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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