0000784199-24-000033 | 10-K | XBRL Viewer

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Employee Benefit Plans (Details) - USD ($)	12 Months Ended
Employee Benefit Plans (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Defined Contribution Plan Disclosure [Line Items]
Company's matching contribution of employees' salary			4.00%
Deferred compensation liability, current	$ 491,000
Deferred compensation liability, non-current	6,760,000	$ 5,468,000
Cash surrender value of life insurance	$ 6,900,000	$ 5,500,000
401(K)
Defined Contribution Plan Disclosure [Line Items]
Company's matching contribution of employees' salary	4.00%	4.00%
Company's total contributions	$ 2,600,000	$ 2,600,000	$ 2,100,000
Discretionary contributions	$ 0	$ 0	$ 0

Goodwill and Other Intangible Assets (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Impairment of indefinite lived intangible assets	$ 0	$ 0	$ 0

Agreements with Endospan	12 Months Ended
Agreements with Endospan	Dec. 31, 2023
Variable Interest Entity, Primary Beneficiary, Does Not Hold Majority Voting Interest, Disclosures [Abstract]
Agreements with Endospan	Agreements with Endospan Exclusive Distribution Agreement and Securities Purchase Option Agreement On September 11, 2019 Artivion’s wholly owned subsidiary, JOTEC, entered into an exclusive distribution agreement (“Endospan Distribution Agreement”) with Endospan Ltd. (“Endospan”), an Israeli corporation, pursuant to which JOTEC obtained exclusive distribution rights for NEXUS, and under a subsequent amendment, the NEXUS DUO (collectively the “NEXUS Products”) and accessories in certain countries in Europe in exchange for a fixed distribution fee of $9.0 million paid in September 2019. We also entered into a securities purchase option agreement (“Endospan Option”) with Endospan for $1.0 million paid in September 2019. The Endospan Option Agreement provides Artivion the option to purchase all the outstanding securities of Endospan from Endospan’s securityholders at the time of acquisition, or the option to acquire all of Endospan’s assets, in each case, for a price between $350.0 and $450.0 million before, or within a certain period of time after FDA approval of NEXUS, with such option expiring if not exercised within 90 days after receiving notice that Endospan has received approval from the FDA for NEXUS. Loan Agreement Artivion and Endospan also entered into a loan agreement (“Endospan Loan”), dated September 11, 2019, in which Artivion agreed to provide Endospan a secured loan of up to $15.0 million to be funded in three tranches of $5.0 million each. The first tranche of the Endospan Loan was funded upon execution of the agreement in September 2019. In September 2020 we funded the second tranche payment of $5.0 million upon the certification of the NEXUS IDE from the FDA. In May 2023 we funded the third tranche payment of $5.0 million upon the certification of enrollment of 50% of the required number of patients in the primary arm of the FDA approved clinical trial for NEXUS. Variable Interest Entity We consolidate the results of a variable interest entity ("VIE") when it is determined that we are the primary beneficiary. Based on our initial evaluation of Endospan and the related agreements with Endospan, we determined that Endospan is a VIE. Although the arrangement with Endospan resulted in our holding a variable interest, it did not empower us to direct those activities of Endospan that most significantly impact the VIE economic performance. Therefore, we are not the primary beneficiary, and we have not consolidated Endospan into our financial results. Our payments to Endospan in September 2019 totaled $15.0 million which included a $9.0 million distribution fee, a $1.0 million securities purchase option, and $5.0 million for the first tranche of the Endospan Loan. The second tranche payment of $5.0 million was funded in September 2020. An additional $5.0 million was funded in May 2023 as part of the third tranche payment described above. We evaluated Endospan for VIE classification as of December 31, 2023 and determined that Endospan meets the criteria of a non-consolidating VIE. Our payments to date, including any loans, guarantees, and other subordinated financial support related to this VIE, totaled $25.0 million as of December 31, 2023, representing our maximum exposure to loss, and were not individually significant to our consolidated financial statements. Valuation The agreements with Endospan were entered into concurrently and had certain terms that are interrelated. In our evaluation of the initial relative fair value of each of the Endospan agreements to determine the amount to record, we utilized discounted cash flows to estimate the fair market value for the Endospan Loan and for the Endospan Distribution Agreement. We estimated the fair value of the Endospan Option utilizing the Monte Carlo simulation. Inputs in our valuation of the Endospan agreements included cash payments and anticipated payments based on the executed agreements with Endospan, projected discounted cash flows in connection with the Endospan transaction, our expected internal rate of return and discount rates, and our assessed probability and timing of receipt of certification of certain approvals and milestones in obtaining FDA approval. Based on the initial fair value of the Endospan Loan and the relative fair values of the Endospan Distribution Agreement and Endospan Option Agreement, we recorded the Endospan Loan value of $358,000 in Other long-term assets in the Consolidated Balance Sheets as of December 31, 2019. The value of the Endospan Distribution Agreement of $1.8 million and $3.5 million was included in Other intangibles, net in the Consolidated Balance Sheets as of December 31, 2023 and 2022, respectively. We elected the fair value option for recording the Endospan Loan. We assess the fair value of the Endospan Loan based on quantitative and qualitative characteristics, and adjust the amount recorded to its current fair market value at each reporting period. We performed an assessment of the fair value of the Endospan Loan and determined that the loan fair value decreased and had no value as of December 31, 2021. As a result of this fair value adjustment, we recorded an expense of $409,000 in Other expense, net on the Consolidated Statements of Operations and Comprehensive Loss during twelve months ended December 31, 2021. In May 2023 we funded a $5.0 million third tranche payment and determined that the loan continued to have no fair value. Consequently, we recorded an expense of $5.0 million in Other expense, net on the Consolidated Statements of Operations and Comprehensive Loss during the twelve months ended December 31, 2023. We did not record a loan fair value adjustment during the twelve months ended December 31, 2022. In the fourth quarter of December 31, 2021 we fully impaired the value of the Endospan Option primarily driven by a decrease in forecasted operating results. We recorded $4.9 million impairment expense included in General, administrative, and marketing expense on the Consolidated Statements of Operations and Comprehensive Loss during the twelve months ended December 31, 2021.

Inventories and Deferred Preservation Costs, net (Schedule of Inventories) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials and supplies	$ 36,907	$ 36,715
Work-in-process	12,687	10,476
Finished goods	32,382	27,287
Total inventories, net	$ 81,976	$ 74,478

Segment and Geographic Information (Schedule Of Net Revenues By Geographic Location) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Total revenues	$ 354,004	$ 313,789	$ 298,836
US
Segment Reporting Information [Line Items]
Total revenues	179,485	161,113	151,151
International
Segment Reporting Information [Line Items]
Total revenues	$ 174,519	$ 152,676	$ 147,685

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

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+ Details

Inventories and Deferred Preservation Costs, net (Narrative) (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Inventory [Line Items]
Consignment inventory	$ 10.7	$ 12.7
Inventory valuation reserve	$ 3.0	$ 2.2
Domestic
Inventory [Line Items]
Consignment inventory percentage	44.00%	41.00%
Foreign
Inventory [Line Items]
Consignment inventory percentage	56.00%	59.00%

Stock Compensation (Summary of Total Stock Compensation Expenses) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock compensation expense	$ 15,146	$ 12,942	$ 11,277
RSA, RSU, and PSU expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock compensation expense	11,875	10,351	9,023
Stock option and ESPP option expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock compensation expense	$ 3,271	$ 2,591	$ 2,254

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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+ Details

Debt (Schedule of Short-Term and Long-Term Balances of Term Loan) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 01, 2017	Dec. 31, 2015	Apr. 30, 2014
Debt Instrument [Line Items]
Total loan balance	$ 312,045	$ 314,779
Less unamortized loan origination costs	(5,063)	(6,672)
Net borrowings	306,982	308,107
Less short-term loan balance, net	(1,451)	(1,608)
Long-term loan balance, net	305,531	306,499
2.45% Sparkasse Zollernalb (KFW Loan 1)
Debt Instrument [Line Items]
Total loan balance	$ 61	296
Interest rate on amounts borrowed	2.45%				2.45%
1.40% Sparkasse Zollernalb (KFW Loan 2)
Debt Instrument [Line Items]
Total loan balance	$ 484	733
Interest rate on amounts borrowed	1.40%			1.40%
Term loan balance
Debt Instrument [Line Items]
Total loan balance	$ 211,500	213,750	$ 225,000
Convertible senior notes
Debt Instrument [Line Items]
Total loan balance	$ 100,000	$ 100,000

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2023
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events Debt Refinancing On January 18, 2024 we entered into a credit and guaranty agreement with Ares Management Credit funds for $350.0 million of senior secured, interest-only, credit facilities, consisting of a $190.0 million term loan facility (the “Initial Term Loan Facility”), a $100.0 million delayed draw term loan facility (the “Delayed Draw Term Loan Facility” and, together with the Initial Term Loan Facility, the “Term Loan Facilities”) and a $60.0 million “senior-priority” revolving credit facility (the “Revolving Credit Facility” and, together with the Term Loan Facilities, the “Credit Facilities”) which has a priority claim ahead of the other secured facilities. The final scheduled maturity date of the Credit Facilities is January 18, 2030. There are no scheduled repayments of principal required to be made prior to the final maturity date. The Credit Facilities are secured by a security interest in substantially all existing and after-acquired real and personal property (subject to certain exceptions and exclusions) of us and the Guarantors. Upon closing, we borrowed $190.0 million under the Initial Term Loan Facility and $30.0 million under the Revolving Credit Facility. The proceeds of the initial borrowings were used along with cash on hand to pay off our existing debt related to our Credit Agreement and related fees and expenses. The $30.0 million of undrawn availability under the Revolving Credit Facility may be drawn for working capital, capital expenditures, and other general corporate purposes. The proceeds of borrowings under the Delayed Draw Term Loan Facility may be used solely to repurchase or repay our outstanding 4.25% Convertible Senior Notes due July 1, 2025 and to pay related fees and expenses. Subject to the satisfaction of a specified maximum total net leverage ratio and other customary conditions, we may borrow under the Delayed Draw Term Loan Facility at any time and from time to time on or prior to the maturity date of the convertible bonds on July 1, 2025. Loans borrowed under the Delayed Draw Term Loan Facility have the same terms as the loans under the Initial Term Loan Facility. The Credit Facilities contain certain customary affirmative and negative covenants, including covenants that limit our ability and the ability of our subsidiaries to, among other things, grant liens, incur debt, dispose of assets, make loans and investments, make acquisitions, make certain restricted payments (including cash dividends), merge or consolidate, change business or accounting or reporting practices, in each case subject to customary exceptions for a credit facility of this size and type. The covenants include a financial maintenance that requires the company’s total net leverage ratio, as defined in the agreement, to be not greater than 6.25x for the test periods from the second quarter of fiscal year 2024 through the fourth quarter of fiscal year 2024 and not greater than 5.75x from the first quarter of fiscal year 2025 and thereafter. The Revolving Credit Facilities bear interest, at our option, at a floating annual rate equal to either the base rate, plus a margin of 3.0%, or Adjusted Term SOFR Rate, plus a margin of 4.0%. The Term Loan Facilities initially bear interest, at our option, at a floating annual rate equal to either the base rate plus a margin of 5.5%, or Adjusted Term SOFR Rate plus a margin of 6.5%. If, after the second quarter of fiscal year 2025 the company reports Total Net Leverage, as defined in the credit facilities, of less than 3.75x the interest margins applicable to the Term Loan Facilities will be reduced by 25 basis points, to 5.25% and 6.25%, for base rate and Adjusted Term SOFR loans, respectively.

Income Taxes (Schedule of Effective Income Tax Rate Reconciliation) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Tax benefit at statutory rate	$ (4,533)	$ (3,147)	$ (3,114)
Increase (reduction) in income taxes resulting from:
Valuation allowance change	9,964	4,779	1,566
Foreign income taxes	2,969	415	1,138
Nondeductible executive compensation	989	878	1,075
Equity compensation	872	472	(477)
Net change in uncertain tax positions	652	527	762
State income taxes, net of federal benefit	281	484	73
Nondeductible entertainment expenses	262	117	65
Foreign interest disallowance	0	151	307
Foreign deferred items	0	(112)	53
Foreign derived intangible income deduction	(501)	(133)	(144)
Research and development credit	(800)	(961)	(959)
Provision to return adjustments	(937)	336	63
Other	(114)	402	(401)
Income tax expense	$ 9,104	$ 4,208	$ 7

Debt (Narrative) (Details)						12 Months Ended
Debt (Narrative) (Details)	Jan. 18, 2024 USD ($)	Apr. 19, 2023 USD ($)	Dec. 19, 2022	Jun. 02, 2021 USD ($)	Jun. 18, 2020 USD ($) $ / shares	Dec. 31, 2023 USD ($) tradingDay businessDay	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 01, 2017 USD ($)	Dec. 31, 2015	Apr. 30, 2014
Line of Credit Facility [Line Items]
Debt						$ 312,045,000	$ 314,779,000
Payments of debt issuance costs						249,000	0	$ 2,219,000
Interest expense						$ 25,299,000	18,224,000	16,887,000
Interest Expense
Line of Credit Facility [Line Items]
Payments of debt issuance costs				$ 361,000
Debt extinguishment costs				474,000
Convertible Senior Notes
Line of Credit Facility [Line Items]
Interest rate on amounts borrowed					4.25%
Effective interest rate						5.05%
Debt instrument, face amount					$ 100,000,000
Proceeds from convertible debt					$ 96,500,000
Conversion ratio					0.0426203
Conversion price (in dollars per share) \| $ / shares					$ 23.46
Debt fair value						$ 106,400,000
Interest expense						5,000,000	4,900,000	$ 4,900,000
Unamortized debt issuance costs						1,100,000	1,900,000
Convertible Senior Notes \| Cumulative Effect, Period of Adoption, Adjustment \| ASU 2020-06
Line of Credit Facility [Line Items]
Notes payable						$ 100,000,000
Convertible Senior Notes \| Subsequent Event
Line of Credit Facility [Line Items]
Interest rate on amounts borrowed	4.25%
Convertible Senior Notes \| Circumstance I
Line of Credit Facility [Line Items]
Conversion trading day threshold \| tradingDay						20
Conversion consecutive trading day threshold \| tradingDay						30
Conversion percentage of stock price threshold						130.00%
Convertible Senior Notes \| Circumstance II
Line of Credit Facility [Line Items]
Conversion trading day threshold \| businessDay						5
Conversion consecutive trading day threshold \| tradingDay						5
Conversion percentage of stock price threshold						98.00%
Convertible Senior Notes \| Circumstance After July 5, 2023
Line of Credit Facility [Line Items]
Conversion trading day threshold \| tradingDay						20
Conversion consecutive trading day threshold \| tradingDay						30
Conversion percentage of stock price threshold						130.00%
Conversion percentage of principal amount						100.00%
2.45% Sparkasse Zollernalb (KFW Loan 1)
Line of Credit Facility [Line Items]
Debt						$ 61,000	296,000
Interest rate on amounts borrowed						2.45%					2.45%
1.40% Sparkasse Zollernalb (KFW Loan 2)
Line of Credit Facility [Line Items]
Debt						$ 484,000	733,000
Interest rate on amounts borrowed						1.40%				1.40%
Credit and Guaranty Agreement \| Secured Debt \| Subsequent Event
Line of Credit Facility [Line Items]
Proceeds from issuance of debt	$ 220,000,000
Debt instrument, face amount	$ 350,000,000
Notes Payable Issued For Prepayment Of Insurance Premiums \| IPFS Corporation
Line of Credit Facility [Line Items]
Interest rate on amounts borrowed		6.65%
Debt instrument, face amount		$ 3,600,000
Loan term		1 year
Notes Payable, Current						$ 1,000,000
Revolving Credit Facility And Term Loan
Line of Credit Facility [Line Items]
Payments of debt issuance costs				2,100,000
Amortization of the debt issuance costs				$ 1,800,000
Revolving Credit Facility And Term Loan \| Credit Agreement
Line of Credit Facility [Line Items]
Debt									$ 255,000,000
Effective interest rate						8.97%
Debt instrument, extension period				2 years 6 months
Revolving Credit Facility And Term Loan \| Amended Credit Agreement Two \| Convertible Senior Notes
Line of Credit Facility [Line Items]
Interest rate on amounts borrowed						4.25%
Term Loan
Line of Credit Facility [Line Items]
Debt						$ 211,500,000	$ 213,750,000		225,000,000
Term Loan \| SOFR
Line of Credit Facility [Line Items]
Credit facility margin			3.50%
Term Loan \| Amended Credit Agreement Two \| Circumstance I
Line of Credit Facility [Line Items]
Debt instrument, extension circumstance period						91 days
Term Loan \| Amended Credit Agreement Two \| Circumstance II
Line of Credit Facility [Line Items]
Debt instrument, extension circumstance period						182 days
Revolving Credit Facility
Line of Credit Facility [Line Items]
Credit facility aggregate commitments									$ 30,000,000
Revolving Credit Facility \| SOFR \| Minimum
Line of Credit Facility [Line Items]
Credit facility margin			4.00%
Revolving Credit Facility \| SOFR \| Maximum
Line of Credit Facility [Line Items]
Credit facility margin			4.25%

Goodwill and Other Intangible Assets (Schedule of Gross Carrying Values, Accumulated Amortization, and Approximate Amortization Period of Definite Lived Intangible Assets) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Net Carrying Value	$ 142,593	$ 151,263
Total other intangibles
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	50,517	49,910
Accumulated Amortization	25,046	22,619
Net Carrying Value	$ 25,471	$ 27,291
Weighted Average Useful Life (Years)	10 years	10 years 3 months 18 days
Acquired technology, net
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 201,897	$ 198,420
Accumulated Amortization	59,304	47,157
Net Carrying Value	$ 142,593	$ 151,263
Weighted Average Useful Life (Years)	18 years 2 months 12 days	18 years 2 months 12 days
Customer lists and relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 28,729	$ 31,030
Accumulated Amortization	10,334	11,100
Net Carrying Value	$ 18,395	$ 19,930
Weighted Average Useful Life (Years)	21 years 7 months 6 days	20 years 6 months
Distribution and manufacturing rights and know-how
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 9,608	$ 9,274
Accumulated Amortization	7,807	5,796
Net Carrying Value	$ 1,801	$ 3,478
Weighted Average Useful Life (Years)	5 years	5 years
Patents
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 4,365	$ 4,246
Accumulated Amortization	3,225	3,180
Net Carrying Value	$ 1,140	$ 1,066
Weighted Average Useful Life (Years)	17 years	17 years
Other
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 7,815	$ 5,360
Accumulated Amortization	3,680	2,543
Net Carrying Value	$ 4,135	$ 2,817
Weighted Average Useful Life (Years)	5 years	4 years 4 months 24 days

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2023
Audit Information [Abstract]
Auditor Firm ID	42
Auditor Name	Ernst & Young LLP
Auditor Location	Atlanta, Georgia

Income Taxes (Summary of Valuation Allowance Deferred Tax Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Deferred Tax Assets, Valuation Allowance [Roll Forward]
Beginning balance	$ 17,942	$ 13,282	$ 7,170
Additions in estimates recorded to deferred income tax expense, net	9,809	4,660	1,505
Additions related to Other comprehensive income, net	5,109	0	4,607
Ending balance	$ 32,860	$ 17,942	$ 13,282

Basis of Presentation and Summary of Significant Accounting Policies (Schedule of Supplemental Disclosures of Cash Flow Information) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Interest	$ 23,332	$ 14,243	$ 14,407
Income taxes	4,865	9,244	5,483
Non-cash investing and financing activities:
Operating lease right-of-use assets	6,181	1,803	31,726
Issuance of common stock for contingent consideration	$ 0	$ 0	$ 10,000

Stock Compensation (Summary of Other Information Concerning Stock Options) (Details) - Stock Options - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted-average fair value of options granted (in dollars per share)	$ 7.87	$ 5.31	$ 8.82
Intrinsic value of options exercised	$ 695,000	$ 1,120,000	$ 2,716,000

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Goodwill and Other Intangible Assets (Scheduled Amortization of Intangible Assets for Next Five Years) (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2024	$ 15,121
2025	13,200
2026	12,972
2027	12,866
2028	12,644
Total	$ 66,803

Stock Compensation (Tables)

12 Months Ended

Dec. 31, 2023

Share-Based Payment Arrangement [Abstract]

Schedule of Shares Available for Grant

We are currently authorized to grant and have available for grant the following number of shares under our stock plans as of December 31, 2023 and 2022:


	Authorized Shares	Available for Grant
Plan		2023	2022
1996 Discounted Employee Stock Purchase Plan, as amended	2,900,000	826,000	967,000
2020 Equity and Cash Incentive Plan	7,145,000	3,281,000	999,000
Total	10,045,000	4,107,000	1,966,000

Schedule of Stock Grant Activity for RSAs

A summary of stock grant activity for the years ended December 31, 2023, 2022, and 2021 for RSAs, RSUs, and PSUs, based on the target number of shares, was as follows:


RSAs	Shares	Weighted Average Grant Date Fair Value
Unvested at December 31, 2020	258,000	$	25.08
Granted	140,000	25.68
Vested	(130,000)	22.40
Forfeited	(33,000)	27.39
Unvested at December 31, 2021	235,000	26.59
Granted	64,000	17.91
Vested	(89,000)	28.60

Unvested at December 31, 2022	210,000	23.09
Granted	78,000	15.45
Vested	(128,000)	22.02
Forfeited	(4,000)	24.90
Unvested at December 31, 2023	156,000	20.11

Schedule of Stock Grant Activity for RSUs


RSUs	Shares	Weighted Average Remaining Contractual Term in years	Aggregate Intrinsic Value
Unvested at December 31, 2020	212,000	1.02	$	5,015,000
Granted	144,000
Vested	(93,000)
Forfeited	(39,000)
Unvested at December 31, 2021	224,000	0.94	4,558,000
Granted	643,000
Vested	(100,000)
Forfeited	(33,000)
Unvested at December 31, 2022	734,000	2.02	8,895,000
Granted	327,000
Vested	(125,000)
Forfeited	(57,000)
Unvested at December 31, 2023	879,000	1.41	15,711,000

Vested and expected to vest	879,000	1.41	$	15,711,000

Schedule of Stock Grant Activity for PSUs


PSUs	Shares	Weighted Average Remaining Contractual Term in years	Aggregate Intrinsic Value
Unvested at December 31, 2020	331,000	1.64	$	7,805,000
Granted	215,000
Vested	(60,000)
Forfeited	(114,000)
Unvested at December 31, 2021	372,000	0.90	7,579,000
Granted	182,000
Vested	(117,000)
Forfeited	(97,000)
Unvested at December 31, 2022	340,000	0.67	4,121,000
Granted	308,000
Vested	(213,000)
Forfeited	(169,000)
Unvested at December 31, 2023	266,000	0.54	4,749,000

Vested and expected to vest	266,000	0.54	$	4,749,000

Summary of Stock Option Activity

A summary of our stock option activity for the years ended December 31, 2023, 2022, and 2021 was as follows:


	Shares	Weighted Average Exercise Price		Weighted Average Remaining Contractual Term in years	Aggregate Intrinsic Value
Outstanding at December 31, 2020	1,241,000	$	18.16	3.38	$	8,215,000
Granted	226,000	24.90
Exercised	(179,000)	12.02
Forfeited	(42,000)	26.00
Outstanding at December 31, 2021	1,246,000	20.00		3.20	4,039,000
Granted	1,031,000	13.29
Exercised	(151,000)	11.85
Forfeited	(3,000)	21.55
Outstanding at December 31, 2022	2,123,000	17.31		4.56	1,150,000
Granted	110,000	17.54
Exercised	(226,000)	11.05
Forfeited	(93,000)	12.59
Expired	(36,000)	25.55
Outstanding at December 31, 2023	1,878,000	18.16		4.12	4,678,000

Vested and expected to vest	1,878,000	$	18.16	4.12	$	4,678,000
Exercisable at December 31, 2023	1,080,000	$	20.59	3.03	$	1,714,000

Summary of Other Information Concerning Stock Options

Other information concerning stock options for the years ended December 31 was as follows:


	2023		2022		2021
Weighted-average fair value of options granted	$	7.87	$	5.31	$	8.82
Intrinsic value of options exercised	695,000		1,120,000		2,716,000

Schedule of Weighted-Average Assumptions Used to Determine the Fair Value of Options

The following weighted-average assumptions were used to determine the fair value of options:


	2023		2022		2021
	Stock Options	ESPP Options	Stock Options	ESPP Options	Stock Options	ESPP Options
Expected life of options	5.00 Years	0.50 Years	5.00 Years	0.50 Years	5.00 Years	0.50 Years
Expected stock price volatility	0.45	0.57	0.40	0.40	0.40	0.45
Risk-free interest rate	4.11%	5.03%	3.58%	1.34%	0.57%	0.07%

Summary of Total Stock Compensation Expenses

The following table summarizes stock compensation expense (in thousands):


	2023		2022		2021
RSA, RSU, and PSU expense	$	11,875	$	10,351	$	9,023
Stock option and ESPP option expense	3,271		2,591		2,254
Total stock compensation expense	$	15,146	$	12,942	$	11,277

Inventories and Deferred Preservation Costs, net (Schedule of Deferred Preservation Costs) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Inventory [Line Items]
Total deferred preservation costs, net	$ 49,804	$ 46,371
Cardiac tissues
Inventory [Line Items]
Total deferred preservation costs, net	24,823	21,799
Vascular tissues
Inventory [Line Items]
Total deferred preservation costs, net	$ 24,981	$ 24,572

Consolidated Statements of Shareholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Additional Paid In Capital	Additional Paid In Capital Cumulative Effect, Period of Adoption, Adjustment	Retained Earnings (Deficit)	Retained Earnings (Deficit) Cumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Income (Loss)	Treasury Stock
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance, treasury stock (in shares)									(1,487)
Balance, shares at Dec. 31, 2020			40,394
Balance at Dec. 31, 2020	$ 328,713	$ (19,639)	$ 404	$ 316,192	$ (16,426)	$ 20,022	$ (3,213)	$ 6,743
Beginning balance, treasury stock at Dec. 31, 2020									$ (14,648)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(14,834)					(14,834)
Other comprehensive income (loss), net of tax	(16,630)							(16,630)
Stock issued (in shares)			553
Stock issued	10,000		$ 6	9,994
Equity compensation (in shares)			260
Equity compensation	11,277		$ 3	11,274
Exercise of options (in shares)			179
Exercise of options	$ 2,146		$ 1	2,145
Employee stock purchase plan (in shares)	87		87
Employee stock purchase plan	$ 1,609		$ 1	1,608
Redemption and repurchase of stock to cover tax withholdings (in shares)			(76)
Redemption and repurchase of stock to cover tax withholdings	(1,914)		$ (1)	(1,913)
Balance, shares at Dec. 31, 2021			41,397
Balance at Dec. 31, 2021	$ 300,728		$ 414	322,874		1,975		(9,887)
Ending balance, treasury stock (in shares) at Dec. 31, 2021									(1,487)
Ending balance, treasury stock at Dec. 31, 2021									$ (14,648)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible Enumeration]	ASU 2020-06
Beginning balance, treasury stock (in shares)									(1,487)
Net loss	$ (19,192)					(19,192)
Other comprehensive income (loss), net of tax	(11,722)							(11,722)
Equity compensation (in shares)			282
Equity compensation	12,942		$ 3	12,939
Exercise of options (in shares)			151
Exercise of options	$ 1,789		$ 1	1,788
Employee stock purchase plan (in shares)	95		95
Employee stock purchase plan	$ 1,579		$ 1	1,578
Redemption and repurchase of stock to cover tax withholdings (in shares)			(95)
Redemption and repurchase of stock to cover tax withholdings	(1,795)		$ (1)	(1,794)
Balance, shares at Dec. 31, 2022			41,830
Balance at Dec. 31, 2022	$ 284,329		$ 418	337,385		(17,217)		(21,609)
Ending balance, treasury stock (in shares) at Dec. 31, 2022	(1,487)								(1,487)
Ending balance, treasury stock at Dec. 31, 2022	$ 14,648								$ (14,648)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance, treasury stock (in shares)	(1,487)								(1,487)
Net loss	$ (30,690)					(30,690)
Other comprehensive income (loss), net of tax	9,599							9,599
Equity compensation (in shares)			412
Equity compensation	15,146		$ 4	15,142
Exercise of options (in shares)			226
Exercise of options	$ 2,502		$ 3	2,499
Employee stock purchase plan (in shares)	141		141
Employee stock purchase plan	$ 1,453		$ 2	1,451
Redemption and repurchase of stock to cover tax withholdings (in shares)			(40)
Redemption and repurchase of stock to cover tax withholdings	(559)		$ (1)	(558)
Balance, shares at Dec. 31, 2023			42,569
Balance at Dec. 31, 2023	$ 281,780		$ 426	$ 355,919		$ (47,907)		$ (12,010)
Ending balance, treasury stock (in shares) at Dec. 31, 2023	(1,487)								(1,487)
Ending balance, treasury stock at Dec. 31, 2023	$ 14,648								$ (14,648)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Beginning balance, treasury stock (in shares)	(1,487)								(1,487)

Financial Instruments (Narrative) (Details) - USD ($)	12 Months Ended
Financial Instruments (Narrative) (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Fair Value Disclosures [Abstract]
Gross realized gains or losses on cash equivalents	$ 0	$ 0	$ 0

Insider Trading Arrangements	3 Months Ended	12 Months Ended
Insider Trading Arrangements	Dec. 31, 2023 shares	Dec. 31, 2023 shares
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		On December 14, 2023 Andrew Green, our Vice President, Regulatory Affairs, adopted a Rule 10b5-1 trading arrangement, pursuant to which he may sell up to 5,456 shares of the Company's common stock. The trading arrangement is intended to satisfy the affirmative defense of Rule 10b5-1(c) under the Exchange Act. The duration of the trading arrangement is from March 14, 2024 to June 14, 2024.
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Andrew Green [Member]
Trading Arrangements, by Individual
Name	Andrew Green
Title	Vice President, Regulatory Affairs,
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	December 14, 2023
Aggregate Available	5,456	5,456
J. Patrick Mackin [Member]
Trading Arrangements, by Individual
Arrangement Duration	92 days

Basis of Presentation and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis of Presentation and Summary of Significant Accounting Policies

Nature of Business

Artivion, Inc. (“Artivion,” the “Company,” “we,” or “us”), is a leader in the manufacturing, processing, and distribution of medical devices and implantable human tissues used in cardiac and vascular surgical procedures for patients with aortic disease. We have four major product families: aortic stent grafts, surgical sealants, On-X mechanical heart valves and related surgical products (“On-X” products), and implantable cardiac and vascular human tissues. Aortic stent grafts include aortic arch stent grafts, abdominal stent grafts, and synthetic vascular grafts. Aortic arch stent grafts include our E-vita Open NEO, E-vita Open Plus, the Ascyrus Medical Dissection Stent (“AMDS”) hybrid prosthesis, the NEXUS endovascular stent graft system (“NEXUS”), the NEXUS DUOTM aortic arch stent graft (“NEXUS DUO”), and E-vita Thoracic 3G products. Abdominal stent grafts include our E-xtra Design Engineering (including Artivex), E-nside, E-tegra, E-ventus BX, and E-liac products. Surgical sealants include our BioGlue Surgical Adhesive products (“BioGlue”). In addition to these four major product families, we sell or distribute PhotoFix bovine surgical patches (“PhotoFix”) and CardioGenesis cardiac laser therapy (prior to our abandonment of the business as of June 30, 2023). We began to manufacture and supply PerClot hemostatic powder (“PerClot”) during the second quarter of 2023 (as part of the Transitional Manufacturing and Supply Agreement (“TMSA”) of the Baxter Transaction, described below).

Basis of Presentation and Principles of Consolidation

We prepare our consolidated financial statements in accordance with accounting principles generally accepted in the United States of America (“US GAAP”). The accompanying consolidated financial statements include the accounts of the Company and our wholly-owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in consolidation. Certain prior-year amounts have been reclassified to conform to the current year presentation.

Foreign Currencies

Our revenues and expenses transacted in foreign currencies are remeasured as they occur at exchange rates in effect at the time of each transaction. Realized and unrealized gains and losses on foreign currency transactions are recorded as a component of Other expense, net on our Consolidated Statements of Operations and Comprehensive Loss. Realized and unrealized gains and losses were a gain of $2.1 million, a loss of $3.1 million, and a loss of $5.5 million for the years ended December 31, 2023, 2022, and 2021, respectively. Our assets and liabilities denominated in foreign currencies are recognized at the exchange rate in effect at the time of each transaction. At period end, the assets and liabilities are translated at the exchange rate in effect as of the balance sheet date and are recorded as a separate component of Accumulated other comprehensive loss in the shareholders' equity section of our Consolidated Balance Sheets.

Use of Estimates

The preparation of the accompanying consolidated financial statements in conformity with US GAAP requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent liabilities at the date of the financial statements, and the reported amounts of revenues and expenses during the reporting periods. Actual results could differ from those estimates. Estimates and assumptions are used when accounting for allowance for doubtful accounts, inventory, deferred preservation costs, acquired assets or businesses, intangible assets, deferred income taxes, commitments and contingencies (including product and tissue processing liability claims, claims incurred but not reported, and amounts recoverable from insurance companies), stock based compensation, certain accrued liabilities (including accrued procurement fees, income taxes, and financial instruments including contingent consideration), and other items as appropriate.

Revenue Recognition

Contracts with Customers

We routinely enter into contracts with customers that include general commercial terms and conditions, notification requirements for price increases, shipping terms and, in most cases, prices for the products and services that we offer. These agreements, however, do not obligate us to provide goods or services to the customer, and there is no consideration promised to us at the onset of these arrangements. For customers without separate agreements, we have a standard list price established by geography and by currency for all products and services, and our invoices contain standard terms and conditions that are applicable to those customers where a separate agreement is not controlling. Our performance obligations are established when a customer submits a purchase order notification (in writing, electronically or verbally) for goods and services, and we accept the order. We identify performance obligations as the delivery of the requested product or service in appropriate quantities and to the location specified in the customer’s contract and/or purchase order. We generally recognize revenue upon the satisfaction of these criteria when control of the product or service has been transferred to the customer at which time we have an unconditional right to receive payment. Our prices are fixed and are not affected by contingent events that could impact the transaction price. We do not offer price concessions and do not accept payment that is less than the price stated when we accept the purchase order. We do not have any material performance obligations where we are acting as an agent for another entity.

Revenues for products, including: aortic stent grafts, surgical sealants, On-X products, and other medical devices, are typically recognized at the time the product is shipped, at which time the title passes to the customer, and there are no further performance obligations. Revenues from consignment are recognized when we receive a notification of implantation. We recognize revenues for preservation services when tissue is shipped to the customer.

Significant Judgments in the Application of the Guidance in ASC 606

There are no significant judgments associated with the satisfaction of our performance obligations. We generally satisfy performance obligations upon shipment of the product or service obligation to the customer. This is consistent with the time in which the customer obtains control of the product or service. Performance obligations are also generally settled quickly after the purchase order acceptance, therefore, the value of unsatisfied performance obligations at the end of any reporting period is immaterial.

We consider variable consideration in establishing the transaction price. Forms of variable consideration potentially applicable to our arrangements include sales returns, rebates, volume-based bonuses, and prompt pay discounts. We use historical information along with an analysis of the expected value to properly calculate and to consider the need to constrain estimates of variable consideration. Such amounts are included as a reduction to revenue from the sale of products and services in the periods in which the related revenue is recognized and adjusted in future periods as necessary.

Commissions and Contract Costs

Sales commissions are earned upon completion of each performance obligation, and therefore, are expensed when incurred. These costs are included in General, administrative, and marketing expenses in the Consolidated Statements of Operations and Comprehensive Loss. We generally do not incur incremental charges associated with securing agreements with customers which would require capitalization and recovery over the life of the agreement.

Practical Expedients

Our payment terms for sales direct to customers are substantially less than the one-year collection period that falls within the practical expedient in the determination of whether a significant financing component exists.

Shipping and Handling Charges

Fees charged to customers for shipping and handling of products and tissues are included in product and preservation service revenues. The costs for shipping and handling of products and tissues are included as a component of cost of products and cost of preservation services.

Taxes Collected from Customers

Taxes collected on the value of transaction revenue are excluded from product and service revenues and cost of sales and are accrued in current liabilities until remitted to governmental authorities.

Advertising Costs

The costs to develop, produce, and communicate our advertising are expensed as incurred and are classified as General, administrative, and marketing expenses. The total amount of advertising expense included in our Consolidated Statements of Operations and Comprehensive Loss was $1.9 million, $1.6 million, and $1.0 million for the years ended December 31, 2023, 2022, and 2021, respectively.

Stock-Based Compensation

We have stock option and stock incentive plans for employees and non-employee directors that provide for grants of restricted stock awards (“RSA”s), restricted stock units (“RSU”s), performance stock units (“PSU”s), and options to purchase shares of our common stock at exercise prices generally equal to the fair values of such stock at the dates of grant. We also maintain a shareholder approved Employee Stock Purchase Plan (the “ESPP”) for the benefit of our employees. The ESPP allows eligible employees the right to purchase common stock on a regular basis at the lower of 85% of the market price at the beginning or end of each offering period. The RSAs, RSUs, PSUs, and stock options granted by us typically vest over a one to three-year period. The stock options granted by us typically expire within seven years of the grant date.

We value our RSAs, RSUs, and PSUs based on the stock price on the date of grant. We expense the related compensation cost of RSAs and RSUs using the straight-line method over the vesting period. We expense the related compensation cost of PSUs based on the number of shares expected to be issued, if achievement of the performance component is probable, using a straight-line method over each vesting tranche of the award which results in accelerated recognition of expenses. The amount of compensation costs expensed related to PSUs is adjusted as needed if we deem that achievement of the performance component is no longer probable or if our expectation of the number of shares to be issued changes. We use a Black-Scholes model to value our stock option grants and expense the related compensation cost using the straight-line method over the vesting period. The fair value of our ESPP options is also determined using a Black-Scholes model and is expensed over the vesting period.

The fair value of stock options and ESPP options is determined on the grant date using assumptions for the expected term, volatility, dividend yield, and the risk-free interest rate. The expected term is primarily based on the contractual term of the option and our data related to historic exercise and post-vesting forfeiture patterns, which is adjusted based on our expectations of future results. Our anticipated volatility level is primarily based on the historic volatility of our common stock, adjusted to remove the effects of certain periods of unusual volatility not expected to recur, and adjusted based on our expectations of future volatility, for the life of the option or option group. Our model includes a zero-dividend yield assumption and we do not anticipate paying dividends in the future. The risk-free interest rate is based on recent US Treasury note auction results with a similar life to that of the option. Our model does not include a discount for post-vesting restrictions, as we have not issued awards with such restrictions.

The period expense for our stock compensation is determined based on the valuations discussed above and forfeitures are accounted for in the period awards are forfeited.

Accumulated Other Comprehensive Loss

Accumulated other comprehensive loss is defined as the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources. The Other comprehensive income/loss, net of tax for the years presented includes foreign currency cumulative translation adjustment and unrealized gain/loss from intra-entity foreign currency loans that are of long term investment nature with no specific repayment terms. The unrealized gains from foreign currency intra-entity loans that are of long term investment nature were $2.7 million and $9.1 million for the years ended December 31, 2023 and 2021, respectively. The unrealized loss from foreign currency intra-entity loans that are of long term investment nature was $6.4 million for the year ended December 31, 2022.

Income Per Common Share

Income per common share is computed using the two-class method, which requires us to include unvested RSAs that contain non-forfeitable rights to dividends (whether paid or unpaid) as participating securities in the income per common share calculation.

Under the two-class method, net income is allocated to the weighted-average number of common shares outstanding during the period and the weighted-average participating securities outstanding during the period. The portion of net income that is allocated to the participating securities is excluded from basic and dilutive net income per common share. Diluted net income per share is computed using the weighted-average number of common shares outstanding plus the dilutive effects of outstanding stock options and awards and other dilutive instruments as appropriate.

Financial Instruments

Our financial instruments include cash equivalents, accounts receivable, notes receivable, accounts payable, and debt obligations. The financial assets’ and liabilities’, such as receivables and accounts payable, carrying values approximate their fair value due to their short-term duration, and the carrying value of their debt obligations approximate fair value as they contain variable interest rates that approximate market values. Other financial instruments are recorded as discussed in the sections below.

Fair Value Measurements

We record certain financial instruments, including cash equivalents, at fair value on a recurring basis. We may make an irrevocable election to measure other financial instruments at fair value on an instrument-by-instrument basis. Fair value financial instruments are recorded in accordance with the fair value measurement framework.

We also measure certain assets and liabilities at fair value on a non-recurring basis. These non-recurring valuations include evaluating assets such as certain financial assets, long-lived assets, and indefinite lived intangible assets for impairment, allocating value to assets in an acquired asset group, applying accounting for business combinations, and the initial recognition of liabilities such as contingent consideration. We use the fair value measurement framework to value these assets and liabilities and report these fair values in the periods in which they are recorded or written down.

The fair value measurement framework includes a fair value hierarchy that prioritizes observable and unobservable inputs used to measure fair values in their broad levels. These levels from highest to lowest priority are as follows:

•Level 1: Quoted prices (unadjusted) in active markets that are accessible at the measurement date for identical assets or liabilities;

•Level 2: Quoted prices in active markets for similar assets or liabilities or observable prices that are based on inputs not quoted in active markets, but corroborated by market data; and

•Level 3: Unobservable inputs or valuation techniques that are used when little or no market data is available.

The determination of fair value and the assessment of a measurement’s placement within the hierarchy requires judgment. Level 3 valuations often involve a higher degree of judgment and complexity. Level 3 valuations may require the use of various cost, market, or income valuation methodologies applied to our unobservable estimates and assumptions. Our assumptions could vary depending on the asset or liability value and the valuation method used. Such assumptions could include: estimates of prices, earnings, costs, actions of market participants, market factors, or the weighting of various valuation methods. We may also engage external advisors to assist in determining fair value as appropriate.

Although we believe that the recorded fair values of our financial instruments are appropriate, these fair values may not be indicative of net realizable value or reflective of future fair values.

Fair Value Measurements - Contingent Consideration

Contingent consideration represents a recurring fair value estimate of potential future payments. The fair value of the contingent consideration liability is estimated by discounting to present value the contingent payments expected to be made based on a probability-weighted scenario approach. A discount rate is applied based on our unsecured credit spread and the term commensurate risk-free rate to the additional consideration to be paid, and then we apply a risk-based estimate of the probability of achieving each scenario to calculate the fair value of the contingent consideration. This fair value measurement is based on unobservable inputs, including management estimates and assumptions about the future achievement of milestones and future estimate of revenues, and is, therefore, classified as Level 3 within the fair value hierarchy.

Cash and Cash Equivalents

Cash and cash equivalents consist primarily of highly liquid investments at the time of acquisition. The carrying value of cash equivalents approximates fair value. We maintain depository accounts with certain financial institutions. Although these depository accounts may exceed government insured depository limits, we have evaluated the credit worthiness of these applicable financial institutions and determined the risk of material financial loss due to the exposure of such credit risk to be minimal.

Cash Flow Supplemental Disclosures

Supplemental disclosures of cash flow information for the years ended December 31 (in thousands):


	2023		2022		2021
Cash paid during the year for:
Interest	$	23,332	$	14,243	$	14,407
Income taxes	4,865		9,244		5,483

Non-cash investing and financing activities:
Operating lease right-of-use assets	$	6,181	$	1,803	$	31,726
Issuance of common stock for contingent consideration	—		—		10,000

Accounts Receivable and Allowance for Doubtful Accounts

Our accounts receivable are primarily from hospitals and distributors that either use or distribute our products and tissues. We assess the likelihood of collection based on a number of factors, including past transaction history and the credit worthiness of the customer, as well as the potential increased risks related to international customers and large distributors. We determine the allowance for doubtful accounts based upon specific reserves for known collection issues, as well as a non-specific reserve based upon aging buckets. We charge off uncollectible amounts against the reserve in the period in which we determine they are uncollectible. Our accounts receivable balances are reported net of allowance for doubtful accounts of $1.9 million and $1.3 million as of December 31, 2023 and 2022, respectively.

Inventories, net

Inventories, net are comprised of finished goods for our product lines including: aortic stent grafts; surgical sealants; On-X products; other medical devices; work-in-process; and raw materials. Inventories for finished goods are valued at the lower of cost or net realizable value on a first-in, first-out basis and raw materials are valued on a moving average cost basis. Typically, upon shipment or upon notification of implant of a medical device on consignment, revenue is recognized, and the related inventory costs are expensed as cost of products. Cost of products also includes, as applicable, lower of cost or net realizable value of write-downs and impairments for products not deemed to be recoverable and, as incurred, idle facility expense, excessive spoilage, extra freight, and re-handling costs.

Inventory costs for manufactured products consist primarily of direct labor and materials (including salary and fringe benefits, raw materials, and supplies) and indirect costs (including allocations of costs from departments that support manufacturing activities and facility allocations). The allocation of fixed production overhead costs is based on actual production levels, to the extent that they are within the range of the facility’s normal capacity. Inventory costs for products purchased for resale or manufactured under contract consist primarily of the purchase cost, freight-in charges, and indirect costs as appropriate.

We regularly evaluate our inventory to determine if the costs are appropriately recorded at the lower of cost or net realizable value. We also evaluate our inventory for costs not deemed to be recoverable, including inventory not expected to ship prior to its expiration. Lower of cost or net realizable value write-downs are recorded if the book value exceeds the estimated net realizable value of the inventory, based on recent sales prices at the time of the evaluation. Impairment write-downs are recorded based on the book value of inventory deemed to be impaired. Actual results may differ from these estimates. Write-downs of inventory are expensed as cost of products, and these write-downs are permanent impairments that create a new cost basis, which cannot be restored to its previous levels if our estimates change.

We recorded write-downs to our inventory totaling $4.4 million, $4.0 million, and $4.8 million for the years ended December 31, 2023, 2022, and 2021, respectively. The 2023 write-downs were primarily related to raw materials, aortic stent grafts inventory, and On-X ascending aortic prosthesis (“AAP”) inventory. The 2022 and 2021 write-downs were primarily related to aortic stent grafts inventory and On-X AAP inventory.

Deferred Preservation Costs, net

Deferred preservation costs include costs of cardiac and vascular tissues available for shipment, tissues currently in active processing, and tissues held in quarantine pending release to implantable status. By federal law, human tissues cannot be bought or sold; therefore, the tissues we preserve are not held as inventory. The costs we incur to procure and process cardiac and vascular tissues are instead accumulated and deferred. Deferred preservation costs are stated at the lower of cost or net realizable value on a first-in, first-out basis and are deferred until revenue is recognized. Upon shipment of tissue to an implanting facility, revenue is recognized, and the related deferred preservation costs are expensed as cost of preservation services. Cost of preservation services also includes, as applicable, lower of cost or net realizable value write-downs and impairments for tissues not deemed to be recoverable, and includes, as incurred, excessive spoilage, extra freight, and re-handling costs.

The calculation of deferred preservation costs involves judgment and complexity and uses the same principles as inventory costing. Donated human tissue is procured from deceased human donors by organ and tissue procurement organizations (“OPOs”) and tissue banks that provide the tissue to us for processing, preservation, and distribution. Deferred preservation costs consist primarily of the procurement fees charged by the OPOs and tissue banks, direct labor and materials (including salary and fringe benefits, laboratory supplies and expenses, and freight-in charges), and indirect costs (including allocations of costs from support departments and facility allocations). Fixed production overhead costs are allocated based on actual tissue processing levels, to the extent that they are within the range of the facility’s normal capacity.

These costs are then allocated among the tissues processed during the period based on cost drivers, such as the number of donors or number of tissues processed. We apply a yield estimate to all tissues in process and in quarantine to estimate the portion of tissues that will ultimately become implantable. We estimate quarantine and in process yields based on our historical yield experience with similar tissues and re-evaluate these estimates periodically. Actual yields could differ significantly from our estimates, which could result in a change in tissues available for shipment and could increase or decrease the balance of deferred preservation costs. These changes could result in additional cost of preservation services expense or could increase per tissue preservation costs, which would impact gross margins on tissue preservation services in future periods.

We regularly evaluate our deferred preservation costs to determine if the costs are appropriately recorded at the lower of cost or net realizable value. We also evaluate our deferred preservation costs for costs not deemed to be recoverable, including tissues not expected to ship prior to the expiration date of their packaging. Lower of cost or net realizable value write-downs are recorded if the tissue processing costs incurred exceed the estimated market value of the tissue services, based on recent average service fees at the time of the evaluation. Impairment write-downs are recorded based on the book value of tissues deemed to be impaired. Actual results may differ from these estimates. Write-downs of deferred preservation costs are expensed as cost of preservation services, and these write-downs are permanent impairments that create a new cost basis, which cannot be restored to its previous levels if our estimates change.

We recorded write-downs to our deferred preservation costs totaling $393,000, $369,000, and $575,000 for the years ended December 31, 2023, 2022, and 2021, respectively, primarily due to tissues not expected to ship prior to the expiration date of the packaging.

Property and Equipment, net

Property and equipment, net is stated at cost less depreciation. Depreciation expense is recorded over the estimated useful lives of the assets, generally three to ten years, on a straight-line basis. Leasehold improvements are amortized on a straight-line basis over the remaining lease term at the time the assets are capitalized or the estimated useful lives of the assets, whichever is shorter.

Property and equipment, net balance for the years ended December 31 was as follows (in thousands):


	2023		2022
Equipment and software	$	66,618	$	72,480
Leasehold improvements	49,107		47,384
Furniture and fixtures	7,555		7,148
Total property and equipment	123,280		127,012
Less accumulated depreciation and amortization	(84,922)		(88,338)
Property and equipment, net	$	38,358	$	38,674

Depreciation expense for the years ended December 31 was as follows (in thousands):


	2023		2022		2021
Depreciation expense	$	7,878	$	7,132	$	7,157

Goodwill and Other Intangible Assets

Our intangible assets consist of goodwill, acquired technology, customer lists and relationships, patents, and other intangible assets, as discussed in Note 7. Our goodwill is attributable to a segment or segments of our business, as appropriate, as the related acquired business that generated the goodwill is integrated into our operations. Upon divestiture of a component of our business, the goodwill related to the segment is allocated to the divested business using the relative fair value allocation method.

We evaluate our goodwill and other indefinite lived intangible assets for impairment on an annual basis during the fourth quarter of the year, and, if necessary, during interim periods if factors indicate that an impairment review is warranted. As of October 31, 2023 and 2022 our indefinite lived intangible assets consisted of goodwill, in-process research and development, and acquired procurement contracts and agreements. We performed a qualitative analysis of our indefinite lived intangible assets as of October 31, 2023 and determined that the fair value of the asset groups and the fair value of the reporting unit more likely than not exceeded their associated carrying values and were, therefore, not impaired.

Our definite lived intangible assets consist of acquired technologies, customer lists and relationships, distribution and manufacturing rights and know-how, patents, and other intangible assets. We amortize our definite lived intangible assets over their expected useful lives using the straight-line method, which we believe approximates the period of economic benefits of the related assets. Our indefinite lived intangible assets do not amortize but are instead subject to periodic impairment testing as discussed in “Impairments of Long-Lived Assets and Indefinite Lived Intangible Assets” below.

Impairments of Long and Indefinite Lived Intangible Assets

Long-Lived Assets

We assess the potential impairment of our: (i) net property and equipment, (ii) amortizing intangible long-lived assets to be held and used and (iii) operating lease right-of-use assets whenever events or changes in circumstances indicate that the carrying value may not be recoverable. Factors that could trigger an impairment review include, but are not limited to, the following:

•Significant underperformance relative to expected historical or projected future operating results;

•Significant negative industry or economic trends;

•Significant decline in our stock price for a sustained period; or

•Significant decline in our market capitalization relative to net book value.

If we determine that an impairment review is necessary, we will evaluate the assets or asset groups by comparing their carrying values to the sum of the undiscounted future cash flows expected to result from their use and eventual disposition. If the carrying values exceed the future cash flows, then the asset or asset group is considered impaired, and we will write down the value of the asset or asset group to its concluded fair value. For the years ended December 31, 2023, 2022, and 2021 we did not record an impairment of our long-lived assets as there were no indicators of impairment or the sum of the undiscounted future cash flows exceeded the carrying value of the long-lived asset (asset group).

Accrued Procurement Fees

Donated tissue is procured from deceased human donors by OPOs and tissue banks that provide the tissue to us for processing, preservation, and distribution. We reimburse the OPOs and tissue banks for their costs to recover the tissue and include these costs as part of deferred preservation costs, as discussed above. We accrue estimated procurement fees due to the OPOs and tissue banks at the time tissues are received based on contractual agreements between us and the OPOs and tissue banks.

Leases

We have operating and finance lease obligations resulting from the lease of land and buildings that comprise our corporate headquarters and various manufacturing facilities; leases related to additional manufacturing, office, and warehouse space; leases on Company vehicles; and leases on a variety of office and other equipment, as discussed in Note 9. Certain of our leases contain escalation clauses, rent concessions, and renewal options for additional periods.

We exercise judgment in the determination of whether a financial arrangement includes a lease and in determining the appropriate discount rates to be applied to leases based on our general collateralized credit standing and the geographical market considerations impacting lease rates across all locations. When available, we use the implicit discount rate in the lease contract to discount lease payments to present value. If an implicit discount rate is not available in the lease contract, we use our incremental borrowing rate. We elected the package of practical expedients that allow us to omit leases with initial terms of 12 months or less from our balance sheet, which are expensed on a straight-line basis over the life of the lease. We have elected not to separate lease and non-lease components for future leases.

Our leases do not include terms or conditions which would result in variable lease payments other than for small office equipment leases with an additional charge for volume of usage. These incremental payments are excluded from our calculation of lease liability and the related right-of-use asset. We do not include option terms in the determination of lease liabilities and the related right-of-use assets unless we determine at lease commencement that the exercise of the option is reasonably certain. Our leases do not contain residual value guarantee provisions or other restrictions or financial covenant provisions.

Debt Issuance Costs

Debt issuance costs related to our term loan and line of credit are capitalized and reported net of the current and long-term debt or as a prepaid asset when there are no outstanding borrowings. If there are unamortized debt issuance costs related to our line of credit but only borrowings on the term loan, these debt issuance costs will be combined with the debt issuance costs related to the term loan and reported net of the current and long-term debt for the term loan. We amortize debt issuance costs to interest expense on our term loan using the effective interest method over the life of the debt agreement. We amortize debt issuance costs to interest expense on our line of credit on a straight-line basis over the life of the debt agreement. Debt issuance costs related to our convertible debt agreement are amortized using the effective interest rate method as a direct deduction from the recorded debt issuance costs allocated to debt.

Liability Claims

In the normal course of business, we are made aware of adverse events involving our products and tissues. Future adverse events could ultimately give rise to a lawsuit against us, and liability claims may be asserted against us in the future based on past events that we are not aware of at the present time. We maintain claims-made insurance policies to mitigate our financial exposure to product and tissue processing liability claims. Claims-made insurance policies generally cover only those asserted claims and incidents that are reported to the insurance carrier while the policy is in effect. Thus, a claims-made policy does not generally represent a transfer of risk for claims and incidents that have been incurred but not reported to the insurance carrier during the policy period. Any punitive damage components of claims are uninsured.

We engage external advisors to assist us in estimating our liability and any related amount recoverable under our insurance policies as of each balance sheet date. We use a frequency-severity approach to estimate our unreported product and tissue processing liability claims, whereby projected losses are calculated by multiplying the estimated number of claims by the estimated average cost per claim. The estimated claims are determined based on the reported claim development method and the Bornhuetter-Ferguson method using a blend of our historical claim experience and industry data. The estimated cost per claim is calculated using a lognormal claims model blending our historical average cost per claim with industry claims data. We use a number of assumptions in order to estimate the unreported loss liability including: the future claim reporting time lag, the frequency of reported claims, the average cost per claim, and the maximum liability per claim. We believe that the assumptions we use provide a reasonable basis for our calculation. However, the accuracy of the estimates is limited by various factors, including, but not limited to, our specific conditions, uncertainties surrounding the assumptions used, and the scarcity of industry data directly relevant to our business activities. Due to these factors, actual results may differ significantly from our assumptions and from the amounts accrued.

We accrue our estimate of unreported product and tissue processing liability claims as a component of Other long-term liabilities and record the related recoverable insurance amounts as a component of Other long-term assets. The amounts recorded represent our estimate of the probable losses and anticipated recoveries for unreported claims related to products sold and services performed prior to the balance sheet date.

Legal Contingencies

We accrue losses from a legal contingency when the loss is both probable and reasonably estimable. The accuracy of our estimates of losses for legal contingencies is limited by uncertainties surrounding litigation. Therefore, actual results may differ significantly from the amounts accrued, if any. We accrue for legal contingencies as a component of accrued expenses and/or other long-term liabilities on our Consolidated Balance Sheets. Gains from legal contingencies are recorded when the contingency is resolved.

Uncertain Tax Positions

We periodically assess our uncertain tax positions and recognize tax benefits if they are “more-likely-than-not” to be upheld upon review by the appropriate taxing authority. We measure the tax benefit by determining the maximum amount that has a “greater than 50 percent likelihood” of ultimately being realized. We reverse previously accrued liabilities for uncertain tax positions when audits are concluded, statutes expire, administrative practices dictate that a liability is no longer warranted, or in other circumstances, as deemed necessary. These assessments can be complex, and we often obtain assistance from external advisors to make these assessments. We recognize interest and penalties related to uncertain tax positions in interest expense, net on our Consolidated Statements of Operations and Comprehensive Loss. See Note 8 for further discussion of our liabilities for uncertain tax positions.

Deferred Income Taxes

Deferred income taxes reflect the net tax effect of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and tax return purposes. We assess the recoverability of our deferred tax assets and provide a valuation allowance against our deferred tax assets when, as a result of this analysis, we believe it is more likely than not that some portion or all of our deferred tax assets will not be realized.

Assessing the recoverability of deferred tax assets involves judgment and complexity including the consideration of prudent and feasible tax planning. Estimates and judgments used in the determination of the need for a valuation allowance and in calculating the amount of a needed valuation allowance include, but are not limited to, the following:

•The ability to carry back deferred tax asset attributes to a prior tax year;

•Timing of the anticipated reversal of book/tax temporary differences;

•Projected future operating results;

•Anticipated future state tax apportionment;

•Timing and amounts of anticipated future taxable income;

•Evaluation of statutory limits regarding usage of certain tax assets; and

•Evaluation of the statutory periods over which certain tax assets can be utilized.

Significant changes in the factors above, or other factors, could affect our ability to use our deferred tax assets. Such changes could have a material, adverse impact on our profitability, financial position, and cash flows. We will continue to assess the recoverability of our deferred tax assets, as necessary, when we experience changes that could materially affect our prior determination of the recoverability of our deferred tax assets.

New Accounting Pronouncements

Recently Adopted

In March 2020 the Financial Accounting Standards Board (the “FASB”) issued Accounting Standard Update (“ASU”) 2020-04, Reference Rate Reform Topic 848 (“ASC 848”). The amendments in this ASU were put forth in response to the market transition from the LIBOR and other interbank offered rates to alternative reference rates. US GAAP requires entities to evaluate whether a contract modification, such as the replacement or change of a reference rate, results in the establishment of a new contract or continuation of an existing contract. ASC 848 allows an entity to elect not to apply certain modification accounting requirements to contracts affected by reference rate reform. The standard provides this temporary election through December 31, 2022 and cannot be applied to contract modifications that occur after December 31, 2022. In January 2021 the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848). The objective of the new reference rate reform standard is to clarify the scope of Topic 848 and provide explicit guidance to help companies applying optional expedients and exceptions. We adopted ASU 2020-04 and ASU 2021-01 on a prospective basis in fiscal year 2022. The adoption of ASU 2020-04 and ASU 2021-01 did not have a material impact on our financial condition or results of operations.

Not Yet Effective

In December 2023 the FASB issued ASU 2023-09, Income Taxes Topic 740 - Improvements to Income Tax Disclosures. This amendment is expected to enhance the transparency and decision usefulness of income tax disclosures by requiring public business entities, on an annual basis, to disclose specific categories in the rate reconciliation, additional information for reconciling items that meet a quantitative threshold and certain information about income taxes paid. This revised guidance is effective for financial statements issued for fiscal years beginning after December 15, 2024. We are currently evaluating the impacts of the new standard.

In November 2023 the FASB issued ASU 2023-07, Segment Reporting Topic 280- Improvements to Reportable Segment Disclosures. This amendment requires disclosure of incremental segment information on an annual and interim basis. This ASU is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024, and requires retrospective application to all prior periods presented in the financial statements. We are currently evaluating the impacts of the new standard.

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares issued (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	75,000,000	75,000,000
Common stock, shares issued (in shares)	42,569,000	41,830,000
Treasury stock at cost (in shares)	1,487,000	1,487,000

Stock Compensation (Summary of Stock Option Activity) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Shares
Expired shares	(36,000)
Stock Options
Shares
Outstanding, Beginning Balance, Shares	2,123,000	1,246,000	1,241,000
Granted, Shares	110,000	1,031,000	226,000
Exercised, Shares	(226,000)	(151,000)	(179,000)
Forfeited, Shares	(93,000)	(3,000)	(42,000)
Outstanding, Ending Balance, Shares	1,878,000	2,123,000	1,246,000	1,241,000
Weighted Average Grant Date Fair Value
Outstanding, Beginning Balance, Weighted Average Exercise Price (in dollars per share)	$ 17.31	$ 20.00	$ 18.16
Granted, Weighted Average Exercise Price (in dollars per share)	17.54	13.29	24.90
Exercised, Weighted Average Exercise Price (in dollars per share)	11.05	11.85	12.02
Forfeited, Weighted Average Exercise Price (in dollars per share)	12.59	21.55	26.00
Expired, Weighted Average Exercise Price (in dollars per share)	25.55
Outstanding, Ending Balance, Weighted Average Exercise Price (in dollars per share)	$ 18.16	$ 17.31	$ 20.00	$ 18.16
Vested and expected to vest, Shares	1,878,000
Exercisable, Shares	1,080,000
Vested and expected to vest, Weighted Average Exercise Price (in dollars per share)	$ 18.16
Exercisable, Weighted Average Exercise Price (in dollars per share)	$ 20.59
Outstanding, Weighted Average Remaining Contractual Term in years	4 years 1 month 13 days	4 years 6 months 21 days	3 years 2 months 12 days	3 years 4 months 17 days
Vested and expected to vest, Weighted Average Remaining Contractual Term in years	4 years 1 month 13 days
Exercisable, Weighted Average Remaining Contractual Term in years	3 years 10 days
Outstanding, Aggregate Intrinsic Value	$ 4,678,000	$ 1,150,000	$ 4,039,000	$ 8,215,000
Vested and expected to vest, Aggregate Intrinsic Value	4,678,000
Exercisable, Aggregate Intrinsic Value	$ 1,714,000

Basis of Presentation and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Supplemental Disclosures of Cash Flow Information

Supplemental disclosures of cash flow information for the years ended December 31 (in thousands):


	2023		2022		2021
Cash paid during the year for:
Interest	$	23,332	$	14,243	$	14,407
Income taxes	4,865		9,244		5,483

Non-cash investing and financing activities:
Operating lease right-of-use assets	$	6,181	$	1,803	$	31,726
Issuance of common stock for contingent consideration	—		—		10,000

Schedule of Property and Equipment and Depreciation Expense

Property and equipment, net balance for the years ended December 31 was as follows (in thousands):


	2023		2022
Equipment and software	$	66,618	$	72,480
Leasehold improvements	49,107		47,384
Furniture and fixtures	7,555		7,148
Total property and equipment	123,280		127,012
Less accumulated depreciation and amortization	(84,922)		(88,338)
Property and equipment, net	$	38,358	$	38,674

Depreciation expense for the years ended December 31 was as follows (in thousands):


	2023		2022		2021
Depreciation expense	$	7,878	$	7,132	$	7,157

Sale of PerClot	12 Months Ended
Sale of PerClot	Dec. 31, 2023
Discontinued Operations and Disposal Groups [Abstract]
Sale of PerClot	Sale of PerClot Overview On July 28, 2021 we entered into an asset purchase agreement, Transitional Manufacturing and Supply Agreement (“TMSA”), and other ancillary agreements related to the sale of PerClot®, a polysaccharide hemostatic agent used in surgery (“PerClot”), to a subsidiary of Baxter International, Inc. (“Baxter”) and an agreement to terminate all of our material agreements with Starch Medical, Inc. (“SMI”) related to PerClot (collectively the “Baxter Transaction”). Under the terms of the Baxter Transaction, Baxter will pay an aggregate of up to $54.5 million in consideration (we will receive up to $41.0 million and SMI will receive up to $13.5 million), consisting of (i) $25.0 million at closing, of which $6.0 million was paid to SMI; (ii) $18.8 million upon our receipt of Premarket Approval (“PMA”) from the US Food and Drug Administration (the “FDA”) for PerClot and our transfer of the PMA to Baxter, of which $4.5 million was paid to SMI; and (iii) up to $10.0 million upon Baxter’s achievement of certain cumulative worldwide net sales of PerClot prior to December 31, 2026 and December 31, 2027, of which up to $3.0 million is payable to SMI. In addition, at the conclusion of our manufacturing and supply services for Baxter, Baxter will pay $780,000 upon transfer of our PerClot manufacturing equipment. Under the terms of the Baxter Transaction, we will continue to provide to Baxter certain transition services relating to the sale of SMI PerClot outside of the US. Within the terms of the TMSA, we will manufacture and supply PerClot for Baxter post PMA for a contractual period of 21 months, subject to short-term renewal provisions. Accounting for the Transaction Upon closing of the Baxter Transaction, we received $25.0 million from Baxter and paid $6.0 million to SMI. We derecognized intangible assets with a carrying value of $1.6 million and wrote-off $1.5 million of prepaid royalties previously recorded on our Consolidated Balance Sheets related to PerClot. Under the terms of the agreement, Baxter acquired intellectual property related to our development efforts for PerClot. We recorded a pre-tax gain of $15.9 million, included as Gain from sale of non-financial assets within the Consolidated Statements of Operations and Comprehensive Loss for the year ended December 31, 2021. The PerClot product line was included as part of our Medical Devices segment. PerClot PMA On May 23, 2023 the FDA granted PMA of PerClot for use to control bleeding in certain open and laparoscopic surgical procedures. Pursuant to the terms of the TMSA of the Baxter Transaction, we transferred the ownership of the PMA to Baxter following approval. In May 2023 we received a payment of $18.8 million from Baxter, of which $4.5 million was paid to SMI. As a result, we recorded a pre-tax gain of $14.3 million as the assets were derecognized upon closing of the Baxter Transaction in fiscal year 2021, which was included as Gain from sale of non-financial assets within the Consolidated Statements of Operations and Comprehensive Loss for the twelve months ended December 31, 2023. Following receipt of the PMA, under the terms of the TMSA, we began manufacturing and supplying PerClot for Baxter and recorded $5.1 million of PerClot revenues on the Consolidated Statements of Operations and Comprehensive Loss during the twelve months ended December 31, 2023. The Company accounted for this TMSA in accordance with the provision of ASU 2016-02, Leases Topic 842 (“ASC 842”) by bifurcating the lease and non-lease components and recognizing each component based on ASC 842 and ASU 2014-09, Revenue from Contracts with Customers Topic 606. The amount of lease revenue was $278,000 for the twelve months ended December 31, 2023.

Income Taxes (Schedule of Uncertain Tax Position Liability and Liability for Interest And Penalties On Uncertain Tax Positions) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Beginning balance	$ 4,508	$ 4,089	$ 2,574
Increase related to current year tax positions	2,728	847	1,661
Increases for foreign exchange differences	116
Decreases for foreign exchange differences		(145)	(121)
Increase related to prior year tax positions	26	20	386
Decrease due to the lapsing of statutes of limitations	(158)	(200)	(241)
Decrease related to prior year tax positions	(508)	(103)	(170)
Decrease due to settlements of prior year tax positions	(1,880)	0	0
Ending balance	$ 4,832	$ 4,508	$ 4,089

Income Taxes

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Income Taxes

Income Tax Expense

Loss before income taxes consisted of the following (in thousands):


	2023		2022		2021
Domestic	$	(24,658)	$	(13,798)	$	(10,263)
Foreign	3,072		(1,186)		(4,564)
Loss before income taxes	$	(21,586)	$	(14,984)	$	(14,827)

Income tax expense consisted of the following (in thousands):


	2023		2022		2021
Current:
Federal	$	5,573	$	1,606	$	1,896
State	1,004		367		551
Foreign	3,851		3,120		3,391
	10,428		5,093		5,838
Deferred:
Federal	$	222	$	236	$	(2,801)
State	157		234		(307)
Foreign	(1,703)		(1,355)		(2,723)
	(1,324)		(885)		(5,831)
Income tax expense	$	9,104	$	4,208	$	7

Our income tax expense in 2023, 2022, and 2021 included our federal, state, and foreign tax obligations. Our effective income tax rate was a tax expense of 42% and 28% for the year ended December 31, 2023 and 2022, respectively. Our effective income tax rate was break-even for the year ended December 31, 2021.

Our income tax rate for the year ended December 31, 2023 was primarily affected by an increase in the valuation allowance on our deferred tax assets, nondeductible executive compensation, income taxes in certain profitable foreign jurisdictions, and additional tax expense for uncertain tax positions, partially offset by the research and development tax credit and foreign derived intangible income deduction. Our income tax rate for the year ended December 31, 2022 was primarily affected by an increase in the valuation allowance on our deferred tax assets, nondeductible executive compensation, and additional tax expense for uncertain tax positions, partially offset by the research and development tax credit. Our income tax rate for the year ended December 31, 2021 was primarily affected by an increase in the valuation allowance on our deferred tax assets, foreign expense items, nondeductible executive compensation, and additional tax expense for uncertain tax positions, partially offset by the reduction of a valuation allowance on prior year items, the research and development tax credit, and releases of uncertain tax positions.

The income tax benefit amounts differ from the amounts computed by applying the US federal statutory income tax rate of 21% for the years ended December 31, 2023, 2022, and 2021 to pretax income as a result of the following (in thousands):


	2023		2022		2021
Tax benefit at statutory rate	$	(4,533)	$	(3,147)	$	(3,114)

Increase (reduction) in income taxes resulting from:
Valuation allowance change	9,964		4,779		1,566
Foreign income taxes	2,969		415		1,138
Nondeductible executive compensation	989		878		1,075
Equity compensation	872		472		(477)
Net change in uncertain tax positions	652		527		762
State income taxes, net of federal benefit	281		484		73
Nondeductible entertainment expenses	262		117		65
Foreign interest disallowance	—		151		307
Foreign deferred items	—		(112)		53
Foreign derived intangible income deduction	(501)		(133)		(144)
Research and development credit	(800)		(961)		(959)
Provision to return adjustments	(937)		336		63
Other	(114)		402		(401)
Total income tax expense	$	9,104	$	4,208	$	7

Deferred Taxes

We generate deferred tax assets primarily as a result of finance and operating leases, net operating losses, excess interest carryforward, accrued compensation, stock compensation, capitalizable research and development costs, unrealized foreign exchange losses, and capital leases. Our deferred tax liabilities are primarily comprised of intangible assets acquired in previous years, finance and operating leases, and capital leases.

The tax effects of temporary differences which give rise to deferred tax assets and liabilities at December 31 were as follows (in thousands):


	2023		2022
Deferred tax assets:
Finance and operating leases	$	13,254	$	12,581
Excess interest carryforward	6,438		5,559
Unrealized gains and losses	5,424		—
Loan revaluation	3,859		2,633
Loss carryforwards	3,205		9,660
Stock compensation	2,761		2,463
Accrued expenses	2,567		1,734
Deferred compensation	1,790		1,317
Property	1,786		1,310
Credit carryforwards	336		503
Inventory and deferred preservation costs write-downs	302		764
Other	1,422		1,650
Less valuation allowance	(32,860)		(17,942)
Total deferred tax assets, net	10,284		22,232

	2023		2022
Deferred tax liabilities:

Unrealized gains and losses	—		(6,624)
Prepaid items	(370)		(323)
Debt costs	(626)		(818)
Finance and operating leases	(12,777)		(12,217)
Intangible assets	(16,106)		(24,601)
Other	(1,169)		(834)
Total deferred tax liabilities	(31,048)		(45,417)

Total deferred tax liabilities, net	$	(20,764)	$	(23,185)

We regularly assess the realizability of deferred tax assets and establish valuation allowances if it is more likely than not that some or all deferred tax assets will not be realized. A summary of valuation allowances against deferred tax assets was as follows (in thousands):


	2023		2022		2021
Beginning balance	$	17,942	$	13,282	$	7,170
Additions in estimates recorded to deferred income tax expense, net	9,809		4,660		1,505
Additions related to Other comprehensive income, net	5,109		—		4,607
Ending balance	$	32,860	$	17,942	$	13,282

As of December 31, 2023 and 2022 we maintained a net deferred tax liability of $20.8 million and $23.2 million, respectively. As of December 31, 2023 and 2022 we maintained valuation allowances against our deferred tax assets of $32.9 million and $17.9 million, respectively, primarily related to net operating loss carryforwards and disallowed excess interest carryforwards.

As of December 31, 2023 we had approximately $1.3 million of federal net operating loss carryforwards related to the acquisitions of Cardiogenesis and Hemosphere for which we have a full valuation allowance against, approximately $1.5 million of state net operating loss carryforwards that will continue to expire in 2024, approximately $443,000 of foreign net operating loss carryforwards that will begin to expire in 2025, and approximately $293,000 in research and development tax credit carryforwards that will begin to expire in 2030, and approximately $81,000 in credits from other jurisdictions that mostly expire in 2027.

As of December 31, 2023 we had a deferred tax asset of $6.4 million of disallowed interest expense deduction carryforwards as a result of the interest deductibility rule imposed by the “Tax Cuts and Jobs Act” of 2017 (“Tax Act”), and later modified by the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). This deferred tax asset can be carried forward indefinitely. This rule disallows interest expense to the extent it exceeds 30% of adjusted taxable income. For the years ended December 31, 2023 and 2022 our interest deduction was limited to $20.4 million and $8.1 million, respectively.

We believe that the realizability of our acquired net operating loss carryforwards will be limited in future periods due to a change in control of our former subsidiaries Hemosphere, Inc. (“Hemosphere”) and Cardiogenesis Corporation (“Cardiogenesis”), as mandated by Section 382 of the Internal Revenue Code of 1986, as amended. We believe that our acquisitions of these companies each constituted a change in control as defined in Section 382 and that, prior to our acquisition, Hemosphere had experienced other equity ownership changes that should be considered such a change in control. The deferred tax assets recorded on our Consolidated Balance Sheets exclude amounts that we expect will not be realizable due to changes in control. A portion of the acquired net operating loss carryforwards is related to state income taxes for which we believe it is more likely than not that some will not be realized. Therefore, we recorded a valuation allowance against these state net operating loss carryforwards. In addition, during the year, the realizability of a portion of our net operating loss carryforwards and other deferred tax assets was limited. We recorded a valuation allowance against these deferred tax assets.

Reinvestment of Unremitted Earnings

We intend to reinvest substantially all of the unremitted earnings of our non-US subsidiaries to fund working capital, strategic investments, and debt repayment and postpone their remittance indefinitely. Accordingly, no provision for state and local taxes or foreign withholding taxes was recorded on these unremitted earnings in the accompanying Consolidated Statements of Operations and Comprehensive Loss. The Company is permanently reinvested with respect to the outside basis differences in its significant non-US subsidiaries. As of December 31, 2023 we had a deferred tax liability of $119,000 for the tax effects of this outside basis difference in the Consolidated Statements of Operations and Comprehensive Loss.

Uncertain Tax Positions

A reconciliation of the beginning and ending balances of our uncertain tax position liability, excluding interest and penalties, was as follows (in thousands):


	2023		2022		2021
Beginning balance	$	4,508	$	4,089	$	2,574
Increase related to current year tax positions	2,728		847		1,661
Increase (decrease) for foreign exchange differences	116		(145)		(121)
Increase related to prior year tax positions	26		20		386
Decrease due to the lapsing of statutes of limitations	(158)		(200)		(241)
Decrease related to prior year tax positions	(508)		(103)		(170)
Decrease due to settlements of prior year tax positions	(1,880)		—		—
Ending balance	$	4,832	$	4,508	$	4,089

We recorded non-current liabilities of $372,000 and $358,000 related to interest and penalties on uncertain tax positions on our Consolidated Balance Sheets as of December 31, 2023 and 2022, respectively. We included expense of $6,500 for December 31, 2023, expense of $145,000 for December 31, 2022, and income of $35,000 for December 31, 2021, respectively, for interest and penalties related to unrecognized tax benefits in our Consolidated Statements of Operations and Comprehensive Loss.

As of December 31, 2023 our uncertain tax liability of $5.2 million, including interest and penalties, was recorded as a reduction to deferred tax assets of $100,000, and a non-current liability of $5.1 million on our Consolidated Balance Sheets. The amount of uncertain tax liabilities that are expected to affect our tax rate if recognized were $4.4 million, $3.6 million, and $3.2 million for the years ended December 31, 2023, 2022, and 2021, respectively. As of December 31, 2022 our total uncertain tax liability, including interest and penalties of $4.9 million, was recorded as a reduction to deferred tax assets of $100,000 and as a non-current liability of $4.8 million on our Consolidated Balance Sheets.

We believe it is reasonably possible that approximately $100,000 of our uncertain tax liability will be recognized in 2024 due to the lapsing of various federal and state and foreign statutes of limitations, of which substantially all would affect the tax rate.

Other

Our tax years 2020 and forward generally remain open to examination by the major taxing jurisdictions to which we are subject. However, certain returns from years prior to 2020, in which net operating losses and tax credits have arisen, are still open for examination by the tax authorities.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//740/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-14

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 270
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482526/740-270-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 17
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-17

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

Financial Instruments (Tables)

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Summary of Financial Instruments Measured at Fair Value

A summary of financial instruments measured at fair value was as follows (in thousands):


December 31, 2023	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market funds	$	22,802	$	—	$	—	$	22,802
Certificates of deposit	3,968		—		—		3,968
Total assets	$	26,770	$	—	$	—	$	26,770

Long-term liabilities:
Contingent consideration	—		—		(63,890)		(63,890)
Total liabilities	$	—	$	—	$	(63,890)	$	(63,890)


December 31, 2022	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market funds	$	10,098	$	—	$	—	$	10,098
Total assets	$	10,098	$	—	$	—	$	10,098

Long-term liabilities:
Contingent consideration	—		—		(40,400)		(40,400)
Total liabilities	$	—	$	—	$	(40,400)	$	(40,400)

Schedule of Reconciliation Of Changes In Fair Value Of Level 3 Liabilities

Changes in fair value of Level 3 assets and liabilities are listed in the tables below (in thousands):


	Contingent Consideration
Balance as of December 31, 2022	$	(40,400)
Change in valuation	(23,490)
Balance as of December 31, 2023	$	(63,890)

Stock Compensation (Schedule of Shares Available for Grant) (Details) - shares	Dec. 31, 2023	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Authorized Shares	10,045,000
Available for Grant	4,107,000	1,966,000
1996 Discounted Employee Stock Purchase Plan, as amended
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Authorized Shares	2,900,000
Available for Grant	826,000	967,000
2020 Equity and Cash Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Authorized Shares	7,145,000
Available for Grant	3,281,000	999,000

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Revenue Recognition (Tables)

12 Months Ended

Dec. 31, 2023

Revenue from Contract with Customer [Abstract]

Schedule of Disaggregation of Revenue

Net revenues by geographic location based on the location of the customer for the years ended December 31, 2023, 2022, and 2021 were as follows (in thousands):


	2023		2022		2021
North America	187,603		167,542		157,881
EMEA	114,814		104,119		109,081
APAC	33,577		27,973		21,696
LATAM	18,010		14,155		10,178
Total revenue	$	354,004	$	313,789	$	298,836

Stock Compensation (Schedule of Stock Grant Activity for RSUs) (Details) - RSUs - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Shares
Unvested, Beginning Balance, Shares	734,000	224,000	212,000
Granted, Shares	327,000	643,000	144,000
Vested, Shares	(125,000)	(100,000)	(93,000)
Forfeited, Shares	(57,000)	(33,000)	(39,000)
Unvested, Ending Balance, Shares	879,000	734,000	224,000	212,000
Vested and expected to vest, Shares	879,000
Outstanding, Weighted Average Remaining Contractual Term in Years	1 year 4 months 28 days	2 years 7 days	11 months 8 days	1 year 7 days
Vested and expected to vest, Weighted Average Remaining Contractual Term in Years	1 year 4 months 28 days
Outstanding, Aggregate Intrinsic Value	$ 15,711,000	$ 8,895,000	$ 4,558,000	$ 5,015,000
Vested and expected to vest, Aggregate Intrinsic Value	$ 15,711,000

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Liability Claims In the normal course of business, we are made aware of adverse events involving our products and tissues. Future adverse events could ultimately give rise to a lawsuit against us, and liability claims may be asserted against us in the future based on past events that we are not aware of at the present time. We maintain claims-made insurance policies to mitigate our financial exposure to product and tissue processing liability claims. Claims-made insurance policies generally cover only those asserted claims and incidents that are reported to the insurance carrier while the policy is in effect. The amounts recorded in these Consolidated Financial Statements as of December 31, 2023 and 2022 represent our estimate of the probable losses and anticipated recoveries for incurred but not reported claims related to products sold and services performed prior to the balance sheet date. Employment Agreements The employment agreement of our Chairman, President, and Chief Executive Officer (“CEO”), Mr. J. Patrick Mackin, provides for a severance payment, which would become payable upon the occurrence of certain employment termination events, including termination by us without cause. PROACT Xa Clinical Trial Termination On September 23, 2022 we announced that we were stopping the PROACT Xa clinical trial as recommended by the trial's independent Data and Safety Monitoring Board. The PROACT Xa clinical trial was a prospective, randomized, trial designed to determine if patients with On-X mechanical aortic valves could be maintained safely and effectively on apixaban rather than on warfarin. As a result of PROACT Xa's early termination, we recorded $4.5 million of termination and wind-down expenses that are included in Research and development operating expenses on the Consolidated Statements of Operations and Comprehensive Loss for the twelve months ended December 31, 2022. The majority of these costs include administrative costs, that we paid during the fourth quarter of 2022 and the first quarter of 2023, as well as the estimated cost of clinical drugs purchased for patients participating in the study that are not expected to be recovered.

Basis of Presentation and Summary of Significant Accounting Policies (Policy)

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Nature of Business

Basis of Presentation and Principles of Consolidation

Foreign Currencies

Use of Estimates

Revenue Recognition

Contracts with Customers

Significant Judgments in the Application of the Guidance in ASC 606

Commissions and Contract Costs

Practical Expedients

Shipping and Handling Charges

Taxes Collected from Customers

Taxes collected on the value of transaction revenue are excluded from product and service revenues and cost of sales and are accrued in current liabilities until remitted to governmental authorities.

Advertising Costs

The costs to develop, produce, and communicate our advertising are expensed as incurred and are classified as General, administrative, and marketing expenses.

Stock-Based Compensation

The period expense for our stock compensation is determined based on the valuations discussed above and forfeitures are accounted for in the period awards are forfeited.

Accumulated Other Comprehensive Loss

Income Per Common Share

Financial Instruments

Fair Value Measurements

•Level 1: Quoted prices (unadjusted) in active markets that are accessible at the measurement date for identical assets or liabilities;

•Level 2: Quoted prices in active markets for similar assets or liabilities or observable prices that are based on inputs not quoted in active markets, but corroborated by market data; and

•Level 3: Unobservable inputs or valuation techniques that are used when little or no market data is available.

Although we believe that the recorded fair values of our financial instruments are appropriate, these fair values may not be indicative of net realizable value or reflective of future fair values.

Fair Value Measurements - Contingent Consideration

Cash and Cash Equivalents

Cash Flow Supplemental Disclosures

Supplemental disclosures of cash flow information for the years ended December 31 (in thousands):


	2023		2022		2021
Cash paid during the year for:
Interest	$	23,332	$	14,243	$	14,407
Income taxes	4,865		9,244		5,483

Non-cash investing and financing activities:
Operating lease right-of-use assets	$	6,181	$	1,803	$	31,726
Issuance of common stock for contingent consideration	—		—		10,000

Accounts Receivable and Allowance for Doubtful Accounts

Inventories, net

Deferred Preservation Costs, net

Property and Equipment, net

Goodwill and Other Intangible Assets

Impairments of Long and Indefinite Lived Intangible Assets

Long-Lived Assets

•Significant underperformance relative to expected historical or projected future operating results;

•Significant negative industry or economic trends;

•Significant decline in our stock price for a sustained period; or

•Significant decline in our market capitalization relative to net book value.

Accrued Procurement Fees

Uncertain Tax Positions

Deferred Income Taxes

•The ability to carry back deferred tax asset attributes to a prior tax year;

•Timing of the anticipated reversal of book/tax temporary differences;

•Projected future operating results;

•Anticipated future state tax apportionment;

•Timing and amounts of anticipated future taxable income;

•Evaluation of statutory limits regarding usage of certain tax assets; and

•Evaluation of the statutory periods over which certain tax assets can be utilized.

New Accounting Pronouncements

Recently Adopted

Not Yet Effective

Loss Per Common Share (Computation of Basic and Diluted (Loss) Income Per Common Share) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Basic loss per common share
Net loss	$ (30,690)	$ (19,192)	$ (14,834)
Net loss allocated to participating securities	123	98	94
Net loss allocated to common shareholders	$ (30,567)	$ (19,094)	$ (14,740)
Basic weighted-average common shares outstanding	40,743	40,032	38,983
Basic loss per common share (in dollars per share)	$ (0.75)	$ (0.48)	$ (0.38)
Diluted loss per common share
Net loss	$ (30,690)	$ (19,192)	$ (14,834)
Net loss allocated to participating securities	123	98	94
Net loss allocated to common shareholders	$ (30,567)	$ (19,094)	$ (14,740)
Diluted (in shares)	40,743	40,032	38,983
Diluted loss per common share (in dollars per share)	$ (0.75)	$ (0.48)	$ (0.38)

Leases (Schedule of Supplemental Cash Flow Information Related to Leases) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Operating cash flows for operating leases	$ 7,263	$ 6,927
Financing cash flows for finance leases	539	507
Operating cash flows for finance leases	$ 84	$ 90

Segment and Geographic Information

12 Months Ended

Dec. 31, 2023

Segment Reporting [Abstract]

Segment and Geographic Information

We have two reportable segments organized according to our products and services: Medical Devices and Preservation Services. The Medical Devices segment includes external revenues from product sales of aortic stent grafts, On-X, surgical sealants, and other product revenues. Aortic stent grafts include aortic arch stent grafts, abdominal stent grafts, and synthetic vascular grafts. Aortic arch stent grafts include our E-vita Open NEO, E-vita Open Plus, AMDS, the NEXUS Products, and E-vita Thoracic 3G. Abdominal stent grafts include our E-xtra Design Engineering, E-nside, E-tegra, E-ventus BX, and E-liac products. Surgical sealants include BioGlue Surgical Adhesive products. The Preservation Services segment includes external services revenues from the preservation of cardiac and vascular tissues. There are no intersegment revenues.

The primary measure of segment performance, as viewed by our management, is segment gross margin or net external revenues less cost of products and preservation services. We do not segregate assets by segment; therefore, asset information is excluded from the segment disclosures below.

The following table summarizes revenues, cost of products and preservation services, and gross margins for our reportable segments (in thousands):


	2023		2022		2021
Revenues:
Medical devices	$	261,185	$	230,353	$	221,597
Preservation services	92,819		83,436		77,239
Total revenues	354,004		313,789		298,836

Cost of products and preservation services:
Medical devices	84,595		72,166		65,196
Preservation services	40,233		39,100		36,126
Total cost of products and preservation services	124,828		111,266		101,322

Gross margin:
Medical devices	176,590		158,187		156,401
Preservation services	52,586		44,336		41,113
Total gross margin	$	229,176	$	202,523	$	197,514

Net revenues by product for the years ended December 31, 2023, 2022, and 2021 were as follows (in thousands):


	2023		2022		2021
Products:
Aortic stent grafts	$	107,469	$	92,752	$	85,387
On-X	74,528		63,904		57,363
Surgical sealants	68,016		65,379		70,714
Other	11,172		8,318		8,133
Total products	261,185		230,353		221,597

Preservation services:	92,819		83,436		77,239
Total revenues	$	354,004	$	313,789	$	298,836

Net revenues by geographic location attributed to countries based on the location of the customer for the years ended December 31, 2023, 2022, and 2021 were as follows (in thousands):


	2023		2022		2021
US	$	179,485	$	161,113	$	151,151
International	174,519		152,676		147,685
Total revenues	$	354,004	$	313,789	$	298,836

Revenues attributed to customers in Germany accounted for 8% of total revenues for the year ended December 31, 2023, 9% for the year ended December 31, 2022, and 10% for the year ended December 31, 2021.

At December 31, 2023 and 2022 $17.5 million and $18.0 million of our long-lived assets were held in the US, respectively, where the corporate headquarters and a portion of our manufacturing facilities are located. Our long-lived international assets were $20.9 million and $20.7 million as of December 31, 2023 and 2022, respectively, of which 97% were located in Hechingen, Germany. At December 31, 2023 and 2022 $247.3 million and $243.6 million, respectively, of our goodwill was allocated entirely to our Medical Devices segment.

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-15

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 31
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-31

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 40
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-40

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//280/tableOfContent

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 26
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-26

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 34
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-34

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

+ Details

Revenue Recognition (Narrative) (Details) $ in Thousands	12 Months Ended
Revenue Recognition (Narrative) (Details) $ in Thousands	Dec. 31, 2023 USD ($)
CardioGenesis Cardiac Laser Therapy
Disaggregation of Revenue [Line Items]
Asset impairment	$ 390

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

Leases

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Leases

We have operating and finance lease obligations resulting from the lease of land and buildings that comprise our corporate headquarters and various manufacturing facilities; leases related to additional manufacturing, office, and warehouse space; leases on company vehicles; and leases on a variety of office and other equipment.

Information related to leases included in the Consolidated Balance Sheets was as follows (in thousands, except lease term and discount rate):


Operating leases:	December 31, 2023		December 31, 2022


Operating lease right-of-use assets, net	$	43,822	$	41,859

Current maturities of operating leases	$	3,395	$	3,308
Non-current maturities of operating leases	43,977		41,257
Total operating lease liabilities	$	47,372	$	44,565

Finance leases:
Property and equipment, at cost	$	6,862	$	6,408
Accumulated amortization	(3,136)		(2,498)
Property and equipment, net	$	3,726	$	3,910

Current maturities of finance leases	$	582	$	513
Non-current maturities of finance leases	3,405		3,644
Total finance lease liabilities	$	3,987	$	4,157

Weighted average remaining lease term (in years):
Operating leases	10.4		11.9
Finance leases	6.8		7.8

Weighted average discount rate:
Operating leases	6.3%		5.9%
Finance leases	2.2%		2.1%

Current maturities of finance leases are included as a component of Other current liabilities on our Consolidated Balance Sheets. A summary of lease expenses for our finance and operating leases included in General, administrative, and marketing expenses on our Consolidated Statements of Operations and Comprehensive Loss was as follows (in thousands):


	December 31, 2023		December 31, 2022
Amortization of property and equipment	$	542	$	518
Interest expense on finance leases	84		89
Total finance lease expense	626		607
Operating lease expensea	7,354		7,432
Sublease income	(278)		(306)
Total lease expense	$	7,702	$	7,733

______________________

a Total rental expense for operating leases was $7.5 million in 2021. The operating lease expense included right-of-use asset amortization and interest expense on the lease liability.

A summary of our cash flow information related to leases was as follows (in thousands):


Cash paid for amounts included in the measurement of lease liabilities:	2023		2022
Operating cash flows for operating leases	$	7,263	$	6,927
Financing cash flows for finance leases	539		507
Operating cash flows for finance leases	84		90

Future minimum lease payments are as follows (in thousands):


	Finance Leases		Operating Leases
2024	$	655	$	6,302
2025	648		7,085
2026	627		6,539
2027	617		6,058
2028	599		5,862
Thereafter	1,136		33,920
Total minimum lease payments	$	4,282	$	65,766
Less amount representing interest	(295)		(18,394)
Present value of net minimum lease payments	3,987		47,372
Less current maturities	(582)		(3,395)
Lease obligations, less current maturities	$	3,405	$	43,977

Leases

We have operating and finance lease obligations resulting from the lease of land and buildings that comprise our corporate headquarters and various manufacturing facilities; leases related to additional manufacturing, office, and warehouse space; leases on company vehicles; and leases on a variety of office and other equipment.

Information related to leases included in the Consolidated Balance Sheets was as follows (in thousands, except lease term and discount rate):


Operating leases:	December 31, 2023		December 31, 2022


Operating lease right-of-use assets, net	$	43,822	$	41,859

Current maturities of operating leases	$	3,395	$	3,308
Non-current maturities of operating leases	43,977		41,257
Total operating lease liabilities	$	47,372	$	44,565

Finance leases:
Property and equipment, at cost	$	6,862	$	6,408
Accumulated amortization	(3,136)		(2,498)
Property and equipment, net	$	3,726	$	3,910

Current maturities of finance leases	$	582	$	513
Non-current maturities of finance leases	3,405		3,644
Total finance lease liabilities	$	3,987	$	4,157

Weighted average remaining lease term (in years):
Operating leases	10.4		11.9
Finance leases	6.8		7.8

Weighted average discount rate:
Operating leases	6.3%		5.9%
Finance leases	2.2%		2.1%


	December 31, 2023		December 31, 2022
Amortization of property and equipment	$	542	$	518
Interest expense on finance leases	84		89
Total finance lease expense	626		607
Operating lease expensea	7,354		7,432
Sublease income	(278)		(306)
Total lease expense	$	7,702	$	7,733

______________________

a Total rental expense for operating leases was $7.5 million in 2021. The operating lease expense included right-of-use asset amortization and interest expense on the lease liability.

A summary of our cash flow information related to leases was as follows (in thousands):


Cash paid for amounts included in the measurement of lease liabilities:	2023		2022
Operating cash flows for operating leases	$	7,263	$	6,927
Financing cash flows for finance leases	539		507
Operating cash flows for finance leases	84		90

Future minimum lease payments are as follows (in thousands):


	Finance Leases		Operating Leases
2024	$	655	$	6,302
2025	648		7,085
2026	627		6,539
2027	617		6,058
2028	599		5,862
Thereafter	1,136		33,920
Total minimum lease payments	$	4,282	$	65,766
Less amount representing interest	(295)		(18,394)
Present value of net minimum lease payments	3,987		47,372
Less current maturities	(582)		(3,395)
Lease obligations, less current maturities	$	3,405	$	43,977

Subsequent Events (Details)		3 Months Ended
Subsequent Events (Details)	Jan. 18, 2024 USD ($)	Jun. 30, 2025	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Jun. 18, 2020 USD ($)
Subsequent Event [Line Items]
Debt			$ 312,045,000	$ 314,779,000
Convertible Senior Notes
Subsequent Event [Line Items]
Debt instrument, face amount					$ 100,000,000
Interest rate on amounts borrowed					4.25%
Subsequent Event \| Convertible Senior Notes
Subsequent Event [Line Items]
Interest rate on amounts borrowed	4.25%
Subsequent Event \| Secured Debt \| Credit and Guaranty Agreement
Subsequent Event [Line Items]
Debt instrument, face amount	$ 350,000,000
Subsequent Event \| Secured Debt \| Initial Term Loan Facility
Subsequent Event [Line Items]
Debt instrument, face amount	190,000,000
Debt	$ 190,000,000
Subsequent Event \| Secured Debt \| Initial Term Loan Facility \| Base Rate
Subsequent Event [Line Items]
Credit facility margin	5.50%
Subsequent Event \| Secured Debt \| Initial Term Loan Facility \| SOFR
Subsequent Event [Line Items]
Credit facility margin	6.50%
Subsequent Event \| Secured Debt \| Delayed Draw Term Loan Facility
Subsequent Event [Line Items]
Debt instrument, face amount	$ 100,000,000
Subsequent Event \| Secured Debt \| Revolving Credit Facility
Subsequent Event [Line Items]
Debt instrument, face amount	60,000,000
Debt	30,000,000
Undrawn availability	$ 30,000,000
Subsequent Event \| Secured Debt \| Revolving Credit Facility \| Base Rate
Subsequent Event [Line Items]
Reduction in variable rate	3.00%
Subsequent Event \| Secured Debt \| Revolving Credit Facility \| SOFR
Subsequent Event [Line Items]
Credit facility margin	4.00%
Subsequent Event \| Secured Debt \| Revolving Credit Facility \| For Period from Second Quarter To Fourth Quarter of Fiscal Year 2024
Subsequent Event [Line Items]
Net leverage ratio	6.25
Subsequent Event \| Secured Debt \| Revolving Credit Facility \| From First Quarter of Fiscal Year 2025 and Thereafter
Subsequent Event [Line Items]
Net leverage ratio	5.75
Subsequent Event \| Secured Debt \| Term Loan Facilities
Subsequent Event [Line Items]
Credit facility margin		0.25%
Subsequent Event \| Secured Debt \| Term Loan Facilities \| SOFR
Subsequent Event [Line Items]
Net leverage ratio		3.75
Subsequent Event \| Secured Debt \| Term Loan Facilities \| If Certain Conditions are Met After Q2, 2025 \| Base Rate
Subsequent Event [Line Items]
Credit facility margin		5.25%
Subsequent Event \| Secured Debt \| Term Loan Facilities \| If Certain Conditions are Met After Q2, 2025 \| SOFR
Subsequent Event [Line Items]
Credit facility margin		6.25%

Basis of Presentation and Summary of Significant Accounting Policies (Schedule of Property and Equipment and Depreciation Expense) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 123,280	$ 127,012
Less accumulated depreciation and amortization	(84,922)	(88,338)
Property and equipment, net	38,358	38,674
Depreciation expense	7,878	7,132	$ 7,157
Equipment and software
Property, Plant and Equipment [Line Items]
Total property and equipment	66,618	72,480
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total property and equipment	49,107	47,384
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total property and equipment	$ 7,555	$ 7,148

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Net cash flows from operating activities:
Net loss	$ (30,690)	$ (19,192)	$ (14,834)
Adjustments to reconcile net loss to net cash from operating activities:
Change in fair value of contingent consideration	23,490	(9,000)	8,870
Depreciation and amortization	23,076	22,442	23,977
Non-cash compensation	14,422	12,344	10,711
Non-cash lease expense	7,354	7,432	7,521
Fair value adjustment of long-term loan	5,000	0	409
Write-down of inventories and deferred preservation costs	4,785	4,374	5,377
Non-cash interest expense	1,858	1,832	2,005
Write-off of Endospan Option	0	0	4,944
Deferred income taxes	(1,385)	(1,717)	(4,470)
Gain from sale of non-financial assets	(14,250)	0	(15,923)
Other	1,358	2,268	2,060
Changes in operating assets and liabilities:
Accounts payable, accrued expenses, and other liabilities	1,682	(1,958)	(1,893)
Prepaid expenses and other assets	535	(2,234)	(1,404)
Receivables	(4,050)	(13,340)	(11,560)
Inventories and deferred preservation costs	(14,360)	(8,404)	(18,375)
Net cash flows provided by (used in) operating activities	18,825	(5,153)	(2,585)
Net cash flows from investing activities:
Proceeds from sale of non-financial assets, net	14,250	0	19,000
Payments for Endospan agreement	(5,000)	0	0
Capital expenditures	(7,430)	(9,016)	(13,091)
Other	(2,322)	(1,699)	(249)
Net cash flows (used in) provided by investing activities	(502)	(10,715)	5,660
Net cash flows from financing activities:
Proceeds from exercise of stock options and issuance of common stock	3,955	3,368	3,756
Proceeds from financing insurance premiums	3,558	0	0
Payment of contingent consideration	0	0	(8,200)
Payment of debt issuance costs	(249)	0	(2,219)
Redemption and repurchase of stock to cover tax withholdings	(559)	(1,795)	(1,914)
Principal payments on short-term notes payable	(2,531)	0	(299)
Repayment of debt	(2,772)	(2,753)	(2,786)
Other	(537)	(459)	(561)
Net cash flows provided by (used in) financing activities	865	(1,639)	(12,223)
Effect of exchange rate changes on cash and cash equivalents	401	1,848	2,200
Increase (decrease) in cash and cash equivalents	19,589	(15,659)	(6,948)
Cash and cash equivalents, beginning of year	39,351	55,010	61,958
Cash and cash equivalents, end of year	$ 58,940	$ 39,351	$ 55,010

Consolidated Statements of Operations and Comprehensive Loss - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenues:
Total revenues	$ 354,004	$ 313,789	$ 298,836
Cost of products and preservation services:
Total cost of products and preservation services	124,828	111,266	101,322
Gross margin	229,176	202,523	197,514
Operating expenses:
General, administrative, and marketing	208,977	157,443	169,774
Research and development	28,707	38,879	35,546
Total operating expenses	237,684	196,322	205,320
Gain from sale of non-financial assets	14,250	0	15,923
Operating income	5,742	6,201	8,117
Interest expense	25,299	18,224	16,887
Interest income	(1,077)	(147)	(79)
Other expense, net	3,106	3,108	6,136
Loss before income taxes	(21,586)	(14,984)	(14,827)
Income tax expense	9,104	4,208	7
Net loss	$ (30,690)	$ (19,192)	$ (14,834)
Loss per share:
Basic (in dollars per share)	$ (0.75)	$ (0.48)	$ (0.38)
Diluted (in dollars per share)	$ (0.75)	$ (0.48)	$ (0.38)
Weighted-average common shares outstanding:
Basic (in shares)	40,743	40,032	38,983
Diluted (in shares)	40,743	40,032	38,983
Net loss	$ (30,690)	$ (19,192)	$ (14,834)
Other comprehensive income (loss):
Foreign currency translation adjustments	9,599	(11,722)	(16,630)
Comprehensive loss	(21,091)	(30,914)	(31,464)
Products
Revenues:
Total revenues	261,185	230,353	221,597
Cost of products and preservation services:
Total cost of products and preservation services	84,595	72,166	65,196
Preservation services
Revenues:
Total revenues	92,819	83,436	77,239
Cost of products and preservation services:
Total cost of products and preservation services	$ 40,233	$ 39,100	$ 36,126

Goodwill and Other Intangible Assets (Schedule of Goodwill by Reportable Segment) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Goodwill [Roll Forward]
Beginning balance	$ 243,631	$ 250,000
Foreign currency translation	3,706	(6,369)
Ending balance	$ 247,337	$ 243,631

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 58,940	$ 39,351
Trade receivables, net	71,796	61,820
Other receivables	2,342	7,764
Inventories, net	81,976	74,478
Deferred preservation costs, net	49,804	46,371
Prepaid expenses and other	15,810	17,550
Total current assets	280,668	247,334
Goodwill	247,337	243,631
Acquired technology, net	142,593	151,263
Operating lease right-of-use assets, net	43,822	41,859
Property and equipment, net	38,358	38,674
Other intangibles, net	29,638	31,384
Deferred income taxes	1,087	1,314
Other long-term assets	8,894	7,339
Total assets	792,397	762,798
Current liabilities:
Accounts payable	13,318	12,004
Accrued compensation	18,715	13,810
Accrued expenses	12,732	12,374
Taxes payable	3,840	2,635
Current maturities of operating leases	3,395	3,308
Current portion of long-term debt	1,451	1,608
Accrued procurement fees	1,439	2,111
Current portion of finance lease obligation	582	513
Other	2,390	1,312
Total current liabilities	57,862	49,675
Long-term debt	305,531	306,499
Contingent consideration	63,890	40,400
Non-current maturities of operating leases	43,977	41,257
Deferred income taxes	21,851	24,499
Deferred compensation liability	6,760	5,468
Non-current finance lease obligations	3,405	3,644
Other	7,341	7,027
Total liabilities	510,617	478,469
Commitments and contingencies
Shareholders' equity:
Preferred stock $0.01 par value per share, 5,000 shares authorized, no shares issued	0	0
Common stock $0.01 par value per share, 75,000 shares authorized, 42,569 and 41,830 shares issued as of December 31, 2023 and 2022, respectively	426	418
Additional paid-in capital	355,919	337,385
Retained deficit	(47,907)	(17,217)
Accumulated other comprehensive loss	(12,010)	(21,609)
Treasury stock at cost, 1,487 shares as of December 31, 2023 and 2022	(14,648)	(14,648)
Total shareholders' equity	281,780	284,329
Total liabilities and shareholders' equity	$ 792,397	$ 762,798

Inventories and Deferred Preservation Costs, net

12 Months Ended

Dec. 31, 2023

Inventory Disclosure [Abstract]

Inventories and Deferred Preservation Costs, net

Inventories, net at December 31, 2023 and 2022 were comprised of the following (in thousands):


	2023		2022
Raw materials and supplies	$	36,907	$	36,715
Work-in-process	12,687		10,476
Finished goods	32,382		27,287
Total inventories, net	$	81,976	$	74,478

Deferred preservation costs, net at December 31, 2023 and 2022 were comprised of the following (in thousands):


	2023		2022
Cardiac tissues	$	24,823	$	21,799
Vascular tissues	24,981		24,572
Total deferred preservation costs, net	$	49,804	$	46,371

To facilitate product usage, we maintain consignment inventory of our On-X heart valves at domestic hospital locations and On-X heart valves, aortic stent grafts, and AMDS products at international hospital locations. We retain title and control over this consignment inventory until notice of implantation is received, at which time we invoice the hospital and recognize revenue. As of December 31, 2023 we had $10.7 million in consignment inventory, with approximately 44% in domestic locations and 56% in foreign locations. As of December 31, 2022 we had $12.7 million in consignment inventory, with approximately 41% in domestic locations and 59% in foreign locations.

Inventory and deferred preservation costs obsolescence reserves were $3.0 million and $2.2 million as of December 31, 2023 and 2022, respectively.

Stock Compensation

12 Months Ended

Dec. 31, 2023

Share-Based Payment Arrangement [Abstract]

Stock Compensation

Overview

We are currently authorized to grant and have available for grant the following number of shares under our stock plans as of December 31, 2023 and 2022:


	Authorized Shares	Available for Grant
Plan		2023	2022
1996 Discounted Employee Stock Purchase Plan, as amended	2,900,000	826,000	967,000
2020 Equity and Cash Incentive Plan	7,145,000	3,281,000	999,000
Total	10,045,000	4,107,000	1,966,000

During 2020 the Shareholders approved a new 2020 Equity and Cash Incentive Plan (“ECIP”) and funded it with 2.7 million of newly issuable shares. On August 11, 2020 4.1 million shares were registered under the 2020 ECIP, consisting of the newly issuable shares as well as 1.4 million of the shares that remained available for grant under the 2009 ECIP as of that date. On May 16, 2023 the Shareholders approved additional 3.0 million shares to be registered under the 2020 ECIP.

Stock Awards

In 2023 the Compensation Committee of our Board of Directors (the “Committee”) authorized awards from approved stock incentive plans of RSAs to non-employee directors and RSUs and PSUs to certain employees and Company officers, which, counting PSUs at target levels, together totaled 681,000 shares and had an aggregate grant date market value of $9.7 million. Two types of PSUs were granted in 2023, an annual grant with a one-year performance period (“Annual PSU”) and an LTIP PSU grant (the “2023 LTIP PSU”) with a one-year performance period. If the highest performance threshold was met, the Annual PSU granted in 2023 represented the right to receive up to 150% of the target number of shares of common stock. The performance component of the Annual PSU granted in 2023 was based on attaining specified levels of revenue growth and specified levels of EBITDA, as defined in the PSU grant documents, for the 2023 calendar year. The Annual PSU granted in 2023 earned approximately 148% of the target number of shares. If the highest performance threshold was met, the 2023 LTIP PSU grant represented a right to receive up to 200% of the target number of shares of common stock. The 2023 LTIP PSU grant earned approximately 200% of target number of shares.

During 2019 the Committee authorized, and we granted, an LTIP PSU (the “Original LTIP”), which has multiple performance periods over a five-year period. If the highest performance thresholds were met, the Original LTIP represents the right to receive up to 288%, and up to 192% for a certain key executive, of the target number of shares of common stock. The performance component of the Original LTIP was based on attaining specified levels of adjusted revenue growth and gross margin, as defined in the Original LTIP grant document, for the years 2019 through 2023. During 2020 we determined that the threshold performance under the first performance period (2019 through 2021) of the Original LTIP was unlikely to be achieved which resulted in a reversal of $1.9 million in expense in the fourth quarter of 2020. During 2022 the second performance period of the Original LTIP earned approximately 136% and 108% to a certain key executive of target number of shares of common stock. During 2023 the third performance period of the Original LTIP earned approximately 213% and 142% to a certain key executive of target number of shares of common stock.

In 2022 the Committee authorized awards from approved stock incentive plans of RSAs to non-employee Directors and RSUs and PSUs to certain employees and Company officers, which, counting PSUs at target levels, together totaled 871,000 shares and had an aggregate grant date market value of $13.5 million. Two types of PSUs were granted in 2022, an annual grant with a one-year performance period and an LTIP PSU grant (the “2022 LTIP PSU”) with a one-year performance period. If the highest performance threshold was met, the Annual PSU granted in 2022 represented the right to receive up to 150% of the target number of shares of common stock. The performance component of the Annual PSU granted in 2022 was based on attaining specified levels of revenue growth and specified levels of EBITDA, as defined in the PSU grant documents, for the 2022 calendar year. The Annual PSU granted in 2022 earned approximately 51% of the target number of shares and subsequently modified on February 13, 2023 to earn approximately 89% of the target number of shares. If the highest performance threshold was met, the 2022 LITP PSU grant represented a right to receive up to 200% of the target number of shares of common stock. The 2022 LTIP PSU grant earned approximately 140% of target number of shares.

In 2021 the Committee authorized awards from approved stock incentive plans of RSUs to certain employees, RSAs to non-employee Directors, and RSAs and PSUs to certain Company officers, which, counting PSUs at target levels, together totaled 500,000 shares and had an aggregate grant date market value of $12.6 million. Two types of PSUs were granted in 2021, an Annual PSU and a special LTIP PSU (the “2021 LTIP PSU”), each with a one-year performance period. If the highest performance threshold was met, the Annual PSU granted in 2021 represented the right to receive up to 150% of the target number of shares of common stock. The performance component of the Annual PSU granted in 2021 was based on attaining specified levels of revenue growth and certain non-financial metrics, as defined in the PSU grant documents, for the 2021 calendar year. The Annual PSU granted in 2021 earned approximately 110% of the target number of shares. If the highest performance threshold was met, the 2021 LTIP PSU grant in 2021 represented a right to receive up to 200% of the target number of shares of common stock. The 2021 LTIP PSU grant earned approximately 118% of target number of shares.

A summary of stock grant activity for the years ended December 31, 2023, 2022, and 2021 for RSAs, RSUs, and PSUs, based on the target number of shares, was as follows:


RSAs	Shares	Weighted Average Grant Date Fair Value
Unvested at December 31, 2020	258,000	$	25.08
Granted	140,000	25.68
Vested	(130,000)	22.40
Forfeited	(33,000)	27.39
Unvested at December 31, 2021	235,000	26.59
Granted	64,000	17.91
Vested	(89,000)	28.60

Unvested at December 31, 2022	210,000	23.09
Granted	78,000	15.45
Vested	(128,000)	22.02
Forfeited	(4,000)	24.90
Unvested at December 31, 2023	156,000	20.11


RSUs	Shares	Weighted Average Remaining Contractual Term in years	Aggregate Intrinsic Value
Unvested at December 31, 2020	212,000	1.02	$	5,015,000
Granted	144,000
Vested	(93,000)
Forfeited	(39,000)
Unvested at December 31, 2021	224,000	0.94	4,558,000
Granted	643,000
Vested	(100,000)
Forfeited	(33,000)
Unvested at December 31, 2022	734,000	2.02	8,895,000
Granted	327,000
Vested	(125,000)
Forfeited	(57,000)
Unvested at December 31, 2023	879,000	1.41	15,711,000

Vested and expected to vest	879,000	1.41	$	15,711,000


PSUs	Shares	Weighted Average Remaining Contractual Term in years	Aggregate Intrinsic Value
Unvested at December 31, 2020	331,000	1.64	$	7,805,000
Granted	215,000
Vested	(60,000)
Forfeited	(114,000)
Unvested at December 31, 2021	372,000	0.90	7,579,000
Granted	182,000
Vested	(117,000)
Forfeited	(97,000)
Unvested at December 31, 2022	340,000	0.67	4,121,000
Granted	308,000
Vested	(213,000)
Forfeited	(169,000)
Unvested at December 31, 2023	266,000	0.54	4,749,000

Vested and expected to vest	266,000	0.54	$	4,749,000

During the years ended December 31, 2023, 2022, and 2021 the total fair value of $6.4 million, $5.8 million, and $7.3 million, respectively, in combined RSAs, RSUs, and PSUs vested.

Stock Options

The Compensation Committee of our Board of Directors authorized grants of stock options from approved stock incentive plans to certain Company officers and employees totaling 110,000, 1,031,000, and 226,000 shares in 2023, 2022, and 2021, respectively, with exercise prices equal to the stock prices on the respective grant dates.

A summary of our stock option activity for the years ended December 31, 2023, 2022, and 2021 was as follows:


	Shares	Weighted Average Exercise Price		Weighted Average Remaining Contractual Term in years	Aggregate Intrinsic Value
Outstanding at December 31, 2020	1,241,000	$	18.16	3.38	$	8,215,000
Granted	226,000	24.90
Exercised	(179,000)	12.02
Forfeited	(42,000)	26.00
Outstanding at December 31, 2021	1,246,000	20.00		3.20	4,039,000
Granted	1,031,000	13.29
Exercised	(151,000)	11.85
Forfeited	(3,000)	21.55
Outstanding at December 31, 2022	2,123,000	17.31		4.56	1,150,000
Granted	110,000	17.54
Exercised	(226,000)	11.05
Forfeited	(93,000)	12.59
Expired	(36,000)	25.55
Outstanding at December 31, 2023	1,878,000	18.16		4.12	4,678,000

Vested and expected to vest	1,878,000	$	18.16	4.12	$	4,678,000
Exercisable at December 31, 2023	1,080,000	$	20.59	3.03	$	1,714,000

Other information concerning stock options for the years ended December 31 was as follows:


	2023		2022		2021
Weighted-average fair value of options granted	$	7.87	$	5.31	$	8.82
Intrinsic value of options exercised	695,000		1,120,000		2,716,000

Employees purchased common stock totaling 141,000, 95,000, and 87,000 shares in 2023, 2022, and 2021, respectively, through our ESPP.

Stock Compensation Expense

The following weighted-average assumptions were used to determine the fair value of options:


	2023		2022		2021
	Stock Options	ESPP Options	Stock Options	ESPP Options	Stock Options	ESPP Options
Expected life of options	5.00 Years	0.50 Years	5.00 Years	0.50 Years	5.00 Years	0.50 Years
Expected stock price volatility	0.45	0.57	0.40	0.40	0.40	0.45
Risk-free interest rate	4.11%	5.03%	3.58%	1.34%	0.57%	0.07%

The following table summarizes stock compensation expense (in thousands):


	2023		2022		2021
RSA, RSU, and PSU expense	$	11,875	$	10,351	$	9,023
Stock option and ESPP option expense	3,271		2,591		2,254
Total stock compensation expense	$	15,146	$	12,942	$	11,277

Included in the total stock compensation expense, as applicable in each period, were expenses related to RSAs, RSUs, PSUs, and stock options issued in each respective year, as well as those issued in prior periods that continue to vest during the period, and compensation related to our ESPP. These amounts were recorded as stock compensation expense and were subject to our normal allocation of expenses to inventory costs and deferred preservation costs. We capitalized $724,000, $598,000, and $566,000 in the years ended December 31, 2023, 2022, and 2021, respectively, of the stock compensation expense into our inventory costs and deferred preservation costs.

As of December 31, 2023 we had total unrecognized compensation expense of $9.1 million related to RSAs, RSUs, and PSUs and $3.1 million related to unvested stock options. As of December 31, 2023 this expense is expected to be recognized over a weighted-average period of 1.66 years for RSUs, 1.55 years for stock options, 0.51 years for PSUs, and 0.30 years for RSAs.

Leases (Summary of Lease Costs) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Amortization of property and equipment	$ 542	$ 518
Interest expense on finance leases	84	89
Total finance lease expense	626	607
Operating lease expense	7,354	7,432	$ 7,500
Sublease income	(278)	(306)
Total lease expense	$ 7,702	$ 7,733

Cover Page - USD ($)

12 Months Ended

Dec. 31, 2023

Feb. 16, 2024

Jun. 30, 2023

Cover [Abstract]

Document Type

10-K

Document Annual Report

true

Document Period End Date

Dec. 31, 2023

Current Fiscal Year End Date

--12-31

Document Transition Report

false

Entity File Number

1-13165

Entity Registrant Name

ARTIVION, INC.

Entity Incorporation, State or Country Code

Entity Tax Identification Number

59-2417093

Entity Address, Address Line One

1655 Roberts Boulevard N.W.

Entity Address, City or Town

Kennesaw

Entity Address, State or Province

Entity Address, Postal Zip Code

30144

City Area Code

770

Local Phone Number

419-3355

Title of 12(b) Security

Common Stock, $0.01 par value

Trading Symbol

AORT

Security Exchange Name

NYSE

Entity Well-known Seasoned Issuer

Yes

Entity Voluntary Filers

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

ICFR Auditor Attestation Flag

true

Document Financial Statement Error Correction

false

Entity Shell Company

false

Entity Public Float

$ 666,252,083

Entity Common Stock, Shares Outstanding

41,225,138

Documents Incorporated by Reference

Documents Incorporated By Reference


Document			Parts Into Which Incorporated
Proxy Statement for the Annual Meeting of Stockholders to be filed within 120 days after December 31, 2023			Part III

Document Fiscal Year Focus

2023

Entity Central Index Key

0000784199

Document Fiscal Period Focus

Amendment Flag

false

Income Taxes (Schedule of Deferred Tax Assets and Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets:
Finance and operating leases	$ 13,254	$ 12,581
Excess interest carryforward	6,438	5,559
Unrealized gains and losses	5,424	0
Loan revaluation	3,859	2,633
Loss carryforwards	3,205	9,660
Stock compensation	2,761	2,463
Accrued expenses	2,567	1,734
Deferred compensation	1,790	1,317
Property	1,786	1,310
Credit carryforwards	336	503
Inventory and deferred preservation costs write-downs	302	764
Other	1,422	1,650
Less valuation allowance	(32,860)	(17,942)	$ (13,282)	$ (7,170)
Total deferred tax assets, net	10,284	22,232
Deferred tax liabilities:
Unrealized gains and losses	0	(6,624)
Prepaid items	(370)	(323)
Debt costs	(626)	(818)
Finance and operating leases	(12,777)	(12,217)
Intangible assets	(16,106)	(24,601)
Other	(1,169)	(834)
Total deferred tax liabilities	(31,048)	(45,417)
Total deferred tax liabilities, net	$ (20,764)	$ (23,185)

Leases (Schedule of Minimum Lease Payments for Finance, Operating, Leases) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Finance Leases
2024	$ 655
2025	648
2026	627
2027	617
2028	599
Thereafter	1,136
Total minimum lease payments	4,282
Less amount representing interest	(295)
Present value of net minimum lease payments	3,987	$ 4,157
Less current maturities	(582)	(513)
Lease obligations, less current maturities	3,405	3,644
Operating Leases
2024	6,302
2025	7,085
2026	6,539
2027	6,058
2028	5,862
Thereafter	33,920
Total minimum lease payments	65,766
Less amount representing interest	(18,394)
Present value of net minimum lease payments	47,372	44,565
Less current maturities	(3,395)	(3,308)
Lease obligations, less current maturities	$ 43,977	$ 41,257

Acquisition of Ascyrus (Details) $ in Thousands		1 Months Ended	12 Months Ended
Acquisition of Ascyrus (Details) $ in Thousands	Sep. 02, 2020 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2023 USD ($) item	Dec. 31, 2022 USD ($)
Business Acquisition [Line Items]
Noncurrent portion of contingent consideration			$ 63,890	$ 40,400
Ascyrus Medical LLC
Business Acquisition [Line Items]
Equity ownership percent	100.00%
Cash consideration	$ 60,000
Common stock value issued in business combination	20,000
Contingent consideration, fair value adjustment			(23,500)	9,000
Noncurrent portion of contingent consideration			$ 63,900	$ 40,400
Ascyrus Medical LLC \| Measurement Input, Discount Rate
Business Acquisition [Line Items]
Contingent consideration, measurement input \| item			0.07
Ascyrus Medical LLC \| Maximum
Business Acquisition [Line Items]
Aggregate amount of consideration transferred	200,000
Ascyrus Medical LLC \| FDA Approval IDE for AMDS
Business Acquisition [Line Items]
Cash consideration	10,000	$ 10,000
Common stock value issued in business combination	10,000	$ 10,000
Ascyrus Medical LLC \| FDA Approval PMA for AMDS
Business Acquisition [Line Items]
Cash consideration	25,000
Ascyrus Medical LLC \| AMDS Obtained In Japan
Business Acquisition [Line Items]
Cash consideration	10,000
Ascyrus Medical LLC \| AMDS Obtained In China
Business Acquisition [Line Items]
Cash consideration	10,000
Ascyrus Medical LLC \| Additional Potential Cash Payment If Japan Or China Obtains Approval
Business Acquisition [Line Items]
Cash consideration	55,000
Ascyrus Medical LLC \| Additional Potential Cash Payment If Japan Or China Obtains Approval \| Maximum
Business Acquisition [Line Items]
Cash consideration	75,000
Ascyrus Medical LLC \| Additional Potential Cash Payment If Japan Or China Obtains Approval \| Minimum
Business Acquisition [Line Items]
Cash consideration	$ 65,000
Ascyrus Medical LLC \| Following FDA Approval For AMDS
Business Acquisition [Line Items]
Aggregate amount of consideration transferred			$ 100,000
Period of required contingent consideration	3 years

Stock Compensation (Schedule of Stock Grant Activity for RSAs) (Details) - RSAs - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Shares
Unvested, Beginning Balance, Shares	210,000	235,000	258,000
Granted, Shares	78,000	64,000	140,000
Vested, Shares	(128,000)	(89,000)	(130,000)
Forfeited, Shares	(4,000)		(33,000)
Unvested, Ending Balance, Shares	156,000	210,000	235,000
Weighted Average Grant Date Fair Value
Unvested, Beginning Balance, Weighted Average Grant Date Fair Value (in dollars per share)	$ 23.09	$ 26.59	$ 25.08
Granted, Weighted Average Grant Date Fair Value (in dollars per share)	15.45	17.91	25.68
Vested, Weighted Average Grant Date Fair Value (in dollars per share)	22.02	28.60	22.40
Forfeited, Weighted Average Grant Date Fair Value (in dollars per share)	24.90		27.39
Unvested, Ending Balance, Weighted Average Grant Date Fair Value (in dollars per share)	$ 20.11	$ 23.09	$ 26.59

Segment and Geographic Information (Revenues, Cost Of Products And Services, And Gross Margins For Operating Segments) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Total revenues	$ 354,004	$ 313,789	$ 298,836
Total cost of products and preservation services	124,828	111,266	101,322
Total gross margin	229,176	202,523	197,514
Operating Segments \| Medical devices
Segment Reporting Information [Line Items]
Total revenues	261,185	230,353	221,597
Total cost of products and preservation services	84,595	72,166	65,196
Total gross margin	176,590	158,187	156,401
Operating Segments \| Preservation services
Segment Reporting Information [Line Items]
Total revenues	92,819	83,436	77,239
Total cost of products and preservation services	40,233	39,100	36,126
Total gross margin	$ 52,586	$ 44,336	$ 41,113

- Definition

Aggregate revenue less cost of goods and services sold or operating expenses directly attributable to the revenue generation activity.

Inventories and Deferred Preservation Costs, net (Tables)

12 Months Ended

Dec. 31, 2023

Inventory Disclosure [Abstract]

Schedule of Inventories

Inventories, net at December 31, 2023 and 2022 were comprised of the following (in thousands):


	2023		2022
Raw materials and supplies	$	36,907	$	36,715
Work-in-process	12,687		10,476
Finished goods	32,382		27,287
Total inventories, net	$	81,976	$	74,478

Schedule of Deferred Preservation Costs

Deferred preservation costs, net at December 31, 2023 and 2022 were comprised of the following (in thousands):


	2023		2022
Cardiac tissues	$	24,823	$	21,799
Vascular tissues	24,981		24,572
Total deferred preservation costs, net	$	49,804	$	46,371

Basis of Presentation and Summary of Significant Accounting Policies (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Foreign currency transaction gain (loss)	$ 2,100,000	$ (3,100,000)	$ (5,500,000)
Advertising expense	1,900,000	1,600,000	1,000,000
Foreign currency translation adjustments	2,700,000	(6,400,000)	9,100,000
Foreign currency translation adjustments	9,599,000	(11,722,000)	(16,630,000)
Allowance for doubtful accounts	1,900,000	1,300,000
Write-down to inventory	4,400,000	4,000,000	4,800,000
Write-downs to deferred preservation costs	393,000	369,000	575,000
Impairment of long-lived assets	$ 0	$ 0	$ 0
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Estimated useful lives	3 years
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Estimated useful lives	10 years
ESPP Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
ESPP, percentage of market price for eligible employees	85.00%
RSAs, RSUs, PSUs and Stock Options \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	1 year
RSAs, RSUs, PSUs and Stock Options \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	3 years
Stock Options \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Period within grant date stock options granted typically expire	7 years

Financial Instruments (Summary of Financial Instruments Measured at Fair Value) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Total assets	$ 26,770	$ 10,098
Contingent consideration	(63,890)	(40,400)
Total liabilities	(63,890)	(40,400)
Money market funds
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents	22,802	10,098
Certificates of deposit
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents	3,968
Level 1
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Total assets	26,770	10,098
Contingent consideration	0	0
Total liabilities	0	0
Level 1 \| Money market funds
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents	22,802	10,098
Level 1 \| Certificates of deposit
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents	3,968
Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Total assets	0	0
Contingent consideration	0	0
Total liabilities	0	0
Level 2 \| Money market funds
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents	0	0
Level 2 \| Certificates of deposit
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents	0
Level 3
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Total assets	0	0
Contingent consideration	(63,890)	(40,400)
Total liabilities	(63,890)	(40,400)
Level 3 \| Money market funds
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents	0	$ 0
Level 3 \| Certificates of deposit
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash equivalents	$ 0

Debt (Tables)

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Schedule of Short-Term and Long-Term Balances of Term Loan

The short-term and long-term balances of our term loans were as follows (in thousands):


	As of December 31,
	2023		2022
Term loan balance	$	211,500	$	213,750
Convertible senior notes	100,000		100,000
2.45% Sparkasse Zollernalb (KFW Loan 1)	61		296
1.40% Sparkasse Zollernalb (KFW Loan 2)	484		733
Total loan balance	312,045		314,779
Less unamortized loan origination costs	(5,063)		(6,672)
Net borrowings	306,982		308,107
Less short-term loan balance, net	(1,451)		(1,608)
Long-term loan balance, net	$	305,531	$	306,499

Schedule of Debt Maturities

At December 31, 2023 the aggregate maturities of long-term debt for the next five years are as follows (in thousands):


	2024		2025		2026		2027		Thereafter		Total
Maturities	$	2,588	$	102,458	$	2,250	$	204,749	$	—	$	312,045

Financial Instruments (Schedule ofReconciliation Of Changes In Fair Value Of Level 3 Liabilities) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (40,400)
Change in valuation	(23,490)	$ 9,000	$ (8,870)
Ending balance	$ (63,890)	$ (40,400)

Income Taxes (Schedule of Income Tax Expense Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Current:
Federal	$ 5,573	$ 1,606	$ 1,896
State	1,004	367	551
Foreign	3,851	3,120	3,391
Current: Income tax expense (benefit)	10,428	5,093	5,838
Deferred:
Federal	222	236	(2,801)
State	157	234	(307)
Foreign	(1,703)	(1,355)	(2,723)
Deferred: Income tax expense (benefit)	(1,324)	(885)	(5,831)
Income tax expense	$ 9,104	$ 4,208	$ 7

Debt

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Debt

Credit Agreement

On December 1, 2017 we entered into a credit and guaranty agreement for a $255.0 million senior secured credit facility, consisting of a $225.0 million secured term loan facility (the “Term Loan Facility”) and a $30.0 million secured revolving credit facility (the “Revolving Credit Facility” and, together with the Term Loan Facility, the “Credit Agreement”). We and each of our existing domestic subsidiaries (subject to certain exceptions and exclusions) guarantee the obligations under the Credit Agreement (the “Guarantors”). The Credit Agreement is secured by a security interest in substantially all existing and after-acquired real and personal property (subject to certain exceptions and exclusions) of us and the Guarantors.

On December 1, 2017 we borrowed the entire $225.0 million Term Loan Facility. The proceeds of the Term Loan Facility were used along with cash on hand and shares of Artivion common stock to (i) fund the acquisition of JOTEC and its subsidiaries (the “JOTEC Acquisition”), (ii) pay certain fees and expenses related to the JOTEC Acquisition and the Credit Agreement, and (iii) pay the outstanding balance of our prior credit facility. The Revolving Credit Facility may be used for working capital, capital expenditures, acquisitions permitted under the Credit Agreement, and other general corporate purposes pursuant to the terms of the Credit Agreement.

The loan under the Term Loan Facility is repayable on a quarterly basis according to the amortization provisions set forth in the Credit Agreement. We have the right to repay the loan under the Credit Agreement in whole or in part at any time. Amounts repaid in respect of the loan under the Term Loan Facility may not be reborrowed. Amounts repaid in respect of the loan under the Revolving Credit Facility may be reborrowed. All outstanding principal and interest in respect of (i) the Term Loan Facility must be repaid on or before December 1, 2024 and (ii) the Revolving Credit Facility must be repaid on or before December 1, 2022.

The Credit Agreement and its subsequent amendments contain certain customary affirmative and negative covenants, including covenants that limit our ability and the ability of our subsidiaries to, among other things, grant liens, incur debt, dispose of assets, make loans and investments, make acquisitions, make certain restricted payments (including cash dividends), merge or consolidate, change business or accounting or reporting practices, in each case subject to customary exceptions for a credit facility of this size and type.

The Credit Agreement includes certain customary events of default that include, among other things, non-payment of principal, interest, or fees; inaccuracy of representations and warranties; breach of covenants; cross-default to certain material indebtedness; bankruptcy and insolvency; and change of control. Upon the occurrence and during the continuance of an event of default, the lenders may declare all outstanding principal and accrued but unpaid interest under the Credit Agreement immediately due and payable and may exercise the other rights and remedies provided under the Credit Agreement and related loan documents.

On June 2, 2021 we entered into an amendment to our Credit Agreement to extend the maturity dates of both our Term Loan and its Revolving Credit Facility. As part of the amendment, the maturity dates of both our Term Loan and its Revolving Credit Facility were each extended by two and one-half years, until June 1, 2027 and June 1, 2025, respectively, subject to earlier springing maturities if our 4.25% Convertible Senior Notes, described below, remain outstanding on April 1, 2025 and December 31, 2024, respectively. With respect to the Term Loan, if the Convertible Senior Notes remained outstanding on April 1, 2025, the Term Loan’s maturity date would be April 1, 2025, or, if the Convertible Senior Notes’ own maturity date had been extended, the earlier of (i) 91 days prior to the Convertible Senior Notes’ new maturity date and (ii) June 1, 2027. In the case of the Revolving Credit Facility, if the Convertible Senior Notes are still outstanding on December 31, 2024, the Revolving Credit Facility’s maturity date will be either December 31, 2024 or, if the Convertible Senior Notes’ own maturity date has been extended, the earlier of (i) 182 days prior to the Convertible Senior Notes’ new maturity date and (ii) June 1, 2025. In connection with this amendment, we paid debt issuance costs of $2.1 million, of which $1.8 million will be amortized over the life of the term loan facility and included in current and long-term debt on the Consolidated Balance Sheets. The remaining $361,000 of debt issuance costs and $474,000 of non-cash debt extinguishment costs were recorded in Interest expense on the Consolidated Statements of Operations and Comprehensive Loss.

On December 19, 2022 in accordance with adopting ASU 2020-04 and 2021-01, we entered into an amendment to our Credit Agreement to replace the LIBOR based benchmark interest rate with the Secured Overnight Financing Rate (“SOFR”) based benchmark interest rate for our Term Loan Facility and our Revolving Credit Facility. Based on historical analysis of the differences between the benchmark rates, SOFR is adjusted to arrive at a Term SOFR rate that serves as the replacement base rate for LIBOR under our amended credit facilities. Under this amendment, at the maturity of our existing LIBOR-based loan on December 30, 2022, the interest rate at the repricing of our Term Loan Facility was calculated as Term SOFR plus a fixed percentage credit spread of 3.50%. The loan under the Revolving Credit Facility bears interest at Term SOFR plus a margin of between 4.00% and 4.25%, depending on our consolidated net leverage ratio. As of December 31, 2023 the aggregate interest rate of the Credit Agreement was 8.97% per annum.

On January 18, 2024 we entered into a credit and guaranty agreement with Ares Management Credit funds to borrow up to $350.0 million senior secured, interest-only, credit facilities. Upon closing, we borrowed a total of $220.0 million which we used, along with cash on hand, to pay off outstanding debt related to the Credit Agreement and related fees and expenses. See Note 17 for further discussion of our new Credit and Guaranty Agreement.

Convertible Senior Notes

On June 18, 2020 we issued $100.0 million aggregate principal amount of 4.25% Convertible Senior Notes with a maturity date of July 1, 2025 (the “Convertible Senior Notes”). The net proceeds from this offering, after deducting initial purchasers’ discounts and costs directly related to this offering, were approximately $96.5 million. On January 1, 2021 we adopted ASU 2020-06 and adjusted the carrying balance of the Convertible Senior Notes to notional. The Convertible Senior Notes balance was $100.0 million recorded in Long-term debt on the Consolidated Balance Sheets as of December 31, 2023. The Convertible Senior Notes may be settled in cash, stock, or a combination thereof, solely at our discretion. The initial conversion rate of the Convertible Senior Notes is 42.6203 shares per $1,000 principal amount, which is equivalent to a conversion price of approximately $23.46 per share, subject to adjustments. We use the if-converted method for assumed conversion of the Convertible Senior Notes for the diluted earnings per share calculation. The fair value and the effective interest rate of the Convertible Senior Notes as of December 31, 2023 was approximately $106.4 million and 5.05%, respectively. The fair value was based on market prices observable for similar instruments and is considered Level 2 in the fair value hierarchy.

The interest expense recognized on the Convertible Senior Notes includes approximately $5.0 million for the aggregate of the contractual coupon interest and the amortization of the debt issuance costs during the twelve months ended December 31, 2023. The interest expense recognized on the Convertible Senior Notes includes approximately $4.9 million for the aggregate of the contractual coupon interest and the amortization of the debt issuance costs for the twelve months ended December 31, 2022 and 2021. Interest on the Convertible Senior Notes began accruing upon issuance and is payable semi-annually. There were $1.1 million and $1.9 million of unamortized debt issuance costs related to convertible senior notes as of December 31, 2023 and 2022, respectively.

Holders of the Convertible Senior Notes may convert their notes at their option at any time prior to January 1, 2025 but only under the following circumstances: (i) during any calendar quarter commencing after the calendar quarter ending on September 30, 2020 (and only during such calendar quarter), if the last reported sale price of our common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (ii) during the five business day period after any five consecutive trading day period in which the trading price per $1,000 principal amount of notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of our common stock and the conversion rate on each such trading day; (iii) we give a notice of redemption with respect to any or all of the notes, at any time prior to the close of business on the second scheduled trading day immediately preceding the redemption date; or (iv) upon the occurrence of specified corporate events. On or after January 1, 2025 until the close of business on the second scheduled trading day immediately preceding the maturity date, holders may convert their notes at any time, regardless of the foregoing circumstances.

We became eligible to redeem the Convertible Senior Notes beginning on July 5, 2023, following the expiration of their non-redemption period. We are able to redeem the Convertible Senior Notes in whole or in part, at our option, if the last reported sale price per share of our common stock has been at least 130% of the conversion price then in effect for at least 20 trading days (whether or not consecutive) during any 30 consecutive trading day period (including the last trading day of such period) ending on, and including, the trading day immediately preceding the date on which we provide notice of redemption. We may redeem for cash all or part of the Convertible Senior Notes at a redemption price equal to 100% of the principal amount of the redeemable Convertible Senior Notes, plus accrued and unpaid interest to, but excluding, the redemption date. No principal payments are due on the Convertible Senior Notes prior to maturity. Other than restrictions relating to certain fundamental changes and consolidations, mergers or asset sales and customary anti-dilution adjustments, the Convertible Senior Notes do not contain any financial covenants and do not restrict us from conducting significant restructuring transactions or issuing or repurchasing any of our other securities. As of December 31, 2023 and 2022 we are not aware of any current events or market conditions that would allow holders to convert the Convertible Senior Notes.

Government Supported Bank Debt

In April 2014 JOTEC obtained the first loan Sparkasse Zollernalb, which is government sponsored by the Kreditanstalt für Wiederaufbau Bank (KFW). The first loan bears an interest rate of 2.45% and is scheduled to mature during the first quarter of 2024. In December 2015 JOTEC obtained the second loan Sparkasse Zollernalb sponsored by KFW. The second loan bears an interest rate of 1.40% and is scheduled to mature during the third quarter of 2025.

The short-term and long-term balances of our term loans were as follows (in thousands):


	As of December 31,
	2023		2022
Term loan balance	$	211,500	$	213,750
Convertible senior notes	100,000		100,000
2.45% Sparkasse Zollernalb (KFW Loan 1)	61		296
1.40% Sparkasse Zollernalb (KFW Loan 2)	484		733
Total loan balance	312,045		314,779
Less unamortized loan origination costs	(5,063)		(6,672)
Net borrowings	306,982		308,107
Less short-term loan balance, net	(1,451)		(1,608)
Long-term loan balance, net	$	305,531	$	306,499

At December 31, 2023 the aggregate maturities of long-term debt for the next five years are as follows (in thousands):


	2024		2025		2026		2027		Thereafter		Total
Maturities	$	2,588	$	102,458	$	2,250	$	204,749	$	—	$	312,045

Our aggregate maturity schedule is subject to change due to a provision within the Credit Agreement that requires us to make annual prepayments based on an excess cash flow calculation.

On April 19, 2023 we issued payable notes in the aggregate of $3.6 million to finance our insurance premiums. The notes have a term of one year and bear an interest rate of 6.65% per annum. The notes payable balance was $1.0 million recorded in Other current liabilities on the Consolidated Balance Sheet as of December 31, 2023.

Interest Expense

Total interest expense was $25.3 million, $18.2 million, and $16.9 million in 2023, 2022, and 2021, respectively. Interest expense includes interest on debt and uncertain tax positions in all periods.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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+ Details

Goodwill and Other Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Carrying Values of Indefinite Lived Intangible Assets

As of December 31, 2023 and 2022 the carrying values of our indefinite lived intangible assets were as follows (in thousands):


	2023		2022
Goodwill	$	247,337	$	243,631
In-process R&D	2,154		2,080
Procurement contracts and agreements	2,013		2,013

Schedule of Goodwill by Reportable Segment

As of December 31, 2023 and 2022 the value of our goodwill, all of which was related to our Medical Devices segment, was as follows (in thousands):


	Medical Devices Segment
	2023		2022
Balance as of January 1,	$	243,631	$	250,000
Foreign currency translation	3,706		(6,369)
Balance as of December 31,	$	247,337	$	243,631

Schedule of Gross Carrying Values, Accumulated Amortization, and Approximate Amortization Period of Definite Lived Intangible Assets


December 31, 2023	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Useful Life (Years)
Acquired technology	$	201,897	$	59,304	$	142,593	18.2
Other intangibles:
Customer lists and relationships	28,729		10,334		18,395		21.6
Distribution and manufacturing rights and know-how	9,608		7,807		1,801		5.0
Patents	4,365		3,225		1,140		17.0
Other	7,815		3,680		4,135		5.0
Total other intangibles	$	50,517	$	25,046	$	25,471	10.0


December 31, 2022	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Useful Life (Years)
Acquired technology	$	198,420	$	47,157	$	151,263	18.2
Other intangibles:
Customer lists and relationships	31,030		11,100		19,930		20.5
Distribution and manufacturing rights and know-how	9,274		5,796		3,478		5.0
Patents	4,246		3,180		1,066		17.0
Other	5,360		2,543		2,817		4.4
Total other intangibles	$	49,910	$	22,619	$	27,291	10.3

Summary of Amortization Expense

Amortization expense recorded in General, administrative, and marketing expenses on our Consolidated Statements of Operations and Comprehensive Loss for the years ended December 31 was as follows (in thousands):


	2023		2022		2021
Amortization expense	$	15,198	$	15,310	$	16,820

Scheduled Amortization of Intangible Assets For Next Five Years

As of December 31, 2023 scheduled amortization of intangible assets for the next five years is as follows (in thousands):


	2024		2025		2026		2027		2028		Total
Amortization expense	$	15,121	$	13,200	$	12,972	$	12,866	$	12,644	$	66,803

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

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+ Details

Goodwill and Other Intangible Assets (Summary of Amortization Expense) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 15,198	$ 15,310	$ 16,820

Stock Compensation (Schedule of Stock Grant Activity for PSUs) (Details) - PSUs - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Shares
Unvested, Beginning Balance, Shares	340,000	372,000	331,000
Granted, Shares	308,000	182,000	215,000
Vested, Shares	(213,000)	(117,000)	(60,000)
Forfeited, Shares	(169,000)	(97,000)	(114,000)
Unvested, Ending Balance, Shares	266,000	340,000	372,000	331,000
Vested and expected to vest, Shares	266,000
Outstanding, Weighted Average Remaining Contractual Term in Years	6 months 14 days	8 months 1 day	10 months 24 days	1 year 7 months 20 days
Vested and expected to vest, Weighted Average Remaining Contractual Term in Years	6 months 14 days
Outstanding, Aggregate Intrinsic Value	$ 4,749,000	$ 4,121,000	$ 7,579,000	$ 7,805,000
Vested and expected to vest, Aggregate Intrinsic Value	$ 4,749,000

Goodwill and Other Intangible Assets

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Other Intangible Assets

Indefinite Lived Intangible Assets

As of December 31, 2023 and 2022 the carrying values of our indefinite lived intangible assets were as follows (in thousands):


	2023		2022
Goodwill	$	247,337	$	243,631
In-process R&D	2,154		2,080
Procurement contracts and agreements	2,013		2,013

We monitor the phases of development of our acquired in-process research and development projects, including the risks associated with further development and the amount and timing of benefits expected to be derived from the completed projects. Incremental costs associated with development are charged to expense as incurred. Capitalized costs are amortized over the estimated useful life of the developed asset once completed. Our in-process research and development projects are reviewed for impairment annually, or more frequently, if events or changes in circumstances indicate that the asset might be impaired. We evaluate our goodwill and indefinite lived intangible assets for impairment on an annual basis during the fourth quarter of the year, and, if necessary, during interim periods if factors indicate that an impairment review is warranted. We did not record any impairment of indefinite lived intangible assets, including goodwill, during the twelve months ended December 31, 2023, 2022, and 2021. In-process research and development, procurement contracts and agreements are included in Other intangibles, net on the Consolidated Balance Sheets as of December 31, 2023 and 2022.

Based on our experience with similar agreements, we believe that our acquired procurement contracts and agreements have indefinite useful lives, as we expect to continue to renew these contracts for the foreseeable future.

As of December 31, 2023 and 2022 the value of our goodwill, all of which was related to our Medical Devices segment, was as follows (in thousands):


	Medical Devices Segment
	2023		2022
Balance as of January 1,	$	243,631	$	250,000
Foreign currency translation	3,706		(6,369)
Balance as of December 31,	$	247,337	$	243,631

Definite Lived Intangible Assets

The definite lived intangible assets balance includes balances related to acquired technology, customer relationships, distribution and manufacturing rights and know-how, patents, and other definite lived intangible assets. As of December 31, 2023 and 2022 the gross carrying values, accumulated amortization, and approximate amortization period of our definite lived intangible assets were as follows (in thousands, except weighted average useful life):


December 31, 2023	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Useful Life (Years)
Acquired technology	$	201,897	$	59,304	$	142,593	18.2
Other intangibles:
Customer lists and relationships	28,729		10,334		18,395		21.6
Distribution and manufacturing rights and know-how	9,608		7,807		1,801		5.0
Patents	4,365		3,225		1,140		17.0
Other	7,815		3,680		4,135		5.0
Total other intangibles	$	50,517	$	25,046	$	25,471	10.0


December 31, 2022	Gross Carrying Value		Accumulated Amortization		Net Carrying Value		Weighted Average Useful Life (Years)
Acquired technology	$	198,420	$	47,157	$	151,263	18.2
Other intangibles:
Customer lists and relationships	31,030		11,100		19,930		20.5
Distribution and manufacturing rights and know-how	9,274		5,796		3,478		5.0
Patents	4,246		3,180		1,066		17.0
Other	5,360		2,543		2,817		4.4
Total other intangibles	$	49,910	$	22,619	$	27,291	10.3

Amortization Expense


	2023		2022		2021
Amortization expense	$	15,198	$	15,310	$	16,820

As of December 31, 2023 scheduled amortization of intangible assets for the next five years is as follows (in thousands):


	2024		2025		2026		2027		2028		Total
Amortization expense	$	15,121	$	13,200	$	12,972	$	12,866	$	12,644	$	66,803

Commitments and Contingencies (Details) $ in Millions	12 Months Ended
Commitments and Contingencies (Details) $ in Millions	Dec. 31, 2022 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Termination and wind-down expenses	$ 4.5

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net Income (Loss) Attributable to Parent	$ (30,690)	$ (19,192)	$ (14,834)

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

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-Topic 235
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-Name Accounting Standards Codification
-Section S99
-Paragraph 1
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+ Details

Income Taxes (Schedule of (Loss) Income Before Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Domestic	$ (24,658)	$ (13,798)	$ (10,263)
Foreign	3,072	(1,186)	(4,564)
Loss before income taxes	$ (21,586)	$ (14,984)	$ (14,827)

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

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+ Details

Loss Per Common Share (Tables)

12 Months Ended

Dec. 31, 2023

Earnings Per Share [Abstract]

Schedule of Computation of Basic and Diluted (Loss) Income Per Common Share

The following table sets forth the computation of basic and diluted loss per common share (in thousands, except per share data):


Basic loss per common share	2023		2022		2021
Net loss	$	(30,690)	$	(19,192)	$	(14,834)
Net loss allocated to participating securities	123		98		94
Net loss allocated to common shareholders	$	(30,567)	$	(19,094)	$	(14,740)

Basic weighted-average common shares outstanding	40,743		40,032		38,983
Basic loss per common share	$	(0.75)	$	(0.48)	$	(0.38)

Diluted loss per common share	2023		2022		2021
Net loss	$	(30,690)	$	(19,192)	$	(14,834)
Net loss allocated to participating securities	123		98		94
Net loss allocated to common shareholders	$	(30,567)	$	(19,094)	$	(14,740)



Diluted weighted-average common shares outstanding	40,743		40,032		38,983
Diluted loss per common share	$	(0.75)	$	(0.48)	$	(0.38)

Agreements with Endospan (Details)		1 Months Ended			3 Months Ended	12 Months Ended
Agreements with Endospan (Details)	Sep. 11, 2019 USD ($)	May 31, 2023 USD ($)	Sep. 30, 2020 USD ($)	Sep. 30, 2019 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2023 USD ($) tranche	Dec. 31, 2021 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2019 USD ($)
Variable Interest Entity [Line Items]
Securities purchase option agreement, expiration period						90 days
Number of tranches \| tranche						3
Endospan
Variable Interest Entity [Line Items]
Securities purchase option agreement	$ 1,000,000			$ 1,000,000
Funded tranche payment	5,000,000	$ 5,000,000	$ 5,000,000			$ 5,000,000
Required percentage of number of patients before tranche of loan funding can be acquired		50.00%
Investment in VIE	15,000,000					25,000,000
Loan									$ 358,000
Distribution agreements, fair value						1,800,000		$ 3,500,000
Expense from fair value adjustment						$ 5,000,000	$ 409,000
Asset impairment					$ 4,900,000
Endospan \| Secured Debt
Variable Interest Entity [Line Items]
Notes receivable balance	15,000,000
Endospan \| Minimum
Variable Interest Entity [Line Items]
Option to purchase outstanding securities				350,000,000.0
Endospan \| Maximum
Variable Interest Entity [Line Items]
Option to purchase outstanding securities				$ 450,000,000
Endospan \| JOTEC GmbH
Variable Interest Entity [Line Items]
Distribution fee	$ 9,000,000

Segment and Geographic Information (Tables)

12 Months Ended

Dec. 31, 2023

Segment Reporting [Abstract]

Revenues, Cost of Products and Services, and Gross Margins for Operating Segments

The following table summarizes revenues, cost of products and preservation services, and gross margins for our reportable segments (in thousands):


	2023		2022		2021
Revenues:
Medical devices	$	261,185	$	230,353	$	221,597
Preservation services	92,819		83,436		77,239
Total revenues	354,004		313,789		298,836

Cost of products and preservation services:
Medical devices	84,595		72,166		65,196
Preservation services	40,233		39,100		36,126
Total cost of products and preservation services	124,828		111,266		101,322

Gross margin:
Medical devices	176,590		158,187		156,401
Preservation services	52,586		44,336		41,113
Total gross margin	$	229,176	$	202,523	$	197,514

Summary of Net Revenues by Product and Service

Net revenues by product for the years ended December 31, 2023, 2022, and 2021 were as follows (in thousands):


	2023		2022		2021
Products:
Aortic stent grafts	$	107,469	$	92,752	$	85,387
On-X	74,528		63,904		57,363
Surgical sealants	68,016		65,379		70,714
Other	11,172		8,318		8,133
Total products	261,185		230,353		221,597

Preservation services:	92,819		83,436		77,239
Total revenues	$	354,004	$	313,789	$	298,836

Schedule of Net Revenues by Geographic Location

Net revenues by geographic location attributed to countries based on the location of the customer for the years ended December 31, 2023, 2022, and 2021 were as follows (in thousands):


	2023		2022		2021
US	$	179,485	$	161,113	$	151,151
International	174,519		152,676		147,685
Total revenues	$	354,004	$	313,789	$	298,836

Revenue Recognition (Disaggregation of Revenue) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Total sources of revenue	$ 354,004	$ 313,789	$ 298,836
North America
Disaggregation of Revenue [Line Items]
Total sources of revenue	187,603	167,542	157,881
EMEA
Disaggregation of Revenue [Line Items]
Total sources of revenue	114,814	104,119	109,081
APAC
Disaggregation of Revenue [Line Items]
Total sources of revenue	33,577	27,973	21,696
LATAM
Disaggregation of Revenue [Line Items]
Total sources of revenue	$ 18,010	$ 14,155	$ 10,178

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

+ References

+ Details

Stock Compensation (Schedule of Weighted-Average Assumptions Used to Determine the Fair Value of Options) (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected life of options	5 years	5 years	5 years
Expected stock price volatility	45.00%	40.00%	40.00%
Risk-free interest rate	4.11%	3.58%	0.57%
ESPP Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected life of options	6 months	6 months	6 months
Expected stock price volatility	57.00%	40.00%	45.00%
Risk-free interest rate	5.03%	1.34%	0.07%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Leases (Schedule of Supplemental Balance Sheet Information Related to Leases) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Operating leases:
Operating lease right-of-use assets, net	$ 43,822	$ 41,859
Current maturities of operating leases	3,395	3,308
Non-current maturities of operating leases	43,977	41,257
Total operating lease liabilities	47,372	44,565
Finance leases:
Property and equipment, at cost	6,862	6,408
Accumulated amortization	(3,136)	(2,498)
Property and equipment, net	3,726	3,910
Current maturities of finance leases	582	513
Non-current maturities of finance leases	3,405	3,644
Total finance lease liabilities	$ 3,987	$ 4,157
Weighted average remaining lease term (in years): Operating leases	10 years 4 months 24 days	11 years 10 months 24 days
Weighted average remaining lease term (in years): Finance leases	6 years 9 months 18 days	7 years 9 months 18 days
Weighted average discount rate: Operating leases	6.30%	5.90%
Weighted average discount rate: Finance leases	2.20%	2.10%

Financial Instruments

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Financial Instruments

A summary of financial instruments measured at fair value was as follows (in thousands):


December 31, 2023	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market funds	$	22,802	$	—	$	—	$	22,802
Certificates of deposit	3,968		—		—		3,968
Total assets	$	26,770	$	—	$	—	$	26,770

Long-term liabilities:
Contingent consideration	—		—		(63,890)		(63,890)
Total liabilities	$	—	$	—	$	(63,890)	$	(63,890)


December 31, 2022	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market funds	$	10,098	$	—	$	—	$	10,098
Total assets	$	10,098	$	—	$	—	$	10,098

Long-term liabilities:
Contingent consideration	—		—		(40,400)		(40,400)
Total liabilities	$	—	$	—	$	(40,400)	$	(40,400)

We used prices quoted from our investment advisors to determine the Level 1 valuation of our investments in money market funds. The estimated market value of all cash equivalents is equal to cost basis as there were no gross realized gains or losses on cash equivalents for the years ended December 31, 2023, 2022, and 2021.

The fair value of the contingent consideration component of the Ascyrus acquisition was updated using Level 3 inputs. See Note 3 for further discussion of the Ascyrus acquisition. Changes in fair value of Level 3 assets and liabilities are listed in the tables below (in thousands):


	Contingent Consideration
Balance as of December 31, 2022	$	(40,400)
Change in valuation	(23,490)
Balance as of December 31, 2023	$	(63,890)

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Segment and Geographic Information (Summary Of Net Revenues By Product And Service) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Product Information [Line Items]
Total revenues	$ 354,004	$ 313,789	$ 298,836
Products
Product Information [Line Items]
Total revenues	261,185	230,353	221,597
Aortic stent grafts
Product Information [Line Items]
Total revenues	107,469	92,752	85,387
On-X
Product Information [Line Items]
Total revenues	74,528	63,904	57,363
Surgical sealants
Product Information [Line Items]
Total revenues	68,016	65,379	70,714
Other
Product Information [Line Items]
Total revenues	11,172	8,318	8,133
Preservation services
Product Information [Line Items]
Total revenues	$ 92,819	$ 83,436	$ 77,239

- Definition

+ References

+ Details

Revenue Recognition

12 Months Ended

Dec. 31, 2023

Revenue from Contract with Customer [Abstract]

Revenue Recognition

Disaggregation of Revenue

Revenues are disaggregated by following geographic regions:

•North America: consists of US and Canada. We market our medical device products and preservation services (predominantly in the US), primarily to physicians through our direct sales representatives who are managed by region managers.

•Europe, the Middle East, and Africa (“EMEA”): we market approved medical device products to physicians, hospitals, and distributors through our direct sales force in certain countries. In countries where there are no direct sales forces, regional sales managers market to distributors who buy medical device products directly from us and sell to hospitals in their respective countries.

•Asia Pacific (“APAC”): we market medical device products that are approved in each country to distributors in the region.

•Latin America (“LATAM”): we market medical device products that are approved in each country to distributors in the region except for Brazil where we sell directly to end customers and distributors.

Net revenues by geographic location based on the location of the customer for the years ended December 31, 2023, 2022, and 2021 were as follows (in thousands):


	2023		2022		2021
North America	187,603		167,542		157,881
EMEA	114,814		104,119		109,081
APAC	33,577		27,973		21,696
LATAM	18,010		14,155		10,178
Total revenue	$	354,004	$	313,789	$	298,836

CardioGenesis cardiac laser therapy business abandonment:

In February 2023 our supplier of CardioGenesis cardiac laser therapy handpieces informed us that it was exiting the business and will no longer be supplying handpieces effective immediately because the sole-source manufacturer of tubing used in the handpiece assembly had gone out of business and a new supplier had yet to be identified and qualified. We evaluated the impact of this disruption on our CardioGenesis cardiac laser therapy business and possible avenues for resumption of supply including the evaluation of alternate suppliers and handpiece manufacturers. As of June 30, 2023 we were unable to identify an alternative source of supply or handpiece manufacturer and do not foresee a resumption of this business in the future. As a result, we wrote-off all of our CardioGenesis cardiac laser therapy assets and recorded an expense of $390,000 during the twelve months ended December 31, 2023 on our Consolidated Statements of Operations and Comprehensive Loss.

Also see segment disclosure in Note 16 below.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-9

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-10

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-15

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-12

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-13

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Topic 606
-Publisher FASB
-URI https://asc.fasb.org//606/tableOfContent

+ Details

Loss Per Common Share

12 Months Ended

Dec. 31, 2023

Earnings Per Share [Abstract]

Loss Per Common Share

The following table sets forth the computation of basic and diluted loss per common share (in thousands, except per share data):


Basic loss per common share	2023		2022		2021
Net loss	$	(30,690)	$	(19,192)	$	(14,834)
Net loss allocated to participating securities	123		98		94
Net loss allocated to common shareholders	$	(30,567)	$	(19,094)	$	(14,740)

Basic weighted-average common shares outstanding	40,743		40,032		38,983
Basic loss per common share	$	(0.75)	$	(0.48)	$	(0.38)

Diluted loss per common share	2023		2022		2021
Net loss	$	(30,690)	$	(19,192)	$	(14,834)
Net loss allocated to participating securities	123		98		94
Net loss allocated to common shareholders	$	(30,567)	$	(19,094)	$	(14,740)



Diluted weighted-average common shares outstanding	40,743		40,032		38,983
Diluted loss per common share	$	(0.75)	$	(0.48)	$	(0.38)

We excluded stock options from the calculation of diluted weighted-average common shares outstanding if the per share value, including the sum of (i) the exercise price of the options and (ii) the amount of the compensation cost attributed to future services and not yet recognized, was greater than the average market price of the shares because the inclusion of these stock options would be antidilutive to loss per common share. For the years ended December 31, 2023, 2022, and 2021 all stock options and awards were excluded from the calculation of diluted weighted-average common shares outstanding as these would be antidilutive to the net loss.

Debt (Schedule of Debt Maturities) (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Debt Disclosure [Abstract]
2024	$ 2,588
2025	102,458
2026	2,250
2027	204,749
Thereafter	0
Total	$ 312,045

Stock Compensation (Narrative) (Details) $ in Thousands				3 Months Ended	12 Months Ended
Stock Compensation (Narrative) (Details) $ in Thousands	May 16, 2023 shares	Feb. 13, 2023	Aug. 11, 2020 shares	Dec. 31, 2020 USD ($)	Dec. 31, 2023 USD ($) item shares	Dec. 31, 2022 USD ($) item shares	Dec. 31, 2021 USD ($) shares	Dec. 31, 2020 shares	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total fair value \| $					$ 6,400	$ 5,800	$ 7,300
Employees purchased common stock, shares					141,000	95,000	87,000
Capitalized stock compensation expense \| $					$ 724	$ 598	$ 566
RSAs, RSUs, And PSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Shares					681,000	871,000	500,000
Aggregate grant date market value \| $					$ 9,700	$ 13,500	$ 12,600
Unrecognized compensation costs \| $					$ 9,100
PSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Shares					308,000	182,000	215,000
Number of performance stock unit grants \| item					2	2
Expected weighted-average period for recognizing the unrecognized compensation costs, in years					6 months 3 days
Annual PSU
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award performance period						1 year	1 year
Annual PSU \| Share-based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage					148.00%	51.00%	110.00%
Annual PSU \| Maximum \| Share-based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage					150.00%		150.00%
Special PSU
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award performance period							1 year
Special PSU \| Share-based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage		89.00%			200.00%	140.00%	118.00%
Special PSU \| Maximum \| Share-based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage					200.00%	200.00%	200.00%
LTIP PSU
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award performance period									5 years
LTIP PSU \| Share-based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage					213.00%	136.00%
LTIP PSU \| Share-based Payment Arrangement, Tranche One \| Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage					142.00%	108.00%
LTIP PSU \| Maximum \| Share-based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage									288.00%
LTIP PSU \| Maximum \| Share-based Payment Arrangement, Tranche One \| Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage									192.00%
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Shares					110,000	1,031,000	226,000
Unrecognized compensation costs \| $					$ 3,100
Expected weighted-average period for recognizing the unrecognized compensation costs, in years					1 year 6 months 18 days
RSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Shares					327,000	643,000	144,000
Expected weighted-average period for recognizing the unrecognized compensation costs, in years					1 year 7 months 28 days
RSAs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Shares					78,000	64,000	140,000
Expected weighted-average period for recognizing the unrecognized compensation costs, in years					3 months 18 days
2020 Equity and Cash Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Increase in shares authorized under plan	3,000,000		4,100,000					2,700,000
2009 Employee Stock Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted, Shares			1,400,000
LTIP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Reversal in expense \| $				$ 1,900

Sale of PerClot (Details) - USD ($) $ in Thousands			12 Months Ended
Sale of PerClot (Details) - USD ($) $ in Thousands	May 23, 2023	Jul. 28, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of non-financial assets, net			$ 14,250	$ 0	$ 19,000
Gain from sale of non-financial assets			14,250	0	15,923
Total sources of revenue			354,004	313,789	$ 298,836
Sublease Income			278	$ 306
PerClot
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration for sale of assets		$ 41,000
Proceeds from sale of non-financial assets, net		25,000
Derecognition of intangible assets		1,600
Write off of prepaids		1,500
Gain (loss) on disposition of business		15,900
Gain from sale of non-financial assets			14,300
Total sources of revenue			$ 5,100
PerClot \| Transfer Of PerClot Manufacturing Equipment
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent consideration receivable		780
PerClot \| Starch Medical Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent liability payment	$ 4,500
PerClot \| Artivion, Inc. And Starch Medical, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration for sale of assets		54,500
Proceeds from sale of non-financial assets, net	$ 18,800	25,000
PerClot \| Artivion, Inc. And Starch Medical, Inc. \| Baxter Achievement Of Worldwide Sales
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent consideration receivable		10,000
PerClot \| Starch Medical Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration for sale of assets		13,500
Proceeds from sale of non-financial assets, net		6,000
PerClot \| Starch Medical Inc. \| Baxter Achievement Of Worldwide Sales
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contingent consideration receivable		$ 3,000

Acquisition of Ascyrus	12 Months Ended
Acquisition of Ascyrus	Dec. 31, 2023
Business Combination, Recognized Identifiable Assets Acquired, Goodwill, and Liabilities Assumed, Less Noncontrolling Interest [Abstract]
Acquisition of Ascyrus	Acquisition of Ascyrus Overview On September 2, 2020 we entered into a Securities Purchase Agreement (the “Ascyrus Agreement”) to acquire 100% of the outstanding equity interests of Ascyrus Medical LLC (“Ascyrus”). Ascyrus developed the AMDS, the world’s first aortic arch remodeling device for use in the treatment of acute Type A aortic dissections. Under the terms of the Ascyrus Agreement, we will pay an aggregate of up to $200.0 million in consideration, consisting of: (i) a cash payment of approximately $60.0 million and the issuance of $20.0 million in shares of Artivion common stock, in each case, that were delivered at the closing of the acquisition, (ii) a cash payment of $10.0 million and the issuance of $10.0 million in shares of Artivion common stock upon FDA approval of the Investigational Device Exemption (“IDE”) application for the AMDS in 2021, (iii) if the FDA approves PMA application submitted for the AMDS, a cash payment of $25.0 million, (iv) if regulatory approval of the AMDS is obtained in Japan on or before June 30, 2027, a cash payment of $10.0 million, (v) if regulatory approval of the AMDS is obtained in China on or before June 30, 2027, a cash payment of $10.0 million and (vi) a potential additional consideration cash payment capped at $55.0 million (or up to $65.0 million to $75.0 million if the Japanese or Chinese approvals are not secured on or before June 30, 2027 and those approval milestone payments are added to the potential additional consideration cash payment cap) calculated as two times the incremental worldwide sales of the AMDS (or any other acquired technology or derivatives of such acquired technology) outside of the European Union during the three-year period following the date the FDA approves a PMA application submitted for the AMDS. Accounting for the Transaction As part of the acquisition, we may be required to pay additional consideration up to $100.0 million to the former shareholders of Ascyrus upon the achievement of certain milestones and the sales-based additional earnout described above. On September 2, 2020 the fair value of the total potential purchase consideration of $200.0 million included the total purchase consideration, as well as the contingent consideration liability discussed below. Our allocation of the purchase consideration was allocated to Ascyrus’s tangible and identifiable intangible assets acquired and liabilities assumed, based on their estimated fair values as of September 2, 2020. The contingent consideration represents the estimated fair value of future potential payments. The fair value of the contingent consideration liability was estimated by discounting to present value the contingent payments expected to be made based on a probability-weighted scenario approach. We applied a discount rate based on our unsecured credit spread and the term commensurate risk-free rate to the additional consideration to be paid, and then applied a risk-based estimate of the probability of achieving each scenario to calculate the fair value of the contingent consideration. This fair value measurement was based on unobservable inputs, including management estimates and assumptions about the future achievement of milestones and future estimate of revenues, and is, therefore, classified as Level 3 within the fair value hierarchy presented in Note 5. We used a discount rate of approximately 7% and estimated future achievement of milestone dates between 2025 and 2026 to calculate the fair value of contingent consideration as of December 31, 2023. We will remeasure this liability at each reporting date and will record changes in the fair value of the contingent consideration in General, administrative, and marketing expenses on the Consolidated Statements of Operations and Comprehensive Loss. Increases or decreases in the fair value of the contingent consideration liability can result from changes in passage of time, discount rates, the timing and amount of our revenue estimates, and the timing and expectation of regulatory approvals. We performed an assessment of the fair value of the contingent consideration and recorded a fair value increase of $23.5 million and a fair value reduction of $9.0 million for the twelve months ended December 31, 2023 and 2022, respectively, in General, administrative, and marketing expenses on the Consolidated Statements of Operations and Comprehensive Loss, as a result of this assessment. In December 2021 the FDA approved our IDE application for AMDS. Upon the approval, we funded a cash payment of $10.0 million and issued $10.0 million in shares of Artivion common stock pursuant to the Ascyrus Agreement. The contingent consideration liability of $63.9 million and $40.4 million was included in Other long-term liabilities as of December 31, 2023 and 2022, respectively, in the Consolidated Balance Sheets.

Goodwill and Other Intangible Assets (Schedule of Carrying Values of Indefinite Lived Intangible Assets) (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Indefinite-lived Intangible Assets [Line Items]
Goodwill	$ 247,337	$ 243,631	$ 250,000
In-process R&D
Indefinite-lived Intangible Assets [Line Items]
Total indefinite lived intangible assets	2,154	2,080
Procurement contracts and agreements
Indefinite-lived Intangible Assets [Line Items]
Total indefinite lived intangible assets	$ 2,013	$ 2,013

- Definition

+ References + Details

Leases (Tables)

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Schedule of Supplemental Balance Sheet Information Related to Leases

Information related to leases included in the Consolidated Balance Sheets was as follows (in thousands, except lease term and discount rate):


Operating leases:	December 31, 2023		December 31, 2022


Operating lease right-of-use assets, net	$	43,822	$	41,859

Current maturities of operating leases	$	3,395	$	3,308
Non-current maturities of operating leases	43,977		41,257
Total operating lease liabilities	$	47,372	$	44,565

Finance leases:
Property and equipment, at cost	$	6,862	$	6,408
Accumulated amortization	(3,136)		(2,498)
Property and equipment, net	$	3,726	$	3,910

Current maturities of finance leases	$	582	$	513
Non-current maturities of finance leases	3,405		3,644
Total finance lease liabilities	$	3,987	$	4,157

Weighted average remaining lease term (in years):
Operating leases	10.4		11.9
Finance leases	6.8		7.8

Weighted average discount rate:
Operating leases	6.3%		5.9%
Finance leases	2.2%		2.1%

Summary of Lease Costs

A summary of lease expenses for our finance and operating leases included in General, administrative, and marketing expenses on our Consolidated Statements of Operations and Comprehensive Loss was as follows (in thousands):


	December 31, 2023		December 31, 2022
Amortization of property and equipment	$	542	$	518
Interest expense on finance leases	84		89
Total finance lease expense	626		607
Operating lease expensea	7,354		7,432
Sublease income	(278)		(306)
Total lease expense	$	7,702	$	7,733

______________________

a Total rental expense for operating leases was $7.5 million in 2021. The operating lease expense included right-of-use asset amortization and interest expense on the lease liability.

Schedule of Supplemental Cash Flow Information Related to Leases

A summary of our cash flow information related to leases was as follows (in thousands):


Cash paid for amounts included in the measurement of lease liabilities:	2023		2022
Operating cash flows for operating leases	$	7,263	$	6,927
Financing cash flows for finance leases	539		507
Operating cash flows for finance leases	84		90

Schedule of Minimum Lease Payments for Finance, Operating, and Sublease Income Leases

Future minimum lease payments are as follows (in thousands):


	Finance Leases		Operating Leases
2024	$	655	$	6,302
2025	648		7,085
2026	627		6,539
2027	617		6,058
2028	599		5,862
Thereafter	1,136		33,920
Total minimum lease payments	$	4,282	$	65,766
Less amount representing interest	(295)		(18,394)
Present value of net minimum lease payments	3,987		47,372
Less current maturities	(582)		(3,395)
Lease obligations, less current maturities	$	3,405	$	43,977

Income Taxes (Narrative) (Details) - USD ($)	12 Months Ended
Income Taxes (Narrative) (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Investments, Owned, Federal Income Tax Note [Line Items]
Effective income tax rate	42.00%	28.00%
Net deferred tax liability	$ 20,764,000	$ 23,185,000
Valuation allowances against deferred tax assets	32,860,000	17,942,000	$ 13,282,000	$ 7,170,000
Federal net operating loss carryforwards related to the acquisitions of Cardiogenesis and Hemosphere	1,300,000
State net operating loss carryforwards	1,500,000
Foreign net operating loss carryforwards	443,000
Research and development tax credit carryforwards	293,000
Other tax credit	81,000
Excess interest carryforward	6,438,000	5,559,000
Interest deduction limit	20,400,000	8,100,000
Non-current liabilities recorded related to interest and penalties on uncertain tax positions	372,000	358,000
Penalties and interest income (expense)	6,500	145,000	(35,000)
Total uncertain tax liability including interest and penalties	5,200,000	4,900,000
Uncertain tax liability recorded as reduction to deferred tax assets	100,000	100,000
Uncertain tax liability recorded to non-current liability	5,100,000	4,800,000
Approximate amount that would affect tax rate	4,400,000	$ 3,600,000	$ 3,200,000
Approximate amount of uncertain tax liability to be recognized	100,000
Foreign Authority
Investments, Owned, Federal Income Tax Note [Line Items]
Net deferred tax liability	$ 119,000

Segment and Geographic Information (Narrative) (Details)	12 Months Ended
	Dec. 31, 2023 USD ($) segment	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Revenues from External Customers and Long-Lived Assets [Line Items]
Number of reportable segments \| segment	2
Total sources of revenue	$ 354,004,000	$ 313,789,000	$ 298,836,000
Goodwill	247,337,000	243,631,000	250,000,000
Domestic
Revenues from External Customers and Long-Lived Assets [Line Items]
Total sources of revenue	179,485,000	161,113,000	151,151,000
Long-lived assets	17,500,000	18,000,000
International
Revenues from External Customers and Long-Lived Assets [Line Items]
Total sources of revenue	174,519,000	152,676,000	147,685,000
Long-lived assets	20,900,000	20,700,000
Medical devices
Revenues from External Customers and Long-Lived Assets [Line Items]
Goodwill	247,300,000	243,600,000
Intersegment Eliminations
Revenues from External Customers and Long-Lived Assets [Line Items]
Total sources of revenue	$ 0	$ 0	$ 0
Revenue \| Geographic Concentration Risk \| Germany
Revenues from External Customers and Long-Lived Assets [Line Items]
Concentration percentage	8.00%	9.00%	10.00%
Long-Lived Assets \| Geographic Concentration Risk \| Germany
Revenues from External Customers and Long-Lived Assets [Line Items]
Concentration percentage	97.00%

Employee Benefit Plans	12 Months Ended
Employee Benefit Plans	Dec. 31, 2023
Retirement Benefits [Abstract]
Employee Benefit Plans	Employee Benefit Plans 401(k) Plan We have a 401(k) savings plan (“401(k) Plan”) providing retirement benefits to all US employees who have completed at least three months of service. We made matching contributions of each participant's contribution up to 4.0% of each participant’s salary in 2023, 2022 and 2021. Our contributions approximated $2.6 million, $2.6 million, and $2.1 million for the years ended 2023, 2022, and 2021, respectively. We may make discretionary contributions to the 401(k) Plan; however, no discretionary contributions were made in any of the past three years. Deferred Compensation Plan Our Deferred Compensation Plan (“Deferred Plan”) allows certain of our US employees to defer receipt of a portion of their salary and cash bonus. The Deferred Plan provides for tax-deferred growth of deferred compensation. Pursuant to the terms of the Deferred Plan, we agree to return the deferred amounts plus gains and losses, based on investment fund options chosen by each respective participant, to the plan participants upon distribution. All deferred amounts and deemed earnings thereon are vested at all times. We have no current plans to match any contributions. Amounts owed to plan participants are unsecured obligations of the Company. We have established a rabbi trust in which it will make contributions to fund our obligations under the Deferred Plan. Pursuant to the terms of the trust, we will be required to make contributions each year to fully match our obligations under the Deferred Plan. The trust’s funds are primarily invested in Company Owned Life Insurance (“COLI”), and we plan to hold the policies until the deaths of the insured. Our deferred compensation liabilities are recorded as a component of Other current liabilities and long-term Deferred compensation liabilities, as appropriate, on the Consolidated Balance Sheets based on the anticipated distribution dates. We recorded $491,000 in Other current liabilities and $6.8 million in Long-term liabilities as of December 31, 2023 in the Consolidated Balance Sheets. We recorded $5.5 million in Long-term liabilities as of December 31, 2022 in the Consolidated Balance Sheets. The cash surrender value of COLI recorded in Other long-term assets on the Consolidated Balance Sheets was $6.9 million and $5.5 million as of December 31, 2023 and 2022, respectively. Changes in the value of participant accounts and changes in the cash surrender value of COLI are recorded as part of our operating expenses and are subject to our normal allocation of expenses to inventory and deferred preservation costs.

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Schedule of (Loss) Income Before Income Taxes

Loss before income taxes consisted of the following (in thousands):


	2023		2022		2021
Domestic	$	(24,658)	$	(13,798)	$	(10,263)
Foreign	3,072		(1,186)		(4,564)
Loss before income taxes	$	(21,586)	$	(14,984)	$	(14,827)

Schedule of Income Tax Expense Benefit

Income tax expense consisted of the following (in thousands):


	2023		2022		2021
Current:
Federal	$	5,573	$	1,606	$	1,896
State	1,004		367		551
Foreign	3,851		3,120		3,391
	10,428		5,093		5,838
Deferred:
Federal	$	222	$	236	$	(2,801)
State	157		234		(307)
Foreign	(1,703)		(1,355)		(2,723)
	(1,324)		(885)		(5,831)
Income tax expense	$	9,104	$	4,208	$	7

Schedule of Effective Income Tax Rate Reconciliation


	2023		2022		2021
Tax benefit at statutory rate	$	(4,533)	$	(3,147)	$	(3,114)

Increase (reduction) in income taxes resulting from:
Valuation allowance change	9,964		4,779		1,566
Foreign income taxes	2,969		415		1,138
Nondeductible executive compensation	989		878		1,075
Equity compensation	872		472		(477)
Net change in uncertain tax positions	652		527		762
State income taxes, net of federal benefit	281		484		73
Nondeductible entertainment expenses	262		117		65
Foreign interest disallowance	—		151		307
Foreign deferred items	—		(112)		53
Foreign derived intangible income deduction	(501)		(133)		(144)
Research and development credit	(800)		(961)		(959)
Provision to return adjustments	(937)		336		63
Other	(114)		402		(401)
Total income tax expense	$	9,104	$	4,208	$	7

Schedule of Deferred Tax Assets and Liabilities

The tax effects of temporary differences which give rise to deferred tax assets and liabilities at December 31 were as follows (in thousands):


	2023		2022
Deferred tax assets:
Finance and operating leases	$	13,254	$	12,581
Excess interest carryforward	6,438		5,559
Unrealized gains and losses	5,424		—
Loan revaluation	3,859		2,633
Loss carryforwards	3,205		9,660
Stock compensation	2,761		2,463
Accrued expenses	2,567		1,734
Deferred compensation	1,790		1,317
Property	1,786		1,310
Credit carryforwards	336		503
Inventory and deferred preservation costs write-downs	302		764
Other	1,422		1,650
Less valuation allowance	(32,860)		(17,942)
Total deferred tax assets, net	10,284		22,232

	2023		2022
Deferred tax liabilities:

Unrealized gains and losses	—		(6,624)
Prepaid items	(370)		(323)
Debt costs	(626)		(818)
Finance and operating leases	(12,777)		(12,217)
Intangible assets	(16,106)		(24,601)
Other	(1,169)		(834)
Total deferred tax liabilities	(31,048)		(45,417)

Total deferred tax liabilities, net	$	(20,764)	$	(23,185)

Summary of Valuation Allowance Deferred Tax Assets

A summary of valuation allowances against deferred tax assets was as follows (in thousands):


	2023		2022		2021
Beginning balance	$	17,942	$	13,282	$	7,170
Additions in estimates recorded to deferred income tax expense, net	9,809		4,660		1,505
Additions related to Other comprehensive income, net	5,109		—		4,607
Ending balance	$	32,860	$	17,942	$	13,282

Schedule of Uncertain Tax Position Liability and Liability for Interest and Penalties on Uncertain Tax Positions

A reconciliation of the beginning and ending balances of our uncertain tax position liability, excluding interest and penalties, was as follows (in thousands):


	2023		2022		2021
Beginning balance	$	4,508	$	4,089	$	2,574
Increase related to current year tax positions	2,728		847		1,661
Increase (decrease) for foreign exchange differences	116		(145)		(121)
Increase related to prior year tax positions	26		20		386
Decrease due to the lapsing of statutes of limitations	(158)		(200)		(241)
Decrease related to prior year tax positions	(508)		(103)		(170)
Decrease due to settlements of prior year tax positions	(1,880)		—		—
Ending balance	$	4,832	$	4,508	$	4,089