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Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | 63 Months Ended
--- | --- | --- | ---
Dec. 31, 2021 | Mar. 31, 2021 | Dec. 31, 2020 | Mar. 31, 2020 | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2020
Operating Activities: |  |  |  |  |  |  |  |  |  |  |  |  |
Net loss |  | $ (5,127) | $ (30,761) | $ (281,050) |  | $ 36,460 | $ (135,818) | $ (348,819) | [1],[2],[3],[4] | $ (157,639) | [1],[2],[3],[4] |  |
Non-cash items included in net loss: |  |  |  |  |  |  |  |  |  |  |  |  |
Loss on debt extinguishment |  |  |  |  |  |  | 60,238 | 1,407 | [2],[4] | 0 | [2],[4] |  |
Stock-based compensation |  |  |  |  |  |  | 40,564 | 35,089 | [2] | 32,553 | [2] |  |
Amortization |  |  |  |  |  |  | 26,517 | 38,312 | [2] | 40,375 | [2] |  |
Depreciation |  |  |  |  |  |  | 24,536 | 29,031 | [2] | 30,317 | [2] |  |
Remeasurement of derivative instruments |  |  |  |  |  |  | 17,618 | 22,085 | [2] | (26) | [2] |  |
Amortization of operating lease assets |  |  |  |  |  |  | 16,935 | 13,977 | [2] | 12,297 | [2] |  |
Amortization of debt issuance costs |  |  |  |  |  |  | 16,657 | 9,710 | [2] | 2,204 | [2] |  |
Deferred tax expense (benefit) |  |  |  |  |  |  | 2,852 | 37,068 | [2] | (26,498) | [2] |  |
Remeasurement of contingent consideration to fair value |  |  |  |  |  |  | 564 | (20,463) | [2] | (29,406) | [2] |  |
Impairment of long-lived assets |  |  |  |  |  |  | 0 | 6,762 | [2] | 142,517 | [2] |  |
Impairment of disposal group and loss on sale |  |  |  |  |  |  | 1,942 | 180,160 | [2] | 0 | [2] |  |
Impairment of goodwill |  |  |  |  |  |  | 0 | 21,269 | [2],[4] | 42,417 | [2],[4] | $ 63,700 |
Other |  |  |  |  |  |  | 717 | 2,000 | [2] | 5,783 | [2] |  |
Changes in operating assets and liabilities: |  |  |  |  |  |  |  |  |  |  |  |  |
Accounts receivable, net |  |  |  |  |  |  | (15,745) | 58,796 | [2] | (5,321) | [2] |  |
Inventories |  |  |  |  |  |  | 4,484 | 5,438 | [2] | (7,924) | [2] |  |
Other current and non-current assets |  |  |  |  |  |  | 24,127 | (39,645) | [2] | (2,077) | [2] |  |
Accounts payable and accrued current and non-current liabilities |  |  |  |  |  |  | 12,993 | (923) | [2] | (38,577) | [2] |  |
Taxes payable |  |  |  |  |  |  | 103 | 3,596 | [2] | (8,442) | [2] |  |
Litigation provision liability |  |  |  |  |  |  | 3,260 | (134,272) | [2] | (123,695) | [2] |  |
Net cash provided by (used in) operating activities |  |  |  |  |  |  | 102,544 | (79,422) | [2] | (91,142) | [2] |  |
Investing Activities: |  |  |  |  |  |  |  |  |  |  |  |  |
Proceeds from sale of Heart Valves, net of cash disposed |  |  |  |  |  |  | 42,945 | 0 | [2] | 0 | [2] |  |
Purchases of property, plant and equipment |  |  |  |  |  |  | (25,478) | (35,024) | [2] | (24,691) | [2] |  |
Proceeds from sale of Respicardia investment and loan |  |  |  |  |  |  | 23,057 | 0 | [2] | 0 | [2] |  |
Purchase of investments |  |  |  |  |  |  | (3,653) | (3,184) | [2] | (2,500) | [2] |  |
Acquisitions, net of cash acquired |  |  |  |  |  |  | (1,694) | (1,719) | [2] | (10,750) | [2] |  |
Other |  |  |  |  |  |  | 1,727 | (1,917) | [2] | (3,349) | [2] |  |
Net cash provided by (used in) investing activities |  |  |  |  |  |  | 36,904 | (41,844) | [2] | (41,290) | [2] |  |
Financing Activities: |  |  |  |  |  |  |  |  |  |  |  |  |
Repayment of long-term debt obligations |  |  |  |  |  |  | (452,256) | (482,065) | [2] | (24,210) | [2] |  |
Proceeds from issuance of ordinary shares, net |  |  |  |  |  |  | 322,557 | 0 | [2] | 0 | [2] |  |
Payment of make-whole premium on long-term debt obligations |  |  |  |  |  |  | (35,594) | 0 | [2] | 0 | [2] |  |
Shares repurchased from employees for minimum tax withholding |  |  |  |  |  |  | (12,942) | (5,601) | [2] | (7,064) | [2] |  |
Payment of contingent consideration |  |  |  |  |  |  | (5,249) | (12,018) | [2] | (18,955) | [2] |  |
Debt issuance costs |  |  |  |  |  |  | (2,450) | (23,736) | [2] | (3,795) | [2] |  |
Proceeds from long-term debt obligations |  |  |  |  |  |  | 0 | 886,899 | [2] | 197,160 | [2] |  |
Proceeds from short term borrowings (maturities greater than 90 days) |  |  |  |  |  |  | 0 | 47,053 | [2] | 0 | [2] |  |
Repayments of short term borrowings (maturities greater than 90 days) |  |  |  |  |  |  | 0 | (44,838) | [2] | 0 | [2] |  |
Purchase of capped call |  |  |  |  |  |  | 0 | (43,096) | [2] | 0 | [2] |  |
Closing adjustment payment for sale of CRM business |  |  |  |  |  |  | 0 | (14,891) | [2] | 0 | [2] |  |
Other |  |  |  |  |  |  | 4,451 | 3,049 | [2] | 3,445 | [2] |  |
Net cash (used in) provided by financing activities |  |  |  |  |  |  | (181,483) | 310,756 | [2] | 146,581 | [2] |  |
Effect of exchange rate changes on cash and cash equivalents |  |  |  |  |  |  | (2,805) | 2,205 | [2] | (216) | [2] |  |
Net (decrease) increase in cash and cash equivalents |  |  |  |  |  |  | (44,840) | 191,695 | [2] | 13,933 | [2] |  |
Cash and cash equivalents at beginning of period | [2] |  | $ 252,832 |  |  | $ 61,137 | 252,832 | 61,137 |  | 47,204 |  |  |
Cash and cash equivalents at end of period |  | $ 207,992 |  | $ 252,832 | [2] |  | 207,992 | 252,832 | [2] | 61,137 | [2] | $ 252,832 | [2]
Supplementary Disclosures of Cash Flow Information: |  |  |  |  |  |  |  |  |  |  |  |  |
Cash paid for interest |  |  |  |  |  |  | 32,569 | 28,573 |  | 15,828 |  |  |
Cash paid for income taxes, net |  |  |  |  |  |  | $ (13,583) | $ 7,493 |  | $ 2,011 |  |  |
[1] | Accumulated deficit and total stockholders’ equity as of December 31, 2020, 2019 and 2018, and net loss for the years ended December 31, 2020 and 2019 have been revised. For further details refer to “Note 1. Nature of Operations.”
[2] | The consolidated statements of cash flows for the years ended December 31, 2020 and 2019 have been revised. For further details refer to “Note 1. Nature of Operations.”
[3] | The consolidated statements of comprehensive income (loss) for the years ended December 31, 2020 and 2019 have been revised. For further details refer to “Note 1. Nature of Operations.”
[4] | The consolidated statements of income (loss) for the years ended December 31, 2020 and 2019 have been revised. For further details refer to “Note 1. Nature of Operations.”

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- Definition The cash outflow for debt initially having maturity due after one year or beyond the normal operating cycle, if longer. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=123570139&loc=d3e3291-108585 + Details
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- Definition The cash outflow from a repayment of a borrowing having initial term of repayment of more than three months but less than one year or one operating cycle (if the normal cycle is more than one year). + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=123570139&loc=d3e3291-108585 + Details
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- Definition Amount of noncash expense for share-based payment arrangement. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=123570139&loc=d3e3602-108585 + Details
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Data Type: | xbrli:monetaryItemType
Balance Type: | debit
Period Type: | duration

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- References No definition available. + Details
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