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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.”