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Consolidated Statements Of Cash Flows - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Net cash flows from operating activities:      
Net (loss) income $ (2,840) $ 3,704 $ 10,778
Adjustments to reconcile net income to net cash from operating activities:      
Depreciation and amortization 18,095 9,745 8,384
Non-cash compensation 6,325 6,919 6,328
Write-down of inventories and deferred preservation costs 649 2,110 1,364
Deferred income taxes (4,485) (1,483) 595
Gain from sale of business components     (7,915)
Other non-cash adjustments to income 2,149 676 268
Changes in operating assets and liabilities:      
Receivables (1,119) (7,258) 4,142
Inventories and deferred preservation costs 2,384 (9,369) (9,460)
Prepaid expenses and other assets (2,407) (2,968) 515
Accounts payable, accrued expenses, and other liabilities (8,870) 8,727 4,720
Net cash flows provided by operating activities 9,881 10,803 19,719
Net cash flows from investing activities:      
Capital expenditures (5,786) (6,632) (6,198)
Acquisition of JOTEC, net of cash acquired   (164,661)  
Acquisition of On-X, net of cash acquired     (91,152)
Acquisition of PhotoFix technology   (409) (1,226)
Proceeds from sale of business component   740 19,795
Other (929) (86) (126)
Net cash flows used in investing activities (6,715) (171,048) (78,907)
Net cash flows from financing activities:      
Repayment of term loan (2,790) (4,994) (1,406)
Payment of debt issuance costs (624) (10,144) (2,289)
Proceeds from issuance of term loan   225,000 75,000
Payoff of debt agreement   (67,219)  
Proceeds from exercise of stock options and issuance of common stock 3,854 3,126 2,203
Redemption and repurchase of stock to cover tax withholdings (2,100) (1,614) (697)
Other (902) (910) 617
Net cash flows (used in) provided by financing activities (2,562) 143,245 73,428
Effect of exchange rate changes on cash cash equivalents, and restricted securities 879 412 (317)
Increase (Decrease) in cash, cash equivalents, and restricted securities 1,483 (16,588) 13,923
Cash, cash equivalents, and restricted securities beginning of year 40,753 57,341 43,418
Cash, cash equivalents, and restricted securities end of year $ 42,236 $ 40,753 $ 57,341