Artivion at 2025 Truist MedTech Conference: Aortic Strategy Unveiled

On Tuesday, 17 June 2025, Artivion (NYSE:AORT) presented its strategic vision at the 2025 Truist Securities MedTech Conference. The company’s leadership highlighted its focus on aortic conditions and the promising pipeline of products aimed at improving patient outcomes. While the outlook is optimistic, challenges such as hospital bureaucracy and market adoption remain.

Key Takeaways

• Artivion focuses on advanced stent grafts and mechanical valves for aortic conditions.
• The company aims for EBITDA growth at twice the rate of revenue growth.
• Key products like AMDS and NEXUS are in various stages of development and approval.
• Artivion plans to exercise its option to acquire Endospan following FDA approval of NEXUS.
• Supply chain disruptions from a prior cyberattack have been resolved.

Financial Results

Artivion’s financial strategy is centered on leveraging high-margin products and operational efficiency:

• Revenue growth is expected to accelerate in the second half of the year, driven by AMDS and On-X valve sales.
• EBITDA growth is targeted at twice the rate of top-line growth, supported by G&A leverage and sales force efficiency.
• Current gross margin stands at 65%, with AMDS expected to significantly enhance margins due to its 90%+ gross margin.
• The conversion of $100 million in convertible debt into 4.3 million shares has improved the balance sheet.

Operational Updates

Artivion is advancing its product pipeline and addressing operational challenges:

• AMDS is being launched in the U.S., with a mid-2026 target for PMA approval.
• NEXUS trial data shows a low stroke rate, with PMA submission expected within 18 months.
• The On-X valve business continues to grow, with a 14% CAGR over eight years.
• Supply chain issues from a cyberattack have been resolved, with recovery expected by the end of Q3.

Future Outlook

Artivion’s future growth is anchored in its robust product pipeline and market expansion:

• The company plans to submit PMA applications every 18 months for products like AMDS, NEXUS, and Arecibo.
• Global market expansion includes targeting Europe, the U.S., and Japan.
• Sequential growth in AMDS adoption and new product launches are key growth drivers.
• Risks include the timing of AMDS adoption due to hospital bureaucracy and IRB processes.

Q&A Highlights

During the Q&A session, Artivion’s management addressed several topics:

• AMDS adoption faces challenges with hospital value analysis committees and IRB approvals.
• NEXUS’s low stroke rate is a market differentiator, designed for the aortic arch.
• Capital allocation focuses on funding the Endospan acquisition and pipeline development, with an emphasis on increasing free cash flow.

For a detailed account, refer to the full conference call transcript below.

Full transcript - 2025 Truist Securities MedTech Conference:

Rich Neuter, Analyst, Truist Securities: Great. Good morning everyone. Thanks for joining us. This is our second annual Truist MedTech Conference in Boston. I’m Rich Neuter.

I cover medical devices at Truist Securities. And to kick off our fireside chat track, we have Artivion and very fortunate to have Artivion’s CEO, Pat Mackin and CFO Lance Berry. Thanks to both of you for joining us. Nice to be here. Maybe just to kick it off, a good place to start.

I’m newer to the story, But one of the things that from following you guys in the periphery that struck me, you guys just have a very unique set of multiple TAMs that are, I don’t want to say bite size, but maybe smaller than what we’re accustomed to from some of the larger med tech players that are out there. But collectively, they offer quite durable growth runway it seems like, and at least for the foreseeable future. So I’d love to maybe just hear an overview of those. And it seems like you guys have new indications and geographic expansion potential in each one of those. And then you’ve also committed to I think EBITDA growth twice the level of your traffic and currency top line growth.

We’d just love to hear kind of how you maintain that and maybe some of the pillars there and provide people.

Pat Mackin, CEO, Artivion: Yeah, I think it all goes back to the strategy that we set several years ago. We’re an aortic focused company, which allows us to have a very tight and focused organization, channel, pipeline. And as you mentioned, individually these TAMs aren’t billion dollar TAMs, but when you string them together, it’s quite a nice offering. And the beauty of it, it’s the same call point, the same sales force. So if you look at our, the biggest part of our kind of unrealized TAM at this point is in the kind of stents and stent grafts for the aorta.

The global market for stents and stent grafts is about 4,000,000,000. About half of that is you know the more commoditized, they’ve been around for a while. So triple As and thoracics. I actually ran Medtronic’s business that has those products you know twenty plus years ago. The area where we’re focused, now we have some products in that area but that’s not really where our focus is.

We’re focused on the advanced stent graft segment which is also about 2,000,000,000. And in many cases those products haven’t even reached, no products have reached The U. S. Yet and we’re kind of a leader in that space. So if you kind of just look at our pipeline and just walk down the aorta and kind of chronologically what’s coming, our first kind of shot on goal is AMDS.

We got an HD back in January. That TAM is about 500 plus million. So we’re already starting to we’ve got it in Europe and other parts of the world. We’re now launching in The U. S.

The next PMA in the pipeline is NexSys from our investment in Endospan. Their data just read out in May at AATS. We would expect to see that PMA in The U. S. In the next eighteen months.

And then the third is our, what’s called the frozen elephant trunk segment, which is basically a total replacement of the aortic arch with a stent and a graft. We have a product called Arecibo. We expect that trial to start later this year. And then next on the list is a branched thoracoabdominal which is also about a half a billion. So if you go from the top, AMBS is 500.

If you go to NEXUS, 600. If you go to frozen elephant trunk, probably two fifty. And if you go to branched thoracoabdominal, another 500. So you’ve got about $2,000,000,000 And the beauty of all these trials is we run a U. S.

Trial. We may have some European centers. But then a year later we submit to Japan. And then we use that data in other parts of the world. So yeah, think as you mentioned, I mean we’ve got a business that like every eighteen months there’s another PMA coming.

So we have products in different phases. We’re just launching AMBS. We finished the trial on Nexus. We’re starting the trial on our Civo and we’re getting ready to start the trial on our next device. So it’s just a kind of a flywheel of things that just keep coming out in a very which allows us to keep our R and D constant in the 7% to 8% range so we can manage it and not have to raise any money.

Rich Neuter, Analyst, Truist Securities: That’s great. Maybe just sticking with, we’ll go in the order there, AMDS. What are the next steps for the PMA and the timing there?

Lance Berry, CFO, Artivion: Yeah so the PMA, it’s a modular PMA, so we’ve submitted three of the four modules at this point. And we’re just working through the process. We have one more that has a testing that’s gonna take a little bit longer for us to finish and then submit. And so we’re looking at approval sometime mid-twenty six. I think the good thing is the HDE really gives us a year, year and a half jumpstart on the launch.

The product will be on the shelf in the hospital. And we really ought to be able to drive a significant amount of the benefits of the launch from the HDE. For those not familiar with the HDE, the one big limiting factor versus a PMA is there’s a cap on the number of procedures you can do in a given year. But for this particular indication, the cap is larger than the whole market. So it’s not really a cap for us.

So it’s a little bit, this HDE is much closer to a PMA than a normal HDE would be.

Rich Neuter, Analyst, Truist Securities: Got it. And maybe just talk a little bit about what aortic dissection is like today and how does AMBS fundamentally change that?

Pat Mackin, CEO, Artivion: Yeah, it’s really a devastating, it’s probably the worst disease in the cardiac space. I mean you, in simple terms, you get a tear in your aorta, in this case kind of in the ascending part right above the valve, and blood starts flowing down kind of a new tube. Which means blood’s not going to your brain, it’s not going to your kidneys, it’s not going to your legs, your gut. So it’s really, the mortality is like one to two percent per hour. These are patients that are medevaced in from kind of tertiary centers.

And the standard of care right now is just to fix the tear with a surgical graft. It’s called a hemiarch, it’s been around for fifty years, there’s really been no innovation. And in cases where there’s what we call malperfusion, where the bleeding, your blood’s going the wrong way, the mortality’s like thirty five percent. So all we’re saying is do the standard of care, put this big stent on, added the big stent, and cut mortality by seventy percent. So it really is, it’s a life changing device.

And we’re the only ones that have it. It’s patented and we have a long runway with this technology.

Rich Neuter, Analyst, Truist Securities: Maybe there’s been some studies recently published. Can you just maybe walk through some of the highlights from those?

Pat Mackin, CEO, Artivion: Yeah, so we ran a FDA trial called Persevere. It was in 25 centers in The US, the big aortic centers. Mass General here in town was in it. And it was in acute type A dissections with patients with malperfusion. And that means again they have blood that’s not going to all the end organs.

So the endpoints on these trials are extremely rigid, right? It’s mortality, stroke, do they require kidney dialysis, or do they have an infarct? So these are not soft endpoints. As I just mentioned, we, in the reference cohort, we saw the primary endpoint was greater than one major adverse event. The reference cohort, fifty eight percent of patients had one of those things happen to them.

They either died, had a stroke, needed dialysis, or had a heart attack. In the treated group in ’93, it was twenty seven percent. So like a fifty percent reduction in major adverse events, hard endpoints. The more impressive was the mortality. If you ask any cardiac surgeon if you have an acute type A with malperfusion, the mortality rate’s about thirty five percent.

We were nine point seven. Seventy two percent reduction. So it really is a life saving technology. And it’s really the first innovation in the aortic arch for acute type A’s in fifty years.

Rich Neuter, Analyst, Truist Securities: And just going commercial here, do you need to do anything to the sales force? Can you just drop this in? Or do you need to kind of build that out?

Lance Berry, CFO, Artivion: You know this is one of the great things about the business model is these products are all focused on the same call point. So no, we don’t really need to build out the sales force. The other thing is most of our products don’t have case coverage. So the reps aren’t standing in these cases. Once they get a surgeon up and going, they’re just not needed for the surgery.

So our current sales force should be completely adequate for launching this product. We have no sales force expansion plans this year. I think further down the line, I think there’s an opportunity maybe for some small incremental increase in the sales force just as it gives us an opportunity not only to sell AMDS and other accounts but also it’s the same surgeons that are using our mechanical valves, using our surgical sealant. So I think there’s a really good cross sell opportunity but that’s really more of an upside opportunity than a required investment.

Rich Neuter, Analyst, Truist Securities: Got it. And have you given any color on kind of how you think that ramp will progress and go?

Lance Berry, CFO, Artivion: Yeah the ramp is tough because really the barriers to the ramp are your normal value analysis committee, which I think most people in med tech understand how bureaucratic and challenging that can be in certain centers. It’s not really, in the end, not a barrier to actually getting in, but it can significantly draw out the time that it takes you to get in the hospital. And then with the HDE, each hospital has to have an IRB. So it’s just for the site, it’s not for every patient, but that’s another administrative thing they have to go through. And so what you’re really trying to predict is how long does it take me to get through these two levels of hospital bureaucracy?

And it’s all over the board. Some that can happen pretty quickly, some that takes months. So that’s the big limiter on the ramp. Far we’ve been working through the process. Gotten, we said on our Q3 call we had over 150 accounts that we’re actively working on, value analysis committees and IRBs, which we felt like that’s a great start out of the gate.

And we’ll see how long it takes us to get through them. We’ve also learned some things, particularly as it relates to IRB. These hospitals are very familiar with IRBs but not really for HDEs. Normally they’re doing them for a clinical trial, for example. So this is a little bit different.

This is possibly the first time they’ve ever done one for an HDE. And so we’ve kinda learned how to package that a little bit better for them so they understand.

Rich Neuter, Analyst, Truist Securities: Is it more cumbersome?

Lance Berry, CFO, Artivion: It’s not more cumbersome. In some ways it’s less cumbersome. You’re not gonna have to consent to every patient. But it’s more just, it’s not what they’re used to.

Rich Neuter, Analyst, Truist Securities: It’s different.

Lance Berry, CFO, Artivion: It’s different. In some ways easier once they understand. So I think that was a learning we’ve had in the first few months. We’ve kind of repackaged our materials to help people understand and that’s going better now. Got it.

Rich Neuter, Analyst, Truist Securities: So 2026 is not really the year that we should expect major inflection or contribution Well it’s tough to say.

Lance Berry, CFO, Artivion: Yeah I mean I think we should just, directionally we should think sequential growth quarter to quarter for a while. Yeah.

Rich Neuter, Analyst, Truist Securities: Maybe just kind of moving down, you know, we started with the MBS $500,000,000 TAM and then I think you said NEXUS is potentially 600. Let’s talk a little bit more about NEXUS now. I think you also had some data there at AATS that you referenced.

Pat Mackin, CEO, Artivion: Yeah, so The US pivotal trial, much like AMBS, was like ninety three patients. The pivotal trial for NEXUS in The US was about sixty patients in chronic dissections. And what’s interesting is that these patients that have an acute type dissection today will have a chronic dissection in ten years. So these pieces go together. So we ran a trial, our partner Endospan ran a sixty patient trial, very similar type endpoints, right?

So mortality, stroke, do they require kidney dialysis, were they paralyzed? You know, very hard endpoints. And these are in patients that are at very high risk of surgery. So when you, and we’ve talked to a bunch of clinicians from the trial. Mortality was similar, kind of in the sub ten percent range between the surgical reference cohort, which you would expect given the sickness of these patients.

Stroke rate was less than six, which is on par with surgery, but phenomenal for a catheter based technology. It’s one of the lowest that’s ever been printed. What’s super impressive is no patients were paralyzed. About two percent on surgical are because if you cover certain branches of the spinal cord, the patient actually comes out of the operation paralyzed. So was about two percent we had none.

And then about five or six percent of patients have to have lifelong dialysis after this because of the hit from the heart lung machine. None. So it’s all catheter, it’s really the future. The clinicians are very excited about it and it fits perfectly within our aortic strategy. It’s the same hospitals.

It’s the same part of the anatomy. This is a pure catheter. And we’ve seen, we already commercialized this product in Europe. We’ve seen patients who are out of the ICU in a day versus eight to 10. So I think the resource utilization on this is going be a big win for the healthcare system and for the patients.

Rich Neuter, Analyst, Truist Securities: Just remind me where, what geographies this is in.

Pat Mackin, CEO, Artivion: So we currently sell it in Europe. So we’ve been in Europe for like the last five years and this configuration is a single branch device. We are already selling a two and a three branch system in Europe today. So that’s, there’s a pipeline coming with that as well.

Rich Neuter, Analyst, Truist Securities: And just for this one and AMDS, just the $506,100,000,000 dollar TAMs, can you just, OUS, is that a, that’s what the

Pat Mackin, CEO, Artivion: word why you Those are global? Global, yeah. Yeah, so for example, the TAM for AMDS, probably like 150 Europe, 150 US, another 100 Japan, and then we get approvals kind of in all these other places off of The U. S. Trial.

So the only part that’s like not in that big number would probably be China because we’re not doing a lot of work in China for various reasons. But pretty much we probably get access to, with The US clinical trial, we get access to probably 75% of the TAMs for all of those.

Rich Neuter, Analyst, Truist Securities: Okay, so right now you have 25% addressable and that’ll open up the remaining. Same kind of split to think on NexSys. Similar. Me. And you mentioned Endospan.

I guess you have an option to purchase there. What is this, I mean it was positive data, but very positive. So I guess, does that mean there’s a higher likelihood that you’re gonna exercise?

Lance Berry, CFO, Artivion: Yeah first of just for everyone that’s listening, we have an option to purchase Indaspan. We have ninety days post FDA approval to exercise our options. We don’t have to make a decision until we know for sure the product is going to get on to The US market. And it’s $135,000,000 upfront when we exercise our option. And then there’s an earn out on incremental revenue in year two, two point five times that.

So that’s the basic deal. As Pat said, we’ve been distributing the product in Europe for a while. We’re big fans. We think it’s a great technology. Obviously the data readout was great.

So hopefully we get through the regulatory process and it goes well. I think a reasonable assumption is if it gets approved, think we should assume that we’ll exercise our option. However in the meantime now that we have this data, we’re gonna be doing our research and understand our original beliefs about the size of the market, rate of adoption, those types of things. Do we still think those hold true now that we have hard data, now that we’ve had surgeons in The US that have used this? So we’ll do our further diligence on that, so no guarantees.

But if you think about capital allocation, I think it’s a reasonable assumption that if it gets approved that we would spend that 135.

Rich Neuter, Analyst, Truist Securities: Since you brought it up, just maybe we’ll pivot there for a minute on capital allocation. Obviously that’s one important key kind of item that we need to be considering over the near to intermediate term. Anything else you want to say on capital allocation strategy and how that fits into a broader?

Lance Berry, CFO, Artivion: Yeah so anyone that’s followed us has known that we’ve been pretty levered in the past. The company had EBITDA and cash flow and Pat levered up and did these acquisitions that are really transformed the company and are really right now about to get the payoff. And we’ve done a really good job of getting that leverage down quite a bit. We also just recently, we had $100,000,000 convertible debt that we converted into shares that got it down further. So we’re in a really good spot right now.

And I think the main thing is to stay there. Let’s keep our leverage at a reasonable level while if we get the opportunity to purchase Endospan and fund our pipeline, which we feel really good about. So we feel like we can do both of those with where we are now without having to lever up. We expect to be significantly increasing our free cash flow from here. We’re free cash flow positive.

The big thing that kind of eats up our EBITDA to free cash flow is interest expense. So we took that down a little bit when we converted into shares, and then as we can generate more we can pay down debt and be able to even produce more free cash flow. So right now it’s kind of like be able to fund Endospan if we’re able to do that as efficiently as possible and drive our leverage down as much as we can.

Rich Neuter, Analyst, Truist Securities: Yep, and sorry, and just taking out the convert, specifically what for the balance sheet currently?

Lance Berry, CFO, Artivion: So took $100,000,000 of debt off the balance sheet and put 4,300,000.0 additional shares out.

Rich Neuter, Analyst, Truist Securities: Got it. And and the Nexus results that were recently presented, what was the doctor feedback and

Pat Mackin, CEO, Artivion: Yeah. It was it was presented in early May out at a big cardiac meeting, AATS in Seattle. And I I had a chance to, I think I met with 20. And what’s unique about this is it’s cardiac and vascular surgeons, which we actually work with both. And I would say that to a person the comments were like, this is great data.

They would jump to the stroke data and say, no one’s put up numbers like that. And if you look deeper, if people are interested, if you look deeper into this category, it’s really all about stroke rate. The patient’s level of how sick they are coming in is probably going to drive the mortality of the data. But when you put a catheter up into the aortic arch and start manipulating it, that’s what’s driving stroke. And this system was specific, the NEXUS system was specifically designed for the aortic arch.

It’s got step by step procedures, and it’s the way it’s deployed. It’s the lowest stroke rate to my knowledge that’s been published in this field. So I think that was super exciting. And then the fact we already mentioned the fact that there was no hit, no dialysis requirements, and no one was paralyzed was a pretty huge outcome.

Rich Neuter, Analyst, Truist Securities: And you were, just going down the three main drivers, you talked about the aortic arch opportunity being $250,000,000 I think, right?

Pat Mackin, CEO, Artivion: So the, it gets confusing. So when you’re in the arch, there’s multiple diseases that can happen. So if you start up kind of with acute type A’s above the aortic valve, that’s one condition, that’s AMDS. We also have the frozen elephant trunk called Arecibo. That can also be used in acute type A’s.

It gets really technical but trust me. Then you progress to a chronic dissection or aneurysm. That can be used with, you can’t use AMDS there, but you can use Nexus or Arecibo. So they, it just depends on like what’s the disease, what’s the patient’s conditions, all these things like which device they’re going to use. Frankly, that was the whole part of the strategy.

We have all of them. And we’re somewhat agnostic. I mean these are $30,000 devices at 90% gross margin. I want what’s best for the surgeon and the patient.

Rich Neuter, Analyst, Truist Securities: Just On X, your On X mechanical valve, that’s been a durable growth driver for you the last few years. Just how stable is that?

Pat Mackin, CEO, Artivion: I mean On X is, we’ve owned, we acquired On X probably eight years ago I think. We’ve grown that business 14% CAGR over that timeframe. And people kept asking like, when’s that gonna run out, when’s that gonna run out? So the TAM on that is about $250,000,000 worldwide. So it’s mechanical aortic and mitral valves.

So there three clinical trials that got us to where we are today. The first one, which was back eight years ago, we’re the first company to do a trial where we could actually prove you could take like half the blood thinners. And when you did that you had a 60% reduction in bleeding. The big knock on a mechanical valve versus a bioprosthetic is the mechanicals last forever, but you gotta take a blood thinner. Tissue valves, no blood thinner, but they don’t last very long, particularly in young patients.

So we got an FDA approval for a low INR, you can almost cut your blood thinners in half, and you reduce bleeding by 60%. That’s why we took all the share and grew like almost 15%. The FDA required us to do a PMA, or a post market approval trial, like they always do, in 500 valves in the real market. 60 centers in The U. S.

We did that trial. We reported those data about a year ago. 87% reduction in major bleeding. That’s also driving growth. And then the real gift was in January there was a big trial presented that we weren’t even in, I didn’t even know it was coming.

One hundred and nine thousand patients in the STS database. They showed a mortality difference. When you hit 60, if you get a tissue valve under 60, you have a higher likelihood of dying versus if you get a mechanical valve. So we’ve done our market research. We think there’s, now the door has opened for us to go after bioprosthetic market in patients 60, which is about $100,000,000 TAM increase from the two fifty.

So that’s gonna provide another wave of growth for the On X valve. And by the way, when we train surgeons on AMDS or NexSys or Arecibo, they all can use the Onyx valve, they can all use our BioGlue. So it’s just a very kind of synergistic cross selling opportunity.

Rich Neuter, Analyst, Truist Securities: Sorry if this is a naive question. How do you translate that data from January STS data set? How do you translate that to a guideline update or?

Pat Mackin, CEO, Artivion: Yeah, the guidelines take some time. So interesting, when Onyxx, when we did the original low INR, Onyxx is the only valve mentioned by names in the guidelines. Never been done before. So we’ll, it’ll be curious to see what happens with the guidelines off this new paper. But it takes time, right?

These don’t happen like the next day. It takes time. So those are the guidelines committees and things like that. But we’re already in the guidelines for low

Rich Neuter, Analyst, Truist Securities: But between, I mean if I’m hearing you correctly, between the expanding TAM as a result of this positive data or mortality benefit and you know, you still had runway previously. Is there any reason why this shouldn’t be a steady double digit growth asset for you?

Pat Mackin, CEO, Artivion: Yeah, think this is gonna be a continued grower. We’re doing some market research right now off that new data. So I don’t want to get over my skis, but I think we can come back probably in the fall with more definitive what it be. But mean Onyx has been growing double digits for almost a decade and we don’t see it slowing down.

Rich Neuter, Analyst, Truist Securities: Yeah. Maybe just going to your outlook for the year. I think you bumped it slightly on What’s and there’s an implied growth acceleration in the back half and you kind of gave us some of the reasons why that should happen. But maybe what’s driving your confidence in that? If you could just summarize that for us.

Lance Berry, CFO, Artivion: Yeah, think there’s two main things. The biggest thing is we expect sequential growth in AMDS throughout the year, quarter. And that’s the biggest thing driving the growth acceleration. Also we did have late last year we had a cyber attack that had some impact on the business mainly from a timing standpoint. It kind of disrupted some supply in particular in our tissue business that we will catch up but resulted in a little bit lower growth certainly in Q1 that will be caught up through the remainder of the year.

So those two things combined are what’s really gonna create the acceleration throughout the year quarter to quarter.

Rich Neuter, Analyst, Truist Securities: And that lateral piece is, you have pretty good visibility to that lateral piece.

Lance Berry, CFO, Artivion: Yeah, and so that’s all from an operational standpoint, the impacts of cyber attack are all behind us in the rearview mirror. And it’s really more about just catching up with the processing we have to do in the tissue business and it is something we have pretty good visibility to. Had heading into Q1, we had given guidance kind of where we thought it was going to be and ended up doing quite a bit better than that, cleared more than we expected. And so and we also we had said we thought it would take us through the end of the year to get it all cleared up. But on the Q1 call we brought that in and said, No, we think we can get it done by the end of Q3.

So that’s all moving in a positive direction and feel like we do have our arms around it pretty good.

Rich Neuter, Analyst, Truist Securities: If there were to be something that is the biggest risk factor on that back half acceleration, what would it be? What would you point to?

Lance Berry, CFO, Artivion: The biggest swing factor in guidance is just AMD’s timing. Again we’re trying to predict timing of hospital bureaucracy, that’s more challenging. Tried to contemplate that in our range however. And we did tighten the range a little bit coming out of Q1. And so I think that’s an indication that we’re feeling good about how we are doing out of the gates.

Rich Neuter, Analyst, Truist Securities: Great. And then maybe just to close it off and maybe it’s a little more for you, Lance. But the growing EBITDA twice as fast as the top line, there’s it seems like a very, very big mix shift impact that’s there. But can you just break down the components of what’s driving that?

Lance Berry, CFO, Artivion: Sure. So if you look at the past several years, we’ve been doing a really good job of EBITDA margin expansion. And that’s really two things. One, most companies our size have a G and A leverage opportunity and we do as well. I think one of the things a little bit unique about our business model though is our sales force is leverageable which frequently in med tech it’s not.

And it gets back you know, not all of our products require case coverage. Right? So we have very tenured, stable sales force and we can actually leverage that cost some. So those have been the two main drivers over the past several years. And then as we start to bring these new products to The US, AMDS being the first one, we’re gonna get to add to that mix gross margin expansion just through mix.

So AMDS is a 90 plus percent gross margin product. Our total gross margin currently 65, so significantly accretive to our current overall average. And then we have multiple products coming behind that over the next several years. So we think that EBITDA margin expansion really is very durable and we should be able to do for a really long time.

Rich Neuter, Analyst, Truist Securities: And isn’t just U. S. Margin, gross margin higher generally than

Lance Berry, CFO, Artivion: In general U. S. Is always higher. I’d say the tissue business is lower. But if you look at the devices in The US, so BioGlue and Onyx, I mean they’re very high gross margins.

So also to the extent we can accelerate Onyx growth in The US with some of this new data, that would be gross margin accretive as well.

Rich Neuter, Analyst, Truist Securities: Great, well we’re out of time. Thank you so much to both of Really appreciate it.

Pat Mackin, CEO, Artivion: Thanks for having us

Rich Neuter, Analyst, Truist Securities: Rich. Thanks.

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