIPMENT:
Land and land improvements	27,412	26,801
Buildings	152,782	151,251
Manufacturing equipment	234,121	221,029
Furniture and fixtures	59,487	54,765
Leasehold improvements	36,992	33,678
Construction-in-progress	85,703	53,491
Total property and equipment	596,497	541,015
Less accumulated depreciation	(229,596)	(209,563)
Property and equipment - net	366,901	331,452
OTHER ASSETS:
Goodwill	352,158	335,433
Deferred income tax assets	2,944	3,001
Right-of-use operating lease assets	79,757
Other assets	59,735	57,579
Total other assets	953,501	858,726
TOTAL	1,761,704	1,620,012
CURRENT LIABILITIES:
Trade payables	52,387	54,024
Accrued expenses	80,486	96,173
Current portion of long-term debt	7,500	22,000
Short-term operating lease liabilities	11,652
Income taxes payable	1,188	3,146
Total current liabilities	153,213	175,343
LONG-TERM DEBT	432,456	373,152
DEFERRED INCOME TAX LIABILITIES	58,290	56,363
LONG-TERM INCOME TAXES PAYABLE	392	392
LIABILITIES RELATED TO UNRECOGNIZED TAX BENEFITS	3,013	3,013
DEFERRED COMPENSATION PAYABLE	13,497	11,219
DEFERRED CREDITS	2,157	2,261
LONG-TERM OPERATING LEASE LIABILITIES	72,056
OTHER LONG-TERM OBLIGATIONS	77,389	65,494
Total liabilities	812,463	687,237
COMMITMENTS AND CONTINGENCIES (Notes 5, 10, 11, 14 and 15)
STOCKHOLDERS' EQUITY:
Preferred stock - 5,000 shares authorized as of September 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 September 30, 2019 - 55,208 and December 31, 2018 - 54,893	584,161	571,383
Retained earnings	373,174	363,425
Accumulated other comprehensive loss	(8,094)	(2,033)
Total stockholders' equity	949,241	932,775
TOTAL	1,761,704	1,620,012
Developed technology
OTHER ASSETS:
Intangible assets	390,796	383,147
Other
OTHER ASSETS:
Intangible assets	$ 68,111	$ 79,566

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
CURRENT ASSETS:
Trade receivables, allowances	$ 2,848	$ 2,355
STOCKHOLDERS' EQUITY:
Preferred stock shares authorized (in shares)	5,000	5,000
Preferred stock shares issued (in shares)	0	0
Common stock shares authorized (in shares)	100,000	100,000
Common stock shares issued (in shares)	55,208	54,893
Common stock shares outstanding (in shares)	55,208	54,893
Developed technology
OTHER ASSETS:
Intangibles, accumulated amortization	$ 137,551	$ 102,357
Other
OTHER ASSETS:
Intangibles, accumulated amortization	$ 62,378	$ 49,136

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME (LOSS) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Income Statement [Abstract]
NET SALES	$ 243,049	$ 221,659	$ 736,930	$ 649,504
COST OF SALES	138,913	119,620	416,194	359,400
GROSS PROFIT	104,136	102,039	320,736	290,104
OPERATING EXPENSES:
Selling, general and administrative	86,936	66,382	245,183	200,389
Research and development	16,987	14,525	49,361	44,163
Intangible asset impairment charge	2,702	657	3,250	657
Contingent consideration expense (benefit)	392	(661)	3,573	(442)
Acquired in-process research and development		75	525	382
Total operating expenses	107,017	80,978	301,892	245,149
INCOME (LOSS) FROM OPERATIONS	(2,881)	21,061	18,844	44,955
OTHER INCOME (EXPENSE):
Interest income	328	359	1,027	847
Interest expense	(3,415)	(2,329)	(9,295)	(8,064)
Other income (expense) - net	278	294	(421)	(429)
Total other expense - net	(2,809)	(1,676)	(8,689)	(7,646)
INCOME (LOSS) BEFORE INCOME TAXES	(5,690)	19,385	10,155	37,309
INCOME TAX EXPENSE (BENEFIT)	(2,292)	2,766	499	4,481
NET INCOME (LOSS)	$ (3,398)	$ 16,619	$ 9,656	$ 32,828
EARNINGS (LOSS) PER COMMON SHARE:
Basic (in dollars per share)	$ (0.06)	$ 0.31	$ 0.18	$ 0.64
Diluted (in dollars per share)	$ (0.06)	$ 0.30	$ 0.17	$ 0.62
AVERAGE COMMON SHARES:
Basic (in shares)	55,152	53,431	55,029	51,434
Diluted (in shares)	55,152	55,103	56,393	53,096

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Statement of Comprehensive Income [Abstract]
Net income (loss)	$ (3,398)	$ 16,619	$ 9,656	$ 32,828
Other comprehensive income (loss):
Cash flow hedges	(207)	667	(3,938)	3,541
Income tax benefit (expense)	53	(172)	1,014	(910)
Foreign currency translation adjustment	(2,779)	(1,637)	(3,120)	(3,241)
Income tax benefit (expense)	(14)	0	(17)	0
Total other comprehensive (loss)	(2,947)	(1,142)	(6,061)	(610)
Total comprehensive income (loss)	$ (6,345)	$ 15,477	$ 3,595	$ 32,218

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands	Common Stock	Retained Earnings	Accumulated Other Comprehensive Income (Loss)	Total
Beginning balance at Dec. 31, 2017	$ 353,392	$ 321,408	$ 1,534	$ 676,334
Beginning balance (in shares) at Dec. 31, 2017	50,248
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)		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	$ 356,228	326,677	5,606	688,511
Ending balance (in shares) at Mar. 31, 2018	50,346
Beginning balance at Dec. 31, 2017	$ 353,392	321,408	1,534	676,334
Beginning balance (in shares) at Dec. 31, 2017	50,248
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)				32,828
Other comprehensive income/loss				(610)
Shares surrendered in exchange for exercise of stock options				$ (2,262)
Shares surrendered in exchange for exercise of stock options (in shares)				(43)
Ending balance at Sep. 30, 2018	$ 568,051	354,236	924	$ 923,211
Ending balance (in shares) at Sep. 30, 2018	54,802
Beginning balance at Mar. 31, 2018	$ 356,228	326,677	5,606	688,511
Beginning balance (in shares) at Mar. 31, 2018	50,346
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)		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	$ 359,570	337,618	2,066	699,254
Ending balance (in shares) at Jun. 30, 2018	50,635
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)		16,619		16,619
Other comprehensive income/loss			(1,142)	(1,142)
Stock-based compensation expense	$ 1,673			1,673
Options exercised	$ 2,624			2,624
Options exercised (in shares)	158
Issuance of common stock under Employee Stock Purchase Plan	$ 282			282
Issuance of common stock under Employee Stock Purchase Plans (in shares)	5
Issuance of common stock, net of offering costs	$ 205,030			205,030
Issuance of common stock, net of offering costs (in shares)	4,025
Shares surrendered in exchange for payment of payroll tax liabilities	$ (551)			(551)
Shares surrendered in exchange for payment of payroll tax liabilities (in shares)	(10)
Shares surrendered in exchange for exercise of stock options	$ (577)			(577)
Shares surrendered in exchange for exercise of stock options (in shares)	(11)
Ending balance at Sep. 30, 2018	$ 568,051	354,236	924	923,211
Ending balance (in shares) at Sep. 30, 2018	54,802
Beginning balance at Dec. 31, 2018	$ 571,383	363,425	(2,033)	$ 932,775
Beginning balance (in shares) at Dec. 31, 2018	54,893			54,893
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)		6,195		$ 6,195
Reclassify deferred gain on sale-leaseback upon adoption of ASC 842		93		93
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	$ 574,946	369,713	(4,548)	940,111
Ending balance (in shares) at Mar. 31, 2019	54,995
Beginning balance at Dec. 31, 2018	$ 571,383	363,425	(2,033)	$ 932,775
Beginning balance (in shares) at Dec. 31, 2018	54,893			54,893
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)				$ 9,656
Other comprehensive income/loss				(6,061)
Shares surrendered in exchange for exercise of stock options				$ (93)
Shares surrendered in exchange for exercise of stock options (in shares)				(3)
Ending balance at Sep. 30, 2019	$ 584,161	373,174	(8,094)	$ 949,241
Ending balance (in shares) at Sep. 30, 2019	55,208			55,208
Beginning balance at Mar. 31, 2019	$ 574,946	369,713	(4,548)	$ 940,111
Beginning balance (in shares) at Mar. 31, 2019	54,995
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)		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	$ 579,250	376,572	(5,147)	950,675
Ending balance (in shares) at Jun. 30, 2019	55,079
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)		(3,398)		(3,398)
Other comprehensive income/loss			(2,947)	(2,947)
Stock-based compensation expense	$ 2,626			2,626
Options exercised	$ 2,037			2,037
Options exercised (in shares)	120
Issuance of common stock under Employee Stock Purchase Plan	$ 341			341
Issuance of common stock under Employee Stock Purchase Plans (in shares)	12
Shares surrendered in exchange for exercise of stock options	$ (93)			(93)
Shares surrendered in exchange for exercise of stock options (in shares)	(3)
Ending balance at Sep. 30, 2019	$ 584,161	$ 373,174	$ (8,094)	$ 949,241
Ending balance (in shares) at Sep. 30, 2019	55,208			55,208

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	$ 9,656	$ 32,828
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	68,507	50,436
Loss on sales and/or abandonment of property and equipment	637	425
Amortization of right-of-use operating lease assets	9,226
Write-off of patents and intangible assets	3,492	744
Acquired in-process research and development	525	382
Amortization of deferred credits	(104)	(106)
Amortization of long-term debt issuance costs	570	603
Stock-based compensation expense	6,915	4,494
Changes in operating assets and liabilities, net of effects from acquisitions:
Trade receivables	(6,786)	(25,482)
Other receivables	72	255
Inventories	(19,302)	(19,375)
Prepaid expenses and other current assets	(3,859)	(2,719)
Prepaid income taxes		(120)
Income tax refund receivables	(8,680)	134
Other assets	(3,832)	(1,370)
Trade payables	(3,775)	15,936
Accrued expenses	66	7,707
Income taxes payable	(928)	(1,528)
Deferred compensation payable	2,276	994
Operating lease liabilities	(8,956)
Other long-term obligations	5,184	(1,381)
Total adjustments	41,248	30,029
Net cash provided by operating activities	50,904	62,857
Capital expenditures for:
Property and equipment	(58,104)	(47,024)
Intangible assets	(2,560)	(2,234)
Proceeds from the sale of property and equipment	262	7
Issuance of note receivable	0	(10,750)
Cash paid in acquisitions, net of cash acquired	(53,512)	(122,770)
Net cash used in investing activities	(113,914)	(182,771)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock	5,863	213,276
Offering costs		(366)
Proceeds from issuance of long-term debt	194,477	380,825
Payments on long-term debt	(149,477)	(450,575)
Long-term debt issuance costs	(1,479)
Contingent payments related to acquisitions	(15,684)	(184)
Payment of taxes related to an exchange of common stock		(2,616)
Net cash provided by financing activities	33,700	140,360
EFFECT OF EXCHANGE RATES ON CASH	(734)	(827)
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS	(30,044)	19,619
CASH AND CASH EQUIVALENTS:
Beginning of period	67,359	32,336
End of period	37,315	51,955
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Interest (net of capitalized interest of $896 and $468, respectively)	9,319	8,018
Income taxes	10,071	6,069
SUPPLEMENTAL DISCLOSURES OF NON-CASH INVESTING AND FINANCING ACTIVITIES
Property and equipment purchases in accounts payable	7,481	3,058
Acquisition purchases in accrued expenses and other long-term obligations	9,583	0
Merit common stock surrendered (3 and 43 shares, respectively) in exchange for exercise of stock options	93	$ 2,262
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 7,431

CONSOLIDATED STATEMENTS OF CA_2

CONSOLIDATED STATEMENTS OF CASH FLOWS (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Statement of Cash Flows [Abstract]
Net capitalized interest	$ 896	$ 468
Shares surrendered in exchange for exercise of stock options (in shares)	3	43

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	1. Basis of Presentation. ​

Inventories

Inventories	9 Months Ended
	Sep. 30, 2019
Inventory Disclosure [Abstract]
Inventories	2. Inventories. ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2019 December 31, 2018 Finished goods ​ $ 126,699 ​ $ 117,703 Work-in-process ​ 24,368 ​ 14,380 Raw materials ​ 65,699 ​ 65,453 Total Inventories ​ $ 216,766 ​ $ 197,536 ​ ​

Stock-Based Compensation Expens

Stock-Based Compensation Expense	9 Months Ended
	Sep. 30, 2019
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation Expense	3. Stock-Based Compensation Expense. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ 2019 2018 2019 2018 Cost of sales ​ $ 346 ​ $ 241 ​ $ 953 ​ $ 657 Research and development ​ 277 ​ 141 ​ 750 ​ 412 Selling, general and administrative ​ 2,003 ​ 1,291 ​ 5,212 ​ 3,425 Stock-based compensation expense before taxes ​ $ 2,626 ​ $ 1,673 ​ $ 6,915 ​ $ 4,494 ​ 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 September 30, 2019, the total remaining unrecognized compensation cost related to non-vested stock options, net of expected forfeitures, was approximately $30.8 million and was expected to be recognized over a weighted average period of 3.13 years. During the three and nine months ended September 30, 2019, we granted stock-based awards representing approximately 107,000 and 1.2 million shares of our common stock, respectively. During the three and nine-month periods ended September 30, 2018, we granted stock-based awards representing 0 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: ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended ​ ​ September 30, ​ ​ 2019 ​ 2018 Risk-free interest rate 1.39% - 2.56% 2.63% - 2.77% Expected option term 3 - 5 years 5.0 years Expected dividend yield — — Expected price volatility 28.66% - 35.79% 34.06% - 34.32% ​ The average risk-free interest rate is determined using the U.S. Treasury rate in effect as of the date of grant, based on the expected term of the stock options. We determine the expected term of the stock options using the historical exercise behavior of employees. The expected price volatility was determined using a weighted average of daily historical volatility of our stock price over the corresponding expected option term and implied volatility based on recent trends of the daily historical volatility. For options with a vesting period, compensation expense is recognized on a straight-line basis over the service period, which corresponds to the vesting period.

Earnings Per Common Share (EPS)

Earnings Per Common Share (EPS)	9 Months Ended
	Sep. 30, 2019
Earnings Per Share, Basic and Diluted [Abstract]
Earnings Per Common Share (EPS)	4. Earnings (Loss) Per Common Share (EPS). ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ ​ September 30, ​ September 30, ​ ​ ​ 2019 ​ 2018 ​ 2019 ​ 2018 ​ Net income (loss) ​ $ (3,398) ​ $ 16,619 ​ $ 9,656 ​ $ 32,828 ​ Average common shares outstanding ​ 55,152 ​ 53,431 ​ 55,029 ​ 51,434 ​ Basic EPS ​ $ (0.06) ​ $ 0.31 ​ $ 0.18 ​ $ 0.64 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Average common shares outstanding ​ ​ 55,152 ​ ​ 53,431 ​ ​ 55,029 ​ ​ 51,434 ​ Effect of dilutive stock options ​ ​ — ​ ​ 1,672 ​ ​ 1,364 ​ ​ 1,662 ​ Total potential shares outstanding ​ ​ 55,152 ​ ​ 55,103 ​ ​ 56,393 ​ ​ 53,096 ​ Diluted EPS ​ $ (0.06) ​ $ 0.30 ​ $ 0.17 ​ $ 0.62 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Stock options excluded as the impact was anti-dilutive ​ ​ 4,299 ​ ​ 667 ​ ​ 1,361 ​ ​ 462 ​ ​

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2019
Business Combinations [Abstract]
Acquisitions	5. Acquisitions. Acquisition-related costs associated with the STD Pharmaceutical acquisition, which were included in selling, general and administrative expenses, were not material. ​ ​ ​ ​ ​ Assets Acquired ​ Trade receivables ​ $ 200 Inventories ​ 843 Prepaid expenses and other assets ​ 49 Intangibles ​ ​ Developed technology ​ ​ 10,148 Goodwill ​ ​ 4,390 Total assets acquired ​ 15,630 ​ ​ ​ ​ Liabilities Assumed ​ Trade payables ​ (53) Accrued expenses ​ (29) Deferred income tax liabilities ​ (1,875) Total liabilities assumed ​ (1,957) ​ ​ ​ ​ Total net assets acquired ​ $ 13,673 ​ We are amortizing the developed technology intangible asset acquired from STD Pharmaceutical over 12 years. 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): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Preliminary Allocation ​ Adjustments (1) ​ Revised Preliminary Allocation Assets Acquired ​ ​ ​ ​ ​ ​ ​ Trade receivables ​ $ 94 ​ $ (39) ​ $ 55 Inventories ​ 349 ​ ​ — ​ ​ 349 Property and equipment ​ 409 ​ ​ — ​ ​ 409 Other long-term assets ​ 30 ​ ​ — ​ ​ 30 Intangibles ​ ​ ​ ​ ​ ​ ​ Developed technology ​ 31,680 ​ ​ 280 ​ ​ 31,960 Customer lists ​ 83 ​ ​ — ​ ​ 83 Trademarks ​ 250 ​ ​ — ​ ​ 250 Goodwill ​ 16,950 ​ ​ 959 ​ ​ 17,909 Total assets acquired ​ 49,845 ​ ​ 1,200 ​ ​ 51,045 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Liabilities Assumed ​ ​ ​ ​ ​ ​ ​ Trade payables ​ (58) ​ ​ — ​ ​ (58) Accrued expenses ​ (261) ​ ​ — ​ ​ (261) Other long-term obligations ​ (1,522) ​ ​ — ​ ​ (1,522) Deferred income tax liabilities ​ (4,590) ​ ​ — ​ ​ (4,590) Total liabilities assumed ​ (6,431) ​ ​ — ​ ​ (6,431) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total net assets acquired ​ $ 43,414 ​ $ 1,200 ​ $ 44,614 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ (1) Amounts represent adjustments to the preliminary purchase price allocation first presented in our June 30, 2019 Form 10-Q resulting from our ongoing activities, including reassessment of the assets acquired and liabilities assumed, with respect to finalizing our purchase price allocation for this acquisition. The larger adjustments primarily relate to the valuation of contingent consideration and intangible assets acquired. ​ 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 Insights’ 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 a final working capital adjustment of approximately $15,000 paid in the third quarter of 2019. We are also 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 nine-month periods ended September 30, 2019, net sales of products acquired from Vascular Insights were approximately $2.0 million and $5.2 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 ​ 21,832 ​ ​ ​ ​ Total net assets acquired ​ $ 58,185 ​ 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 earn-out payments of $15 million for achievement of supply chain and scalability metrics paid in the third quarter of 2019 and potential payments 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 nine-month periods ended September 30, 2019, net sales of Cianna Medical products were approximately $11.6 million and $35.7 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 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): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Preliminary Allocation ​ Adjustments (1) ​ Revised Preliminary Allocation Assets Acquired ​ ​ ​ ​ ​ ​ ​ ​ ​ Trade receivables ​ $ 6,151 ​ $ — ​ $ 6,151 Inventories ​ 5,803 ​ ​ — ​ ​ 5,803 Prepaid expenses and other current assets ​ 315 ​ ​ — ​ ​ 315 Property and equipment ​ 1,047 ​ ​ — ​ ​ 1,047 Other long-term assets ​ 14 ​ ​ — ​ ​ 14 Intangibles ​ ​ ​ ​ ​ ​ Developed technology ​ ​ 134,510 ​ ​ — ​ ​ 134,510 Customer lists ​ 3,330 ​ ​ — ​ ​ 3,330 Trademarks ​ 7,080 ​ ​ — ​ ​ 7,080 Goodwill ​ 65,885 ​ ​ (4,506) ​ ​ 61,379 Total assets acquired ​ 224,135 ​ ​ (4,506) ​ ​ 219,629 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Liabilities Assumed ​ ​ ​ ​ ​ ​ Trade payables ​ (1,497) ​ ​ — ​ ​ (1,497) Accrued expenses ​ (2,384) ​ ​ — ​ ​ (2,384) Other long-term liabilities ​ (1,527) ​ ​ — ​ ​ (1,527) Deferred income tax liabilities ​ (30,363) ​ ​ 4,423 ​ ​ (25,940) Total liabilities assumed ​ (35,771) ​ ​ 4,423 ​ ​ (31,348) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total net assets acquired ​ $ 188,364 ​ $ (83) ​ $ 188,281 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ (1) Amounts represent adjustments to the preliminary purchase price allocation first presented in our December 31, 2018 Form 10-K resulting from our ongoing activities, including reassessment of the assets acquired and liabilities assumed, with respect to finalizing our purchase price allocation for this acquisition. ​ 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. We also recorded a contingent consideration liability of $1.6 million related to milestone payments payable pursuant to the terms of an acquired contract with Sontina Medical LLC. 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 nine-month periods ended September 30, 2019, our net sales of BD products were approximately $12.5 million and $35.9 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 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 approximately eight years. The following table summarizes our consolidated results of operations for the three and nine-month periods ended September 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 ​ Nine Months Ended ​ ​ ​ September 30, 2018 ​ September 30, 2018 ​ ​ As Reported Pro Forma As Reported Pro Forma ​ Net sales ​ $ 221,659 ​ $ 234,751 ​ $ 649,504 ​ $ 687,203 ​ Net income ​ 16,619 ​ 11,335 ​ ​ 32,828 ​ 16,496 ​ Earnings per common share: ​ ​ ​ ​ ​ ​ ​ Basic ​ $ 0.31 ​ $ 0.21 ​ $ 0.64 ​ $ 0.32 ​ Diluted ​ $ 0.30 ​ $ 0.21 ​ $ 0.62 ​ $ 0.31 ​ * The pro forma results for the three and nine-month periods ended September 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 STD Pharmaceutical, 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	9 Months Ended
	Sep. 30, 2019
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers	6. Revenue from Contracts with Customers. 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 nine-month periods ended September 30, 2019 and 2018 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Three Months Ended ​ ​ September 30, 2019 ​ September 30, 2018 ​ United States International Total United States International Total Cardiovascular ​ ​ ​ ​ ​ ​ Stand-alone devices ​ $ 55,816 ​ $ 40,510 ​ $ 96,326 ​ $ 52,173 ​ $ 38,802 ​ $ 90,975 Cianna Medical ​ 11,544 ​ ​ 94 ​ 11,638 ​ — ​ — ​ — Custom kits and procedure trays ​ 23,115 ​ ​ 10,857 ​ 33,972 ​ 23,199 ​ 9,896 ​ 33,095 Inflation devices ​ 8,156 ​ ​ 14,027 ​ 22,183 ​ 7,819 ​ 15,074 ​ 22,893 Catheters ​ 20,262 ​ ​ 24,164 ​ 44,426 ​ 18,081 ​ 22,510 ​ 40,591 Embolization devices ​ 5,254 ​ ​ 7,079 ​ 12,333 ​ 5,145 ​ 7,250 ​ 12,395 CRM/EP ​ 11,524 ​ ​ 2,024 ​ 13,548 ​ 10,462 ​ 1,739 ​ 12,201 Total ​ 135,671 ​ 98,755 ​ 234,426 ​ 116,879 ​ 95,271 ​ 212,150 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Endoscopy ​ ​ ​ ​ ​ ​ Endoscopy devices ​ 8,340 ​ ​ 283 ​ 8,623 ​ 9,229 ​ 280 ​ 9,509 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total ​ $ 144,011 ​ $ 99,038 ​ $ 243,049 ​ $ 126,108 ​ $ 95,551 ​ $ 221,659 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended ​ Nine Months Ended ​ ​ ​ September 30, 2019 ​ September 30, 2018 ​ ​ United States International Total United States International Total ​ Cardiovascular ​ ​ ​ ​ ​ ​ ​ Stand-alone devices ​ $ 165,121 ​ $ 130,154 ​ $ 295,275 ​ $ 147,125 ​ $ 119,592 ​ $ 266,717 ​ Cianna Medical ​ 35,622 ​ ​ 101 ​ 35,723 ​ — ​ — ​ — ​ Custom kits and procedure trays ​ 68,292 ​ ​ 32,965 ​ 101,257 ​ 69,184 ​ 31,175 ​ 100,359 ​ Inflation devices ​ 24,475 ​ ​ 44,040 ​ 68,515 ​ 23,647 ​ 45,970 ​ 69,617 ​ Catheters ​ 60,370 ​ ​ 72,439 ​ 132,809 ​ 50,055 ​ 63,775 ​ 113,830 ​ Embolization devices ​ 15,234 ​ ​ 22,934 ​ 38,168 ​ 15,272 ​ 22,434 ​ 37,706 ​ CRM/EP ​ 33,157 ​ ​ 6,666 ​ 39,823 ​ 31,058 ​ 5,105 ​ 36,163 ​ Total ​ 402,271 ​ 309,299 ​ 711,570 ​ 336,341 ​ 288,051 ​ 624,392 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Endoscopy ​ ​ ​ ​ ​ ​ ​ Endoscopy devices ​ 24,459 ​ ​ 901 ​ 25,360 ​ 24,269 ​ 843 ​ 25,112 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total ​ $ 426,730 ​ $ 310,200 ​ $ 736,930 ​ $ 360,610 ​ $ 288,894 ​ $ 649,504 ​ ​

Segment Reporting

Segment Reporting	9 Months Ended
	Sep. 30, 2019
Segment Reporting [Abstract]
Segment Reporting	7. Segment Reporting. Financial information relating to our reportable operating segments and reconciliations to the consolidated totals for the three and nine-month periods ended September 30, 2019 and 2018, were as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended Nine Months Ended ​ ​ September 30, September 30, ​ ​ 2019 2018 2019 2018 ​ Net Sales ​ ​ ​ ​ ​ Cardiovascular ​ $ 234,426 ​ $ 212,150 ​ $ 711,570 ​ $ 624,392 ​ Endoscopy ​ 8,623 ​ 9,509 ​ 25,360 ​ 25,112 ​ Total net sales ​ 243,049 ​ 221,659 ​ 736,930 ​ 649,504 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Operating Income (Loss) ​ ​ ​ ​ ​ Cardiovascular ​ (6,210) ​ 18,199 ​ 11,263 ​ 37,263 ​ Endoscopy ​ 3,329 ​ 2,862 ​ 7,581 ​ 7,692 ​ Total operating income (loss) ​ (2,881) ​ 21,061 ​ 18,844 ​ 44,955 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total other expense - net ​ (2,809) ​ (1,676) ​ (8,689) ​ (7,646) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Income tax expense (benefit) ​ (2,292) ​ 2,766 ​ 499 ​ 4,481 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Net income (loss) ​ $ (3,398) ​ $ 16,619 ​ $ 9,656 ​ $ 32,828 ​ ​

Recently Issued Financial Accou

Recently Issued Financial Accounting Standards	9 Months Ended
	Sep. 30, 2019
Accounting Policies [Abstract]
Recently Issued Financial Accounting Standards	8. 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) In June 2018, the FASB issued ASU 2018-07, Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting Compensation - Stock Compensation 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, In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities 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, In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820) In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, 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	9 Months Ended
	Sep. 30, 2019
Income Tax Disclosure [Abstract]
Income Taxes	9. Income Taxes.

Revolving Credit Facility and L

Revolving Credit Facility and Long-Term Debt	9 Months Ended
	Sep. 30, 2019
Debt Disclosure [Abstract]
Revolving Credit Facility and Long-Term Debt	10. Revolving Credit Facility and Long-Term Debt. ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2019 December 31, 2018 Term Loans ​ $ 150,000 ​ $ 72,500 Revolving credit loans ​ 290,500 ​ 316,000 Collateralized debt facility ​ — ​ 7,000 Less unamortized debt issuance costs ​ (544) ​ (348) Total long-term debt ​ 439,956 ​ 395,152 Less current portion ​ 7,500 ​ 22,000 Long-term portion ​ $ 432,456 ​ $ 373,152 ​ Third Amended and Restated Credit Agreement ​ On July 31, 2019, we entered into a Third Amended and Restated Credit Agreement (the "Third Amended Credit Agreement"), with Wells Fargo Bank, National Association, as administrative agent and a lender, and Wells Fargo Securities, LLC, BOFA Securities, Inc., HSBC Bank USA, National Association, and U.S. Bank National Association as joint lead arrangers and joint bookrunners, and Bank of America, N.A., HSBC Bank USA, National Association and U.S. Bank National Association as co-syndication agents. In addition, Bank of America, N.A., HSBC Bank USA, National Association, U.S. Bank, National Association, BMO Harris Bank, N.A., and MUFG Union Bank, Ltd. 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 for multicurrency borrowings, standby letters of credit and swingline loans. 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 term loans and revolving credit loans in whole or in part, without premium or penalty, other than breakage fees (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 (as defined in the Third Amended Credit Agreement). 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 Leverage Ratio (1) ​ 4.0 to 1.0 Consolidated Interest Coverage Ratio (2) ​ 3.0 to 1.0 Facility Capital Expenditures (3) ​ ​ $50 million (1) Maximum Consolidated Total Net 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. ​ As of September 30, 2019, we believe we were in compliance with all covenants set forth in the Third Amended Credit Agreement. As of September 30, 2019, we had outstanding borrowings of approximately $440.5 million under the Third Amended Credit Agreement, with additional available borrowings of approximately $191.1 million, based on the leverage ratio required pursuant to the Third Amended Credit Agreement. Our interest rate as of September 30, 2019 was a fixed rate of 2.37% on $175 million as a result of an interest rate swap (see Note 11) and a variable floating rate of 3.29% on $265.5 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 September 30, 2019, were as follows (in thousands): ​ ​ ​ ​ Years Ending ​ Future Minimum December 31, Principal Payments Remaining 2019 $ 1,875 2020 ​ 7,500 2021 ​ ​ 7,500 2022 ​ ​ 8,438 2023 ​ ​ 11,250 2024 ​ 403,937 Total future minimum principal payments ​ $ 440,500 ​

Derivatives

Derivatives	9 Months Ended
	Sep. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivatives	11. 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. 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 September 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 September 30, 2019 was an asset of approximately $1.2 million, which was partially offset by approximately $0.3 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. 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 September 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 5,930 Brazilian Real ​ BRL ​ 7,830 Canadian Dollar CAD 6,495 Swiss Franc CHF 3,780 Chinese Renminbi CNY 408,000 Danish Krone DKK 32,225 Euro EUR 33,150 British Pound GBP 7,315 Japanese Yen JPY 1,190,000 Korean Won KRW 7,000,000 Mexican Peso MXN 453,500 Norwegian Krone ​ NOK ​ 14,050 Swedish Krona SEK 43,450 ​ 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 September 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 12,695 Brazilian Real BRL 13,000 Canadian Dollar CAD 1,795 Swiss Franc CHF 739 Chinese Renminbi CNY 69,069 Danish Krone DKK 4,072 Euro EUR 1,225 British Pound GBP 6,982 Hong Kong Dollar HKD 11,000 Japanese Yen JPY 1,380,856 Korean Won KRW 7,343,000 Mexican Peso MXN 35,000 Norwegian Krone ​ NOK ​ 2,999 Swedish Krona SEK 12,647 Singapore Dollar ​ SGD ​ 600 South African Rand ZAR 40,218 ​ Balance Sheet Presentation of Derivative Instruments. The fair value of derivative instruments on a gross basis was as follows on the dates indicated (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair Value ​ Balance Sheet Location September 30, 2019 December 31, 2018 Derivative instruments designated as hedging instruments ​ ​ Assets ​ ​ Interest rate swap Other assets (long-term) ​ $ 1,201 ​ $ 5,772 Foreign currency forward contracts Prepaid expenses and other assets ​ 1,821 ​ 613 Foreign currency forward contracts Other assets (long-term) ​ 496 ​ 151 ​ ​ ​ ​ ​ ​ ​ ​ ​ Liabilities ​ ​ Foreign currency forward contracts Accrued expenses ​ (1,262) ​ (711) Foreign currency forward contracts Other long-term obligations ​ (333) ​ (101) ​ ​ ​ ​ ​ ​ ​ ​ ​ Derivative instruments not designated as hedging instruments ​ ​ Assets ​ ​ Foreign currency forward contracts Prepaid expenses and other assets ​ $ 541 ​ $ 814 Liabilities ​ ​ Foreign currency forward contracts Accrued expenses ​ (505) ​ (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 (“OCI”), accumulated other comprehensive income (“AOCI”), and net earnings in our consolidated statements of income, consolidated statements of comprehensive income and consolidated balance sheets (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amount of Gain/(Loss) ​ ​ ​ ​ Consolidated Statements of ​ Amount of Gain/(Loss) ​ ​ recognized in OCI ​ ​ ​ ​ Income ​ reclassified from AOCI ​ ​ Three Months Ended September 30, ​ ​ ​ ​ Three Months Ended September 30, ​ Three Months Ended September 30, ​ 2019 2018 ​ 2019 ​ 2018 2019 ​ 2018 Derivative instrument ​ ​ Location in statements of income ​ ​ ​ ​ Interest rate swap ​ $ (186) ​ $ 664 ​ Interest expense ​ $ (3,415) ​ $ (2,329) ​ $ 520 ​ $ 428 Foreign currency forward contracts ​ 505 ​ 543 ​ Revenue ​ 243,049 ​ 221,659 ​ 118 ​ 86 ​ ​ ​ ​ ​ ​ ​ ​ Cost of sales ​ (138,913) ​ (119,620) ​ (112) ​ 26 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amount of Gain/(Loss) ​ ​ ​ ​ Consolidated Statements of ​ Amount of Gain/(Loss) ​ ​ recognized in OCI ​ ​ ​ ​ Income ​ reclassified from AOCI ​ ​ Nine Months Ended September 30, ​ ​ ​ ​ Nine Months Ended September 30, ​ Nine Months Ended September 30, ​ 2019 2018 ​ 2019 ​ 2018 2019 ​ 2018 Derivative instrument ​ ​ Location in statements of income ​ ​ ​ ​ Interest rate swap ​ ​ (2,855) ​ $ 3,532 ​ Interest expense ​ ​ (9,295) ​ (8,064) ​ $ 1,716 ​ $ 998 Foreign currency forward contracts ​ 555 ​ 1,112 ​ Revenue ​ 736,930 ​ 649,504 ​ 220 ​ (299) ​ ​ ​ ​ ​ ​ ​ ​ Cost of sales ​ (416,194) ​ (359,400) ​ (298) ​ 404 ​ As of September 30, 2019, approximately $(467,000), or $(347,000) 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 September 30, 2019, approximately $933,000, or $693,000 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 September 30, Nine Months Ended September 30, Derivative Instrument Location in statements of income 2019 2018 2019 2018 Foreign currency forward contracts Other income (expense) ​ $ 2,402 ​ $ 1,143 ​ $ 1,647 ​ $ 3,181 ​

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2019
Fair Value Disclosures [Abstract]
Fair Value Measurements	12. Fair Value Measurements. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair Value Measurements Using ​ ​ Total Fair ​ Quoted prices in ​ Significant other ​ Significant ​ ​ Value at ​ active markets ​ observable inputs ​ unobservable inputs ​ September 30, 2019 (Level 1) (Level 2) (Level 3) Interest rate contract (1) ​ $ 1,201 ​ $ — ​ $ 1,201 ​ $ — Foreign currency contract assets, current and long-term (2) ​ $ 2,858 ​ $ — ​ $ 2,858 ​ $ — Foreign currency contract liabilities, current and long-term (3) ​ $ (2,100) ​ $ — ​ $ (2,100) ​ $ — Contingent receivable asset ​ $ 506 ​ $ — ​ $ — ​ $ 506 Contingent consideration liabilities ​ $ (79,608) ​ $ — ​ $ — ​ $ (79,608) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair Value Measurements Using ​ ​ Total Fair ​ Quoted prices in ​ Significant other ​ Significant ​ ​ Value at ​ active markets ​ observable inputs ​ unobservable inputs ​ December 31, 2018 (Level 1) (Level 2) (Level 3) Interest rate contract (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 contract 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 current 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 or other 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 nine-month periods ended September 30, 2019 and 2018, consisted of the following (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended Nine Months Ended ​ September 30, September 30, ​ 2019 2018 2019 2018 Beginning balance ​ $ 93,204 ​ $ 10,912 ​ $ 82,236 ​ $ 10,956 Contingent consideration liability recorded as the result of acquisitions (see Note 5) ​ 1,203 ​ — ​ 9,583 ​ — Fair value adjustments recorded to income ​ 273 ​ (828) ​ 3,473 ​ (741) Contingent payments made ​ (15,072) ​ (53) ​ (15,684) ​ (184) Ending balance ​ $ 79,608 ​ $ 10,031 ​ $ 79,608 ​ $ 10,031 ​ As of September 30, 2019, approximately $72.5 million in contingent consideration liability was included in other long-term obligations and approximately $7.1 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 September 30, 2019 and December 31, 2018 had a value of approximately $506,000 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 nine-month periods ended September 30, 2019, we recorded a loss on the contingent receivable of approximately $(119,000) and $(101,000), respectively. During the three and nine-month periods ended September 30, 2018, we recorded a loss of approximately $(167,000) and $(299,000), 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 September 30, 2019 and December 31, 2018 (amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair value at ​ ​ ​ ​ ​ ​ ​ ​ September 30, ​ Valuation ​ ​ ​ ​ Contingent consideration asset or liability 2019 technique Unobservable inputs Range Revenue-based royalty payments contingent liability ​ $ 8,916 Discounted cash flow Discount rate 13% - 25% ​ ​ ​ Projected year of payments 2019-2034 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Revenue milestones contingent liability ​ $ 67,807 Monte Carlo simulation Discount rate 13% - 15% ​ ​ ​ Projected year of payments 2019-2022 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Regulatory approval contingent liability ​ $ 2,885 ​ Scenario-based method ​ Discount rate ​ 3.9% ​ ​ ​ ​ ​ ​ ​ Probability of milestone payment ​ 65% ​ ​ ​ ​ ​ ​ ​ Projected year of payment ​ 2022 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Contingent receivable asset ​ $ 506 Discounted cash flow Discount rate 0% ​ ​ ​ Probability of milestone payment 100% ​ ​ ​ ​ ​ ​ Projected year of payments 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair value at ​ ​ ​ ​ ​ ​ ​ December 31, ​ Valuation ​ ​ ​ ​ Contingent consideration asset or liability 2018 technique Unobservable inputs Range Revenue-based royalty payments contingent liability ​ $ 10,661 Discounted cash flow Discount rate 9.9% - 25% ​ ​ ​ ​ Projected year of payments 2018-2037 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Supply chain milestone contingent liability ​ $ 13,593 Discounted cash flow Discount rate 5.3% ​ ​ ​ ​ Probability of milestone payment 95% ​ ​ ​ ​ ​ ​ ​ ​ Projected year of payments ​ 2019 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Revenue milestones contingent liability ​ $ 57,982 Discounted cash flow Discount rate 3.3% - 13% ​ ​ ​ ​ Projected year of payments 2019-2023 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Contingent receivable asset ​ $ 607 Discounted cash flow Discount rate 10% ​ ​ ​ ​ 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. An increase (decrease) in the probability of any milestone payment may result in higher (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. We recognize or disclose the fair value of certain assets, such as non-financial assets, primarily property and equipment, intangible assets and goodwill in connection with impairment evaluations. All our nonrecurring valuations use significant unobservable inputs and therefore fall under Level 3 of the fair value hierarchy. 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	9 Months Ended
	Sep. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	13. Goodwill and Intangible Assets. ​ ​ ​ ​ ​ ​ 2019 Goodwill balance at January 1 ​ $ 335,433 Effect of foreign exchange ​ (1,069) Additions and adjustments as the result of acquisitions ​ 17,794 Goodwill balance at September 30 ​ $ 352,158 ​ Total accumulated goodwill impairment losses aggregated to approximately $8.3 million as of September 30, 2019 and December 31, 2018. We did not have any goodwill impairments for the nine-month periods ended September 30, 2019 and 2018. The total goodwill balance as of September 30, 2019 and December 31, 2018, was related to our cardiovascular segment. Other intangible assets at September 30, 2019 and December 31, 2018, consisted of the following (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2019 ​ ​ Gross Carrying ​ Accumulated ​ Net Carrying ​ Amount Amortization Amount Patents ​ $ 21,938 ​ $ (6,449) ​ $ 15,489 Distribution agreements ​ 8,012 ​ (6,537) ​ 1,475 License agreements ​ 26,975 ​ (12,226) ​ 14,749 Trademarks ​ 30,232 ​ (8,743) ​ 21,489 Covenants not to compete ​ 1,029 ​ (1,023) ​ 6 Customer lists ​ 39,803 ​ (27,400) ​ 12,403 In-process technology ​ 2,500 ​ — ​ 2,500 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total ​ $ 130,489 ​ $ (62,378) ​ $ 68,111 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2018 ​ ​ Gross Carrying ​ Accumulated ​ Net Carrying ​ Amount Amortization 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 nine-month periods ended September 30, 2019 was approximately $15.5 million and $45.2 million, respectively. Aggregate amortization expense for the three and nine-month periods ended September 30, 2018 was approximately $10.5 million and $29.4 million, respectively. We evaluate long-lived assets, including amortizing intangible assets, for impairment whenever events or changes in circumstances indicate that their carrying amounts may not be recoverable. We perform the impairment analysis at the asset group for which the lowest level of identifiable cash flows is largely independent of the cash flows of other assets and liabilities. We compare the carrying value of the amortizing intangible assets acquired to the undiscounted cash flows expected to result from the asset group and determine whether the carrying amount is recoverable. We determine the fair value of our amortizing assets based on estimated future cash flows discounted back to their present value using a discount rate that reflects the risk profiles of the underlying activities. During the nine months ended September 30, 2019, we recorded impairment charges related to our amortizing intangible assets of approximately $869,000 from our July 2015 acquisition of certain assets from Distal Access, LLC, $548,000 from our June 2016 acquisition of certain assets from Lazarus Medical Technologies, LLC, and $1.8 million from our July 2017 acquisition of certain assets from Pleuratech ApS. Total impairment charges for the three and nine-month periods ended September 30, 2019 were approximately $2.7 million and $3.3 million, respectively. During the three months ended September 30, 2018, we compared the carrying value of the amortizing intangible assets acquired in our July 2015 acquisition of certain assets from Quellent, LLC, all of which pertained to our cardiovascular segment, to the undiscounted cash flows expected to result from the asset group and determined that the carrying amount was not recoverable. We recorded an impairment charge for Quellent of approximately $657,000 during the three months ended September 30, 2018. Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of September 30, 2019 (in thousands): ​ ​ ​ ​ Year Ending December 31, ​ Estimated Amortization Expense Remaining 2019 ​ $ 15,435 2020 ​ 59,265 2021 ​ 51,916 2022 ​ 50,504 2023 ​ ​ 49,297 2024 ​ 46,360 ​

Leases

Leases	9 Months Ended
	Sep. 30, 2019
Leases [Abstract]
Leases	14. Leases. 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 30 years. A number of our lease agreements contain options to renew at our discretion for periods of up to 15 years and options to terminate the leases within one year. The lease term used to calculate 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 September 30, 2019 recorded on our consolidated balance sheet are related to our cardiovascular segment. From time to time we enter into agreements to sublease a portion of our facilities to third parties. Such sublease income is not material. 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 nine-month periods ended September 30, 2019 and 2018 was not significant. The following was included in our consolidated balance sheet as of September 30, 2019 (in thousands): ​ ​ ​ ​ ​ As of September 30, 2019 Assets ​ ROU operating lease assets ​ $ 79,757 ​ ​ ​ ​ Liabilities ​ Short-term operating lease liabilities ​ $ 11,652 Long-term operating lease liabilities ​ 72,056 Total operating lease liabilities ​ $ 83,708 ​ 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 as of January 1, 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 nine months ended September 30, 2019 were as follows, in thousands: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended Nine Months Ended Lease Cost ​ Classification ​ September 30, 2019 ​ September 30, 2019 Operating lease cost (a) Selling, general and administrative expenses ​ $ 4,253 ​ $ 12,650 Sublease (income) (b) Selling, general and administrative expenses ​ (37) ​ (328) Net lease cost ​ $ 4,216 ​ $ 12,322 (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 nine months ended September 30, 2019 was as follows: ​ ​ ​ ​ ​ Nine Months Ended ​ ​ September 30, 2019 Cash paid for amounts included in the measurement of lease liabilities ​ $ 11,028 Right-of-use assets obtained in exchange for lease obligations ​ $ 7,431 ​ 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 September 30, 2019, the following disclosures for remaining lease term and incremental borrowing rates were applicable: ​ ​ ​ ​ ​ September 30, 2019 Weighted average remaining lease term 12.4 years ​ Weighted average discount rate 3.3% ​ ​ As of September 30, 2019, maturities of operating lease liabilities were as follows, in thousands: ​ ​ ​ ​ Year ended December 31, Amounts due under Operating Leases Remaining 2019 ​ $ 3,575 2020 ​ 13,562 2021 ​ 12,568 2022 ​ 10,058 2023 ​ 8,038 Thereafter ​ 58,492 Total lease payments ​ 106,293 Less: Imputed interest ​ (22,585) Total ​ $ 83,708 ​ 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 September 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	9 Months Ended
	Sep. 30, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	15. Commitments and Contingencies. 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 have responded to the subpoena, as well as additional related requests. 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 investigation for the three and nine-month periods ended September 30, 2019 were approximately $2.4 million and $5.0 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.

Basis of Presentation (Policies

Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation.
Revenue from Contracts with Customers	Revenue from Contracts with Customers. 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 AdoptedIn February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, Leases (Topic 842) 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, In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820) In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, We do not believe any other issued and not yet effective accounting standards will be relevant to our consolidated financial statements.
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. Interest Rate Risk. Foreign Currency Risk. Balance Sheet Presentation of Derivative Instruments.

Inventories (Tables)

Inventories (Tables)	9 Months Ended
	Sep. 30, 2019
Inventory Disclosure [Abstract]
Schedule of Inventory	​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2019 December 31, 2018 Finished goods ​ $ 126,699 ​ $ 117,703 Work-in-process ​ 24,368 ​ 14,380 Raw materials ​ 65,699 ​ 65,453 Total Inventories ​ $ 216,766 ​ $ 197,536

Stock-Based Compensation Expe_2

Stock-Based Compensation Expense (Tables)	9 Months Ended
	Sep. 30, 2019
Share-based Payment Arrangement [Abstract]
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ September 30, ​ September 30, ​ 2019 2018 2019 2018 Cost of sales ​ $ 346 ​ $ 241 ​ $ 953 ​ $ 657 Research and development ​ 277 ​ 141 ​ 750 ​ 412 Selling, general and administrative ​ 2,003 ​ 1,291 ​ 5,212 ​ 3,425 Stock-based compensation expense before taxes ​ $ 2,626 ​ $ 1,673 ​ $ 6,915 ​ $ 4,494
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions	​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended ​ ​ September 30, ​ ​ 2019 ​ 2018 Risk-free interest rate 1.39% - 2.56% 2.63% - 2.77% Expected option term 3 - 5 years 5.0 years Expected dividend yield — — Expected price volatility 28.66% - 35.79% 34.06% - 34.32%

Earnings Per Common Share (EP_2

Earnings Per Common Share (EPS) (Tables)	9 Months Ended
	Sep. 30, 2019
Earnings Per Share, Basic and Diluted [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Nine Months Ended ​ ​ ​ September 30, ​ September 30, ​ ​ ​ 2019 ​ 2018 ​ 2019 ​ 2018 ​ Net income (loss) ​ $ (3,398) ​ $ 16,619 ​ $ 9,656 ​ $ 32,828 ​ Average common shares outstanding ​ 55,152 ​ 53,431 ​ 55,029 ​ 51,434 ​ Basic EPS ​ $ (0.06) ​ $ 0.31 ​ $ 0.18 ​ $ 0.64 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Average common shares outstanding ​ ​ 55,152 ​ ​ 53,431 ​ ​ 55,029 ​ ​ 51,434 ​ Effect of dilutive stock options ​ ​ — ​ ​ 1,672 ​ ​ 1,364 ​ ​ 1,662 ​ Total potential shares outstanding ​ ​ 55,152 ​ ​ 55,103 ​ ​ 56,393 ​ ​ 53,096 ​ Diluted EPS ​ $ (0.06) ​ $ 0.30 ​ $ 0.17 ​ $ 0.62 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Stock options excluded as the impact was anti-dilutive ​ ​ 4,299 ​ ​ 667 ​ ​ 1,361 ​ ​ 462 ​

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2019
Business Acquisition [Line Items]
Business Acquisition, Pro Forma Information	The following table summarizes our consolidated results of operations for the three and nine-month periods ended September 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 ​ Nine Months Ended ​ ​ ​ September 30, 2018 ​ September 30, 2018 ​ ​ As Reported Pro Forma As Reported Pro Forma ​ Net sales ​ $ 221,659 ​ $ 234,751 ​ $ 649,504 ​ $ 687,203 ​ Net income ​ 16,619 ​ 11,335 ​ ​ 32,828 ​ 16,496 ​ Earnings per common share: ​ ​ ​ ​ ​ ​ ​ Basic ​ $ 0.31 ​ $ 0.21 ​ $ 0.64 ​ $ 0.32 ​ Diluted ​ $ 0.30 ​ $ 0.21 ​ $ 0.62 ​ $ 0.31 ​ * The pro forma results for the three and nine-month periods ended September 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.
Fibrovein Holdings Limited
Business Acquisition [Line Items]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	​ ​ ​ ​ ​ Assets Acquired ​ Trade receivables ​ $ 200 Inventories ​ 843 Prepaid expenses and other assets ​ 49 Intangibles ​ ​ Developed technology ​ ​ 10,148 Goodwill ​ ​ 4,390 Total assets acquired ​ 15,630 ​ ​ ​ ​ Liabilities Assumed ​ Trade payables ​ (53) Accrued expenses ​ (29) Deferred income tax liabilities ​ (1,875) Total liabilities assumed ​ (1,957) ​ ​ ​ ​ Total net assets acquired ​ $ 13,673
Brightwater
Business Acquisition [Line Items]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Preliminary Allocation ​ Adjustments (1) ​ Revised Preliminary Allocation Assets Acquired ​ ​ ​ ​ ​ ​ ​ Trade receivables ​ $ 94 ​ $ (39) ​ $ 55 Inventories ​ 349 ​ ​ — ​ ​ 349 Property and equipment ​ 409 ​ ​ — ​ ​ 409 Other long-term assets ​ 30 ​ ​ — ​ ​ 30 Intangibles ​ ​ ​ ​ ​ ​ ​ Developed technology ​ 31,680 ​ ​ 280 ​ ​ 31,960 Customer lists ​ 83 ​ ​ — ​ ​ 83 Trademarks ​ 250 ​ ​ — ​ ​ 250 Goodwill ​ 16,950 ​ ​ 959 ​ ​ 17,909 Total assets acquired ​ 49,845 ​ ​ 1,200 ​ ​ 51,045 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Liabilities Assumed ​ ​ ​ ​ ​ ​ ​ Trade payables ​ (58) ​ ​ — ​ ​ (58) Accrued expenses ​ (261) ​ ​ — ​ ​ (261) Other long-term obligations ​ (1,522) ​ ​ — ​ ​ (1,522) Deferred income tax liabilities ​ (4,590) ​ ​ — ​ ​ (4,590) Total liabilities assumed ​ (6,431) ​ ​ — ​ ​ (6,431) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total net assets acquired ​ $ 43,414 ​ $ 1,200 ​ $ 44,614 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ (1) Amounts represent adjustments to the preliminary purchase price allocation first presented in our June 30, 2019 Form 10-Q resulting from our ongoing activities, including reassessment of the assets acquired and liabilities assumed, with respect to finalizing our purchase price allocation for this acquisition. The larger adjustments primarily relate to the valuation of contingent consideration and intangible assets acquired.
Vascular Insights
Business Acquisition [Line Items]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	​ ​ ​ ​ ​ Inventories $ 1,353 Intangibles ​ Developed technology ​ 32,750 Customer list ​ 840 Trademarks ​ 1,410 Goodwill ​ 21,832 ​ ​ ​ ​ Total net assets acquired ​ $ 58,185
Cianna Medical
Business Acquisition [Line Items]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Preliminary Allocation ​ Adjustments (1) ​ Revised Preliminary Allocation Assets Acquired ​ ​ ​ ​ ​ ​ ​ ​ ​ Trade receivables ​ $ 6,151 ​ $ — ​ $ 6,151 Inventories ​ 5,803 ​ ​ — ​ ​ 5,803 Prepaid expenses and other current assets ​ 315 ​ ​ — ​ ​ 315 Property and equipment ​ 1,047 ​ ​ — ​ ​ 1,047 Other long-term assets ​ 14 ​ ​ — ​ ​ 14 Intangibles ​ ​ ​ ​ ​ ​ Developed technology ​ ​ 134,510 ​ ​ — ​ ​ 134,510 Customer lists ​ 3,330 ​ ​ — ​ ​ 3,330 Trademarks ​ 7,080 ​ ​ — ​ ​ 7,080 Goodwill ​ 65,885 ​ ​ (4,506) ​ ​ 61,379 Total assets acquired ​ 224,135 ​ ​ (4,506) ​ ​ 219,629 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Liabilities Assumed ​ ​ ​ ​ ​ ​ Trade payables ​ (1,497) ​ ​ — ​ ​ (1,497) Accrued expenses ​ (2,384) ​ ​ — ​ ​ (2,384) Other long-term liabilities ​ (1,527) ​ ​ — ​ ​ (1,527) Deferred income tax liabilities ​ (30,363) ​ ​ 4,423 ​ ​ (25,940) Total liabilities assumed ​ (35,771) ​ ​ 4,423 ​ ​ (31,348) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total net assets acquired ​ $ 188,364 ​ $ (83) ​ $ 188,281 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ (1) Amounts represent adjustments to the preliminary purchase price allocation first presented in our December 31, 2018 Form 10-K resulting from our ongoing activities, including reassessment of the assets acquired and liabilities assumed, with respect to finalizing our purchase price allocation for this acquisition.
DirectACCESS Medical, LLC
Business Acquisition [Line Items]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	​ ​ ​ ​ ​ Inventories $ 971 Intangibles ​ Developed technology ​ 4,840 Customer list ​ 120 Trademarks ​ 400 Goodwill ​ 938 ​ ​ ​ ​ Total net assets acquired ​ $ 7,269
Becton, Dickinson and Company
Business Acquisition [Line Items]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	​ ​ ​ ​ ​ 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

Revenue from Contracts with C_2

Revenue from Contracts with Customers. (Tables)	9 Months Ended
	Sep. 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 nine-month periods ended September 30, 2019 and 2018 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ Three Months Ended ​ ​ September 30, 2019 ​ September 30, 2018 ​ United States International Total United States International Total Cardiovascular ​ ​ ​ ​ ​ ​ Stand-alone devices ​ $ 55,816 ​ $ 40,510 ​ $ 96,326 ​ $ 52,173 ​ $ 38,802 ​ $ 90,975 Cianna Medical ​ 11,544 ​ ​ 94 ​ 11,638 ​ — ​ — ​ — Custom kits and procedure trays ​ 23,115 ​ ​ 10,857 ​ 33,972 ​ 23,199 ​ 9,896 ​ 33,095 Inflation devices ​ 8,156 ​ ​ 14,027 ​ 22,183 ​ 7,819 ​ 15,074 ​ 22,893 Catheters ​ 20,262 ​ ​ 24,164 ​ 44,426 ​ 18,081 ​ 22,510 ​ 40,591 Embolization devices ​ 5,254 ​ ​ 7,079 ​ 12,333 ​ 5,145 ​ 7,250 ​ 12,395 CRM/EP ​ 11,524 ​ ​ 2,024 ​ 13,548 ​ 10,462 ​ 1,739 ​ 12,201 Total ​ 135,671 ​ 98,755 ​ 234,426 ​ 116,879 ​ 95,271 ​ 212,150 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Endoscopy ​ ​ ​ ​ ​ ​ Endoscopy devices ​ 8,340 ​ ​ 283 ​ 8,623 ​ 9,229 ​ 280 ​ 9,509 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total ​ $ 144,011 ​ $ 99,038 ​ $ 243,049 ​ $ 126,108 ​ $ 95,551 ​ $ 221,659 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Nine Months Ended ​ Nine Months Ended ​ ​ ​ September 30, 2019 ​ September 30, 2018 ​ ​ United States International Total United States International Total ​ Cardiovascular ​ ​ ​ ​ ​ ​ ​ Stand-alone devices ​ $ 165,121 ​ $ 130,154 ​ $ 295,275 ​ $ 147,125 ​ $ 119,592 ​ $ 266,717 ​ Cianna Medical ​ 35,622 ​ ​ 101 ​ 35,723 ​ — ​ — ​ — ​ Custom kits and procedure trays ​ 68,292 ​ ​ 32,965 ​ 101,257 ​ 69,184 ​ 31,175 ​ 100,359 ​ Inflation devices ​ 24,475 ​ ​ 44,040 ​ 68,515 ​ 23,647 ​ 45,970 ​ 69,617 ​ Catheters ​ 60,370 ​ ​ 72,439 ​ 132,809 ​ 50,055 ​ 63,775 ​ 113,830 ​ Embolization devices ​ 15,234 ​ ​ 22,934 ​ 38,168 ​ 15,272 ​ 22,434 ​ 37,706 ​ CRM/EP ​ 33,157 ​ ​ 6,666 ​ 39,823 ​ 31,058 ​ 5,105 ​ 36,163 ​ Total ​ 402,271 ​ 309,299 ​ 711,570 ​ 336,341 ​ 288,051 ​ 624,392 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Endoscopy ​ ​ ​ ​ ​ ​ ​ Endoscopy devices ​ 24,459 ​ ​ 901 ​ 25,360 ​ 24,269 ​ 843 ​ 25,112 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total ​ $ 426,730 ​ $ 310,200 ​ $ 736,930 ​ $ 360,610 ​ $ 288,894 ​ $ 649,504 ​

Segment Reporting (Tables)

Segment Reporting (Tables)	9 Months Ended
	Sep. 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 nine-month periods ended September 30, 2019 and 2018, were as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended Nine Months Ended ​ ​ September 30, September 30, ​ ​ 2019 2018 2019 2018 ​ Net Sales ​ ​ ​ ​ ​ Cardiovascular ​ $ 234,426 ​ $ 212,150 ​ $ 711,570 ​ $ 624,392 ​ Endoscopy ​ 8,623 ​ 9,509 ​ 25,360 ​ 25,112 ​ Total net sales ​ 243,049 ​ 221,659 ​ 736,930 ​ 649,504 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Operating Income (Loss) ​ ​ ​ ​ ​ Cardiovascular ​ (6,210) ​ 18,199 ​ 11,263 ​ 37,263 ​ Endoscopy ​ 3,329 ​ 2,862 ​ 7,581 ​ 7,692 ​ Total operating income (loss) ​ (2,881) ​ 21,061 ​ 18,844 ​ 44,955 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total other expense - net ​ (2,809) ​ (1,676) ​ (8,689) ​ (7,646) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Income tax expense (benefit) ​ (2,292) ​ 2,766 ​ 499 ​ 4,481 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Net income (loss) ​ $ (3,398) ​ $ 16,619 ​ $ 9,656 ​ $ 32,828 ​

Revolving Credit Facility and_2

Revolving Credit Facility and Long-Term Debt (Tables)	9 Months Ended
	Sep. 30, 2019
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2019 December 31, 2018 Term Loans ​ $ 150,000 ​ $ 72,500 Revolving credit loans ​ 290,500 ​ 316,000 Collateralized debt facility ​ — ​ 7,000 Less unamortized debt issuance costs ​ (544) ​ (348) Total long-term debt ​ 439,956 ​ 395,152 Less current portion ​ 7,500 ​ 22,000 Long-term portion ​ $ 432,456 ​ $ 373,152
Schedule of Long-term Debt Covenants	​ ​ ​ ​ ​ ​ ​ ​ Covenant Requirement Consolidated Total Leverage Ratio (1) ​ 4.0 to 1.0 Consolidated Interest Coverage Ratio (2) ​ 3.0 to 1.0 Facility Capital Expenditures (3) ​ ​ $50 million (1) Maximum Consolidated Total Net 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 September 30, 2019, were as follows (in thousands): ​ ​ ​ ​ Years Ending ​ Future Minimum December 31, Principal Payments Remaining 2019 $ 1,875 2020 ​ 7,500 2021 ​ ​ 7,500 2022 ​ ​ 8,438 2023 ​ ​ 11,250 2024 ​ 403,937 Total future minimum principal payments ​ $ 440,500

Derivatives (Tables)

Derivatives (Tables)	9 Months Ended
	Sep. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Notional Amounts of Outstanding Derivative Positions	​ ​ ​ ​ ​ ​ Currency Symbol Forward Notional Amount Australian Dollar AUD 5,930 Brazilian Real ​ BRL ​ 7,830 Canadian Dollar CAD 6,495 Swiss Franc CHF 3,780 Chinese Renminbi CNY 408,000 Danish Krone DKK 32,225 Euro EUR 33,150 British Pound GBP 7,315 Japanese Yen JPY 1,190,000 Korean Won KRW 7,000,000 Mexican Peso MXN 453,500 Norwegian Krone ​ NOK ​ 14,050 Swedish Krona SEK 43,450 ​ ​ ​ ​ ​ ​ Currency Symbol Forward Notional Amount Australian Dollar AUD 12,695 Brazilian Real BRL 13,000 Canadian Dollar CAD 1,795 Swiss Franc CHF 739 Chinese Renminbi CNY 69,069 Danish Krone DKK 4,072 Euro EUR 1,225 British Pound GBP 6,982 Hong Kong Dollar HKD 11,000 Japanese Yen JPY 1,380,856 Korean Won KRW 7,343,000 Mexican Peso MXN 35,000 Norwegian Krone ​ NOK ​ 2,999 Swedish Krona SEK 12,647 Singapore Dollar ​ SGD ​ 600 South African Rand ZAR 40,218
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 September 30, 2019 December 31, 2018 Derivative instruments designated as hedging instruments ​ ​ Assets ​ ​ Interest rate swap Other assets (long-term) ​ $ 1,201 ​ $ 5,772 Foreign currency forward contracts Prepaid expenses and other assets ​ 1,821 ​ 613 Foreign currency forward contracts Other assets (long-term) ​ 496 ​ 151 ​ ​ ​ ​ ​ ​ ​ ​ ​ Liabilities ​ ​ Foreign currency forward contracts Accrued expenses ​ (1,262) ​ (711) Foreign currency forward contracts Other long-term obligations ​ (333) ​ (101) ​ ​ ​ ​ ​ ​ ​ ​ ​ Derivative instruments not designated as hedging instruments ​ ​ Assets ​ ​ Foreign currency forward contracts Prepaid expenses and other assets ​ $ 541 ​ $ 814 Liabilities ​ ​ Foreign currency forward contracts Accrued expenses ​ (505) ​ (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 (“OCI”), accumulated other comprehensive income (“AOCI”), and net earnings in our consolidated statements of income, consolidated statements of comprehensive income and consolidated balance sheets (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amount of Gain/(Loss) ​ ​ ​ ​ Consolidated Statements of ​ Amount of Gain/(Loss) ​ ​ recognized in OCI ​ ​ ​ ​ Income ​ reclassified from AOCI ​ ​ Three Months Ended September 30, ​ ​ ​ ​ Three Months Ended September 30, ​ Three Months Ended September 30, ​ 2019 2018 ​ 2019 ​ 2018 2019 ​ 2018 Derivative instrument ​ ​ Location in statements of income ​ ​ ​ ​ Interest rate swap ​ $ (186) ​ $ 664 ​ Interest expense ​ $ (3,415) ​ $ (2,329) ​ $ 520 ​ $ 428 Foreign currency forward contracts ​ 505 ​ 543 ​ Revenue ​ 243,049 ​ 221,659 ​ 118 ​ 86 ​ ​ ​ ​ ​ ​ ​ ​ Cost of sales ​ (138,913) ​ (119,620) ​ (112) ​ 26 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amount of Gain/(Loss) ​ ​ ​ ​ Consolidated Statements of ​ Amount of Gain/(Loss) ​ ​ recognized in OCI ​ ​ ​ ​ Income ​ reclassified from AOCI ​ ​ Nine Months Ended September 30, ​ ​ ​ ​ Nine Months Ended September 30, ​ Nine Months Ended September 30, ​ 2019 2018 ​ 2019 ​ 2018 2019 ​ 2018 Derivative instrument ​ ​ Location in statements of income ​ ​ ​ ​ Interest rate swap ​ ​ (2,855) ​ $ 3,532 ​ Interest expense ​ ​ (9,295) ​ (8,064) ​ $ 1,716 ​ $ 998 Foreign currency forward contracts ​ 555 ​ 1,112 ​ Revenue ​ 736,930 ​ 649,504 ​ 220 ​ (299) ​ ​ ​ ​ ​ ​ ​ ​ Cost of sales ​ (416,194) ​ (359,400) ​ (298) ​ 404
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 September 30, Nine Months Ended September 30, Derivative Instrument Location in statements of income 2019 2018 2019 2018 Foreign currency forward contracts Other income (expense) ​ $ 2,402 ​ $ 1,143 ​ $ 1,647 ​ $ 3,181

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2019
Fair Value Disclosures [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair Value Measurements Using ​ ​ Total Fair ​ Quoted prices in ​ Significant other ​ Significant ​ ​ Value at ​ active markets ​ observable inputs ​ unobservable inputs ​ September 30, 2019 (Level 1) (Level 2) (Level 3) Interest rate contract (1) ​ $ 1,201 ​ $ — ​ $ 1,201 ​ $ — Foreign currency contract assets, current and long-term (2) ​ $ 2,858 ​ $ — ​ $ 2,858 ​ $ — Foreign currency contract liabilities, current and long-term (3) ​ $ (2,100) ​ $ — ​ $ (2,100) ​ $ — Contingent receivable asset ​ $ 506 ​ $ — ​ $ — ​ $ 506 Contingent consideration liabilities ​ $ (79,608) ​ $ — ​ $ — ​ $ (79,608) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair Value Measurements Using ​ ​ Total Fair ​ Quoted prices in ​ Significant other ​ Significant ​ ​ Value at ​ active markets ​ observable inputs ​ unobservable inputs ​ December 31, 2018 (Level 1) (Level 2) (Level 3) Interest rate contract (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 contract 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 current 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	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended Nine Months Ended ​ September 30, September 30, ​ 2019 2018 2019 2018 Beginning balance ​ $ 93,204 ​ $ 10,912 ​ $ 82,236 ​ $ 10,956 Contingent consideration liability recorded as the result of acquisitions (see Note 5) ​ 1,203 ​ — ​ 9,583 ​ — Fair value adjustments recorded to income ​ 273 ​ (828) ​ 3,473 ​ (741) Contingent payments made ​ (15,072) ​ (53) ​ (15,684) ​ (184) Ending balance ​ $ 79,608 ​ $ 10,031 ​ $ 79,608 ​ $ 10,031
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 September 30, 2019 and December 31, 2018 (amounts in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair value at ​ ​ ​ ​ ​ ​ ​ ​ September 30, ​ Valuation ​ ​ ​ ​ Contingent consideration asset or liability 2019 technique Unobservable inputs Range Revenue-based royalty payments contingent liability ​ $ 8,916 Discounted cash flow Discount rate 13% - 25% ​ ​ ​ Projected year of payments 2019-2034 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Revenue milestones contingent liability ​ $ 67,807 Monte Carlo simulation Discount rate 13% - 15% ​ ​ ​ Projected year of payments 2019-2022 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Regulatory approval contingent liability ​ $ 2,885 ​ Scenario-based method ​ Discount rate ​ 3.9% ​ ​ ​ ​ ​ ​ ​ Probability of milestone payment ​ 65% ​ ​ ​ ​ ​ ​ ​ Projected year of payment ​ 2022 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Contingent receivable asset ​ $ 506 Discounted cash flow Discount rate 0% ​ ​ ​ Probability of milestone payment 100% ​ ​ ​ ​ ​ ​ Projected year of payments 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fair value at ​ ​ ​ ​ ​ ​ ​ December 31, ​ Valuation ​ ​ ​ ​ Contingent consideration asset or liability 2018 technique Unobservable inputs Range Revenue-based royalty payments contingent liability ​ $ 10,661 Discounted cash flow Discount rate 9.9% - 25% ​ ​ ​ ​ Projected year of payments 2018-2037 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Supply chain milestone contingent liability ​ $ 13,593 Discounted cash flow Discount rate 5.3% ​ ​ ​ ​ Probability of milestone payment 95% ​ ​ ​ ​ ​ ​ ​ ​ Projected year of payments ​ 2019 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Revenue milestones contingent liability ​ $ 57,982 Discounted cash flow Discount rate 3.3% - 13% ​ ​ ​ ​ Projected year of payments 2019-2023 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Contingent receivable asset ​ $ 607 Discounted cash flow Discount rate 10% ​ ​ ​ ​ Probability of milestone payment 67% ​ ​ ​ ​ ​ ​ ​ Projected year of payments 2019 ​

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Changes in carrying amount of goodwill	​ ​ ​ ​ ​ ​ 2019 Goodwill balance at January 1 ​ $ 335,433 Effect of foreign exchange ​ (1,069) Additions and adjustments as the result of acquisitions ​ 17,794 Goodwill balance at September 30 ​ $ 352,158
Other intangible assets	Other intangible assets at September 30, 2019 and December 31, 2018, consisted of the following (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ September 30, 2019 ​ ​ Gross Carrying ​ Accumulated ​ Net Carrying ​ Amount Amortization Amount Patents ​ $ 21,938 ​ $ (6,449) ​ $ 15,489 Distribution agreements ​ 8,012 ​ (6,537) ​ 1,475 License agreements ​ 26,975 ​ (12,226) ​ 14,749 Trademarks ​ 30,232 ​ (8,743) ​ 21,489 Covenants not to compete ​ 1,029 ​ (1,023) ​ 6 Customer lists ​ 39,803 ​ (27,400) ​ 12,403 In-process technology ​ 2,500 ​ — ​ 2,500 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total ​ $ 130,489 ​ $ (62,378) ​ $ 68,111 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2018 ​ ​ Gross Carrying ​ Accumulated ​ Net Carrying ​ Amount Amortization 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 September 30, 2019 (in thousands): ​ ​ ​ ​ Year Ending December 31, ​ Estimated Amortization Expense Remaining 2019 ​ $ 15,435 2020 ​ 59,265 2021 ​ 51,916 2022 ​ 50,504 2023 ​ ​ 49,297 2024 ​ 46,360

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2019
Leases [Abstract]
Schedule of Consolidated Balance Sheet Information and Supplemental Information	The following was included in our consolidated balance sheet as of September 30, 2019 (in thousands): ​ ​ ​ ​ ​ As of September 30, 2019 Assets ​ ROU operating lease assets ​ $ 79,757 ​ ​ ​ ​ Liabilities ​ Short-term operating lease liabilities ​ $ 11,652 Long-term operating lease liabilities ​ 72,056 Total operating lease liabilities ​ $ 83,708
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 nine months ended September 30, 2019 were as follows, in thousands: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended Nine Months Ended Lease Cost ​ Classification ​ September 30, 2019 ​ September 30, 2019 Operating lease cost (a) Selling, general and administrative expenses ​ $ 4,253 ​ $ 12,650 Sublease (income) (b) Selling, general and administrative expenses ​ (37) ​ (328) Net lease cost ​ $ 4,216 ​ $ 12,322 (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 nine months ended September 30, 2019 was as follows: ​ ​ ​ ​ ​ Nine Months Ended ​ ​ September 30, 2019 Cash paid for amounts included in the measurement of lease liabilities ​ $ 11,028 Right-of-use assets obtained in exchange for lease obligations ​ $ 7,431 ​ 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 September 30, 2019, the following disclosures for remaining lease term and incremental borrowing rates were applicable: ​ ​ ​ ​ ​ September 30, 2019 Weighted average remaining lease term 12.4 years ​ Weighted average discount rate 3.3% ​
Maturities of Operating Lease Liabilities	As of September 30, 2019, maturities of operating lease liabilities were as follows, in thousands: ​ ​ ​ ​ Year ended December 31, Amounts due under Operating Leases Remaining 2019 ​ $ 3,575 2020 ​ 13,562 2021 ​ 12,568 2022 ​ 10,058 2023 ​ 8,038 Thereafter ​ 58,492 Total lease payments ​ 106,293 Less: Imputed interest ​ (22,585) Total ​ $ 83,708
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

Inventories (Details)

Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Finished goods	$ 126,699	$ 117,703
Work-in-process	24,368	14,380
Raw materials	65,699	65,453
Total Inventories	$ 216,766	$ 197,536

Stock-Based Compensation Expe_3

Stock-Based Compensation Expense - Allocation of Recognized Period Costs (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	$ 2,626	$ 1,673	$ 6,915	$ 4,494
Cost of sales
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	346	241	953	657
Research and development
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	277	141	750	412
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Allocated share-based compensation	$ 2,003	$ 1,291	$ 5,212	$ 3,425

Stock-Based Compensation Expe_4

Stock-Based Compensation Expense - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Share-based Payment Arrangement [Abstract]
Compensation cost not yet recognized	$ 30.8		$ 30.8
Compensation cost not yet recognized, period of recognition			3 years 1 month 17 days
Options granted in period (in shares)	107,000	0	1,200,000	692,002

Stock-Based Compensation Expe_5

Stock-Based Compensation Expense - Fair Value Calculation Assumptions (Details)	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected option term		5 years
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	1.39%	2.63%
Expected option term	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%
Expected option term	5 years
Expected price volatility	35.79%	34.32%

Earnings Per Common Share (EP_3

Earnings Per Common Share (EPS) - Basic EPS (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Sep. 30, 2019	Sep. 30, 2018
Earnings Per Share, Basic and Diluted [Abstract]
Net income (loss)	$ (3,398)	$ 6,859	$ 6,195	$ 16,619	$ 10,941	$ 5,269	$ 9,656	$ 32,828
Average common shares outstanding (in shares)	55,152			53,431			55,029	51,434
Basic EPS (in dollars per share)	$ (0.06)			$ 0.31			$ 0.18	$ 0.64

Earnings Per Common Share (EP_4

Earnings Per Common Share (EPS) - Diluted EPS (Details) - $ / shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Earnings Per Share, Basic and Diluted [Abstract]
Average common shares outstanding (in shares)	55,152	53,431	55,029	51,434
Effect of dilutive stock options (in shares)		1,672	1,364	1,662
Total potential shares outstanding (in shares)	55,152	55,103	56,393	53,096
Diluted EPS (in dollars per share)	$ (0.06)	$ 0.30	$ 0.17	$ 0.62
Stock options excluded as the impact was anti-dilutive (in shares)	4,299	667	1,361	462

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) - USD ($)	Aug. 01, 2019	Jun. 14, 2019	Mar. 28, 2019	Dec. 14, 2018	Nov. 13, 2018	May 23, 2018	Feb. 14, 2018	Sep. 30, 2019	Sep. 30, 2019	Dec. 31, 2018
Fluidx
Business Acquisition [Line Items]
Payments to acquire shares			$ 2,000,000
Ownership percentage								12.70%	12.70%
Fibrovein Holdings Limited
Business Acquisition [Line Items]
Purchase consideration, upfront payment	$ 13,700,000
Weighted average useful life	12 years
Fibrovein Holdings Limited | STD Pharmaceutical Products Limited
Business Acquisition [Line Items]
Ownership percentage	100.00%
Brightwater
Business Acquisition [Line Items]
Purchase consideration, upfront payment		$ 35,000,000
Working capital adjustment		$ 104,000
Weighted average useful life		12 years 10 months 24 days
Brightwater | Achievement of CE Certification
Business Acquisition [Line Items]
Earn-out payments		$ 5,000,000
Brightwater | Achievement of Sales Milestones
Business Acquisition [Line Items]
Earn-out payments		$ 10,000,000
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				$ 40,000,000
Working capital adjustment								$ 15,000
Weighted average useful life				11 years 9 months 18 days
Contingent liability				$ 20,000,000
Net sales related to acquisition								2,000,000	$ 5,200,000
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					$ 135,000,000
Working capital adjustment					$ 1,200,000
Weighted average useful life					10 years 8 months 12 days
Net sales related to acquisition								11,600,000	35,700,000
Acquisition-related costs										$ 3,500,000
Cianna Medical | Achievement of Supply Chain and Scalability Metrics
Business Acquisition [Line Items]
Earn-out payments					$ 15,000,000
Cianna Medical | Annual Net Sales Milestone
Business Acquisition [Line Items]
Earn-out payments					$ 50,000,000
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						$ 7,300,000
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
Contingent liability							$ 1,600,000
Net sales related to acquisition								$ 12,500,000	$ 35,900,000
Acquisition-related costs										$ 1,800,000
Total purchase price							$ 100,300,000
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	Sep. 30, 2019	Aug. 01, 2019	Jun. 14, 2019	Dec. 31, 2018	Dec. 14, 2018	Nov. 13, 2018	May 23, 2018	Feb. 14, 2018
Assets Acquired
Goodwill	$ 352,158			$ 335,433
Fibrovein Holdings Limited
Assets Acquired
Trade receivables		$ 200
Inventories		843
Prepaid expenses and other assets		49
Intangibles		10,148
Goodwill		4,390
Total assets acquired		15,630
Liabilities Assumed
Trade payables		(53)
Accrued expenses		(29)
Deferred income tax liabilities		(1,875)
Total liabilities assumed		(1,957)
Total net assets acquired		$ 13,673
Brightwater
Assets Acquired
Trade receivables			$ 55
Inventories			349
Property and equipment			409
Other long-term assets			30
Goodwill			17,909
Total assets acquired			51,045
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			44,614
Brightwater | Adjusments
Assets Acquired
Trade receivables			(39)
Goodwill			959
Total assets acquired			1,200
Liabilities Assumed
Total net assets acquired			1,200
Brightwater | Preliminary Allocation
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			31,960
Brightwater | Developed technology | Adjusments
Assets Acquired
Intangibles			280
Brightwater | Developed technology | Preliminary Allocation
Assets Acquired
Intangibles			31,680
Brightwater | Customer Lists
Assets Acquired
Intangibles			83
Brightwater | Customer Lists | Preliminary Allocation
Assets Acquired
Intangibles			83
Brightwater | Trademarks
Assets Acquired
Intangibles			250
Brightwater | Trademarks | Preliminary Allocation
Assets Acquired
Intangibles			$ 250
Vascular Insights
Assets Acquired
Inventories					$ 1,353
Goodwill					21,832
Total assets acquired					58,185
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						61,379
Total assets acquired						219,629
Liabilities Assumed
Trade payables						(1,497)
Accrued expenses						(2,384)
Other long-term liabilities						(1,527)
Deferred income tax liabilities						(25,940)
Total liabilities assumed						(31,348)
Total net assets acquired						188,281
Cianna Medical | Adjusments
Assets Acquired
Goodwill						(4,506)
Total assets acquired						(4,506)
Liabilities Assumed
Deferred income tax liabilities						4,423
Total liabilities assumed						4,423
Total net assets acquired						(83)
Cianna Medical | Preliminary Allocation
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						65,885
Total assets acquired						224,135
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						188,364
Cianna Medical | Developed technology
Assets Acquired
Intangibles						134,510
Cianna Medical | Developed technology | Preliminary Allocation
Assets Acquired
Intangibles						134,510
Cianna Medical | Customer Lists
Assets Acquired
Intangibles						3,330
Cianna Medical | Customer Lists | Preliminary Allocation
Assets Acquired
Intangibles						3,330
Cianna Medical | Trademarks
Assets Acquired
Intangibles						7,080
Cianna Medical | Trademarks | Preliminary Allocation
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						9 Months Ended
	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Sep. 30, 2019	Sep. 30, 2018
As Reported
Net sales	$ 243,049			$ 221,659			$ 736,930	$ 649,504
Net income	$ (3,398)	$ 6,859	$ 6,195	$ 16,619	$ 10,941	$ 5,269	$ 9,656	$ 32,828
Basic (in dollars per share)	$ (0.06)			$ 0.31			$ 0.18	$ 0.64
Diluted (in dollars per share)	$ (0.06)			$ 0.30			$ 0.17	$ 0.62
Pro Forma
Net sales				$ 234,751				$ 687,203
Net income				$ 11,335				$ 16,496
Basic, Pro Forma (in dollars per share)				$ 0.21				$ 0.32
Diluted, Pro Forma (in dollars per share)				$ 0.21				$ 0.31

Revenue from Contracts with C_3

Revenue from Contracts with Customers. - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Disaggregation of Revenue [Line Items]
Net sales	$ 243,049	$ 221,659	$ 736,930	$ 649,504
United States
Disaggregation of Revenue [Line Items]
Net sales	144,011	126,108	426,730	360,610
International
Disaggregation of Revenue [Line Items]
Net sales	99,038	95,551	310,200	288,894
Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	234,426	212,150	711,570	624,392
Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	135,671	116,879	402,271	336,341
Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	98,755	95,271	309,299	288,051
Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	8,623	9,509	25,360	25,112
Stand-alone devices | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	96,326	90,975	295,275	266,717
Stand-alone devices | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	55,816	52,173	165,121	147,125
Stand-alone devices | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	40,510	38,802	130,154	119,592
Cianna Medical | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	11,638	0	35,723	0
Cianna Medical | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	11,544	0	35,622	0
Cianna Medical | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	94	0	101	0
Custom kits and procedure trays | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	33,972	33,095	101,257	100,359
Custom kits and procedure trays | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	23,115	23,199	68,292	69,184
Custom kits and procedure trays | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	10,857	9,896	32,965	31,175
Inflation devices | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	22,183	22,893	68,515	69,617
Inflation devices | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	8,156	7,819	24,475	23,647
Inflation devices | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	14,027	15,074	44,040	45,970
Catheters | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	44,426	40,591	132,809	113,830
Catheters | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	20,262	18,081	60,370	50,055
Catheters | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	24,164	22,510	72,439	63,775
Embolization devices | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	12,333	12,395	38,168	37,706
Embolization devices | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	5,254	5,145	15,234	15,272
Embolization devices | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	7,079	7,250	22,934	22,434
CRM/EP | Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	13,548	12,201	39,823	36,163
CRM/EP | Cardiovascular | United States
Disaggregation of Revenue [Line Items]
Net sales	11,524	10,462	33,157	31,058
CRM/EP | Cardiovascular | International
Disaggregation of Revenue [Line Items]
Net sales	2,024	1,739	6,666	5,105
Endoscopy devices | Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	8,623	9,509	25,360	25,112
Endoscopy devices | Endoscopy | United States
Disaggregation of Revenue [Line Items]
Net sales	8,340	9,229	24,459	24,269
Endoscopy devices | Endoscopy | International
Disaggregation of Revenue [Line Items]
Net sales	$ 283	$ 280	$ 901	$ 843

Segment Reporting - Narrative (

Segment Reporting - Narrative (Details)	9 Months Ended
	Sep. 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						9 Months Ended
	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Sep. 30, 2019	Sep. 30, 2018
Segment Reporting Information [Line Items]
Net sales	$ 243,049			$ 221,659			$ 736,930	$ 649,504
Operating income	(2,881)			21,061			18,844	44,955
Total other expense - net	(2,809)			(1,676)			(8,689)	(7,646)
Income tax expense (benefit)	(2,292)			2,766			499	4,481
Net income	(3,398)	$ 6,859	$ 6,195	16,619	$ 10,941	$ 5,269	9,656	32,828
Cardiovascular
Segment Reporting Information [Line Items]
Net sales	234,426			212,150			711,570	624,392
Operating income	(6,210)			18,199			11,263	37,263
Endoscopy
Segment Reporting Information [Line Items]
Net sales	8,623			9,509			25,360	25,112
Operating income	$ 3,329			$ 2,862			$ 7,581	$ 7,692

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Income Tax Disclosure [Abstract]
Income tax expense (benefit)	$ (2,292)	$ 2,766	$ 499	$ 4,481
Effective tax rate	40.30%	14.30%	4.90%	12.00%

Revolving Credit Facility and_3

Revolving Credit Facility and Long-Term Debt - Principal Balances under Long-term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Line of Credit Facility [Line Items]
Long-term debt	$ 440,500
Collateralized debt facility		$ 7,000
Less unamortized debt issuance costs	(544)	(348)
Total long-term debt	439,956	395,152
Less current portion	7,500	22,000
Long-term portion	432,456	373,152
Term Loan
Line of Credit Facility [Line Items]
Long-term debt	150,000	72,500
Revolving Credit Facility
Line of Credit Facility [Line Items]
Long-term debt	$ 290,500	$ 316,000

Revolving Credit Facility and_4

Revolving Credit Facility and Long-Term Debt - Narrative (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Line of Credit Facility [Line Items]
Outstanding borrowings	$ 440,500
Collateralized debt facility		$ 7,000
Term Loan
Line of Credit Facility [Line Items]
Outstanding borrowings	150,000	72,500
Revolving Credit Facility
Line of Credit Facility [Line Items]
Outstanding borrowings	290,500	$ 316,000
Credit Agreement
Line of Credit Facility [Line Items]
Outstanding borrowings	440,500
Remaining borrowing capacity on line of credit	$ 191,100
Fixed interest rate percent	2.37%	2.12%
Debt subject to fixed interest rate	$ 175,000	$ 175,000
Variable interest rate percent	3.29%	3.52%
Debt subject to variable interest rate	$ 265,500	$ 213,500
Credit Agreement | Term Loan
Line of Credit Facility [Line Items]
Debt instrument, face amount	150,000
Credit Agreement | Revolving Credit Facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity	$ 600,000

Revolving Credit Facility and_5

Revolving Credit Facility and Long-Term Debt - Financial Covenants (Details) - Credit Agreement $ in Millions	9 Months Ended
	Sep. 30, 2019USD ($)
Debt Instrument [Line Items]
Consolidated Total Leverage Ratio	4
Consolidated EBITDA	3
Facility Capital Expenditures	$ 50

Revolving Credit Facility and_6

Revolving Credit Facility and Long-Term Debt - Future Minimum Payments on Long-term Debt (Details) $ in Thousands	Sep. 30, 2019USD ($)
Debt Disclosure [Abstract]
Remaining 2019	$ 1,875
2020	7,500
2021	7,500
2022	8,438
2023	11,250
2024	403,937
Total future minimum principal payments	$ 440,500

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) - USD ($)	9 Months Ended
	Sep. 30, 2019	Dec. 31, 2018	Aug. 05, 2016
Derivative [Line Items]
Deferred taxes used to offset fair value of interest rate swap	$ 300,000	$ 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	$ (467,000)
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, net of tax	(347,000)
Interest expense
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, gross	933,000
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, net of tax	693,000
Interest rate swap
Derivative [Line Items]
Notional amount of derivative			$ 175,000,000
Fixed rate			1.12%
Other assets (long-term) | Interest rate swap | Designated as hedging instrument
Derivative [Line Items]
Total Asset Derivatives	$ 1,201,000	$ 5,772,000

Derivatives - Forward Notional

Derivatives - Forward Notional Contracts (Details) - Foreign currency forward contract € 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	Sep. 30, 2019ZAR (R)DerivativeInstrument	Sep. 30, 2019SGD ($)DerivativeInstrument	Sep. 30, 2019JPY (¥)DerivativeInstrument	Sep. 30, 2019CHF (SFr)DerivativeInstrument	Sep. 30, 2019BRL (R$)DerivativeInstrument	Sep. 30, 2019DKK (kr)DerivativeInstrument	Sep. 30, 2019EUR (€)DerivativeInstrument	Sep. 30, 2019SEK (kr)DerivativeInstrument	Sep. 30, 2019KRW (₩)DerivativeInstrument	Sep. 30, 2019HKD ($)DerivativeInstrument	Sep. 30, 2019CAD ($)DerivativeInstrument	Sep. 30, 2019AUD ($)DerivativeInstrument	Sep. 30, 2019NOK (kr)DerivativeInstrument	Sep. 30, 2019CNY (¥)DerivativeInstrument	Sep. 30, 2019GBP (£)DerivativeInstrument	Sep. 30, 2019MXN ($)DerivativeInstrument
Designated as hedging instrument | Derivatives designated as cash flow hedges
Derivative [Line Items]
Average number of contracts entered into per month	150	150	150	150	150	150	150	150	150	150	150	150	150	150	150	150
Notional amount of derivative			¥ 1,190,000	SFr 3,780	R$ 7830	kr 32,225	€ 33,150	kr 43,450	₩ 7,000,000		$ 6,495	$ 5,930	kr 14,050	¥ 408,000	£ 7,315	$ 453,500
Not designated as hedging instrument
Derivative [Line Items]
Average number of contracts entered into per month	20	20	20	20	20	20	20	20	20	20	20	20	20	20	20	20
Notional amount of derivative	R 40,218	$ 600	¥ 1,380,856	SFr 739	R$ 13000	kr 4,072	€ 1,225	kr 12,647	₩ 7,343,000	$ 11,000	$ 1,795	$ 12,695	kr 2,999	¥ 69,069	£ 6,982	$ 35,000

Derivatives - Fair Value of Der

Derivatives - Fair Value of Derivative Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Designated as hedging instrument | Interest rate swap | Other assets (long-term)
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	$ 1,201	$ 5,772
Designated as hedging instrument | Foreign currency forward contract | Other assets (long-term)
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	496	151
Designated as hedging instrument | Foreign currency forward contract | Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	1,821	613
Designated as hedging instrument | Foreign currency forward contract | Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(1,262)	(711)
Designated as hedging instrument | Foreign currency forward contract | Other long-term obligations
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(333)	(101)
Not designated as hedging instrument | Foreign currency forward contract | Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	541	814
Not designated as hedging instrument | Foreign currency forward contract | Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	$ (505)	$ (796)

Derivatives - Amount of Gain (L

Derivatives - Amount of Gain (Loss) Recognized in OCI and Income Statement (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	$ (207)	$ 667	$ (3,938)	$ 3,541
Derivatives designated as cash flow hedges | Interest rate swap
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	(186)	664	(2,855)	3,532
Derivatives designated as cash flow hedges | Interest rate swap | Interest expense
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	(3,415)	(2,329)	(9,295)	(8,064)
Amount of Gain/(Loss) reclassified from AOCI	520		1,716
Amount of Gain/(Loss) reclassified from AOCI		428		998
Derivatives designated as cash flow hedges | Foreign currency forward contract
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in OCI	505	543	555	1,112
Derivatives designated as cash flow hedges | Foreign currency forward contract | Revenue
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	243,049	221,659	736,930	649,504
Amount of Gain/(Loss) reclassified from AOCI	118		220
Amount of Gain/(Loss) reclassified from AOCI		86		(299)
Derivatives designated as cash flow hedges | Foreign currency forward contract | Cost of sales
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) recognized in income	(138,913)	(119,620)	(416,194)	(359,400)
Amount of Gain/(Loss) reclassified from AOCI	$ (112)		$ (298)
Amount of Gain/(Loss) reclassified from AOCI		$ 26		$ 404

Derivatives - Gain (Loss) in th

Derivatives - Gain (Loss) in the Consolidated Statements of Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Not designated as hedging instrument | Foreign currency forward contract | Other income (expense)
Derivative [Line Items]
Gain (loss) on derivative	$ 2,402	$ 1,143	$ 1,647	$ 3,181

Fair Value Measurements - Finan

Fair Value Measurements - Financial Assets and (Liabilities) Carried at Fair Value (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Fair Value, Inputs, Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	$ 1,201	$ 5,772
Foreign currency contract liabilities, current and long-term	2,858	1,578
Foreign currency contract liabilities, current and long-term	(2,100)	(1,608)
Fair Value, Inputs, Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent receivable asset	506	607
Contingent consideration liabilities	(79,608)	(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	1,201	5,772
Foreign currency contract liabilities, current and long-term	2,858	1,578
Foreign currency contract liabilities, current and long-term	(2,100)	(1,608)
Contingent receivable asset	506	607
Contingent consideration liabilities	$ (79,608)	$ (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		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 93,204	$ 10,912	$ 82,236	$ 10,956
Contingent consideration liability recorded as the result of acquisitions	1,203	0	9,583	0
Fair value adjustments recorded to income	$ 273	$ (828)	$ 3,473	$ (741)
Fair Value, Recurring Basis, Unobservable Input Reconciliation, Liability, Gain (Loss), Statement of Income [Extensible List]	us-gaap:BusinessCombinationContingentConsiderationArrangementsContingentConsiderationBenefit	us-gaap:BusinessCombinationContingentConsiderationArrangementsContingentConsiderationBenefit	us-gaap:BusinessCombinationContingentConsiderationArrangementsContingentConsiderationBenefit	us-gaap:BusinessCombinationContingentConsiderationArrangementsContingentConsiderationBenefit
Contingent payments made	$ (15,072)	$ (53)	$ (15,684)	$ (184)
Ending balance	$ 79,608	$ 10,031	$ 79,608	$ 10,031

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Intangible asset impairment charge	$ 2,702	$ 657	$ 3,250	$ 657
Impairment of other assets	196	0	829	86
Contingent Receivable | Contingent Consideration
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Gain (loss) on contingent receivable	$ (119)	$ (167)	$ (101)	$ (299)
Fair Value, Recurring Basis, Unobservable Input Reconciliation, Asset, Gain (Loss), Statement of Income [Extensible List]	us-gaap:BusinessCombinationContingentConsiderationArrangementsContingentConsiderationBenefit	us-gaap:BusinessCombinationContingentConsiderationArrangementsContingentConsiderationBenefit	us-gaap:BusinessCombinationContingentConsiderationArrangementsContingentConsiderationBenefit	us-gaap:BusinessCombinationContingentConsiderationArrangementsContingentConsiderationBenefit
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	$ 72,500		$ 72,500		$ 58,500
Accrued expenses
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, current	$ 7,100		$ 7,100		$ 23,800

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value Inputs, Liabilities, Quantitative Information (Details) - Fair Value, Inputs, Level 3 $ in Thousands	Sep. 30, 2019USD ($)	Dec. 31, 2018USD ($)
Revenue-based royalty
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	$ 8,916	$ 10,661
Supply chain milestone
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities		13,593
Revenue milestones
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	67,807	57,982
Regulatory approval
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration liabilities	2,885
Contingent receivable
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Contingent consideration asset	$ 506	$ 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	0.13	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		0.053
Discount rate | Revenue milestones | Minimum | Discounted Cash Flow
Fair Value Inputs, Liabilities, Quantitative Information [Line Items] (Deprecated 2018-01-31)
Unobservable inputs, contingent liability	0.13	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	0.15	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	0.039
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	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		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	1	0.67

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2019USD ($)
Goodwill [Roll Forward]
Goodwill balance at beginning of period	$ 335,433
Effect of foreign exchange	(1,069)
Additions and adjustments as the result of acquisitions	17,794
Goodwill balance at end of period	$ 352,158

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Other Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Other
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 130,489	$ 128,702
Accumulated Amortization	(62,378)	(49,136)
Net Carrying Amount	68,111	79,566
Patents
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	21,938	19,378
Accumulated Amortization	(6,449)	(5,012)
Net Carrying Amount	15,489	14,366
Distribution agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	8,012	8,012
Accumulated Amortization	(6,537)	(5,766)
Net Carrying Amount	1,475	2,246
License agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	26,975	26,930
Accumulated Amortization	(12,226)	(7,411)
Net Carrying Amount	14,749	19,519
Trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	30,232	29,998
Accumulated Amortization	(8,743)	(6,586)
Net Carrying Amount	21,489	23,412
Covenants not to compete
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	1,029	1,028
Accumulated Amortization	(1,023)	(1,000)
Net Carrying Amount	6	28
Customer Lists
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	39,803	39,936
Accumulated Amortization	(27,400)	(23,361)
Net Carrying Amount	12,403	16,575
In-process technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	2,500	3,420
Accumulated Amortization	0	0
Net Carrying Amount	$ 2,500	$ 3,420

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Narrative (Details) (Imported) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
Accumulated impairment loss	$ 8,300		$ 8,300		$ 8,300
Aggregate amortization expense	15,500	$ 10,500	45,200	$ 29,400
Intangible asset impairment charge	$ 2,702	657	3,250	$ 657
Distal Access [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible asset impairment charge			869
Lazarus Medical Technologies, LLC
Finite-Lived Intangible Assets [Line Items]
Intangible asset impairment charge			548
Pleuratech [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible asset impairment charge			$ 1,800
Quellent LLC
Finite-Lived Intangible Assets [Line Items]
Intangible asset impairment charge		$ 657

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Future Amortization Expense (Details) $ in Thousands	Sep. 30, 2019USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remaining 2019	$ 15,435
2020	59,265
2021	51,916
2022	50,504
2023	49,297
2024	$ 46,360

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($)	9 Months Ended
	Sep. 30, 2019	Dec. 31, 2018	Dec. 31, 2015
Lessee, Lease, Description [Line Items]
Renewal term (up to)	15 years
Termination option (within)	1 year
Sale and leaseback transaction			$ 2,000,000
Deferred gain from sale and leaseback transaction		$ 93,000
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease term	1 year
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease term	30 years

Leases - Schedule of Consolidat

Leases - Schedule of Consolidated Balance Sheet Information (Details) $ in Thousands	Sep. 30, 2019USD ($)
Leases [Abstract]
ROU operating lease assets	$ 79,757
Short-term operating lease liabilities	11,652
Long-term operating lease liabilities	72,056
Total operating lease liabilities	$ 83,708

Leases - Components of Lease Co

Leases - Components of Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2019
Leases [Abstract]
Operating lease cost	$ 4,253	$ 12,650
Sublease (income)	(37)	(328)
Net lease cost	$ 4,216	$ 12,322

Leases - Supplemental Cash Flow

Leases - Supplemental Cash Flow Information (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2019USD ($)
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 11,028
Right-of-use operating lease assets obtained in exchange for operating lease liabilities	$ 7,431

Leases - Supplemental Disclosur

Leases - Supplemental Disclosure (Details)	Sep. 30, 2019
Leases [Abstract]
Weighted average remaining lease term	12 years 4 months 24 days
Weighted average discount rate	3.30%

Leases - Maturities of Operatin

Leases - Maturities of Operating Lease Liabilities (Details) $ in Thousands	Sep. 30, 2019USD ($)
Leases [Abstract]
Remaining 2019	$ 3,575
2020	13,562
2021	12,568
2022	10,058
2023	8,038
Thereafter	58,492
Total lease payments	106,293
Less: Imputed interest	(22,585)
Less: Imputed interest	$ 83,708

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	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2019
U.S. Department of Justice Matter
Loss Contingencies [Line Items]
Legal expenses	$ 2.4	$ 5