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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Net cash flows from operating activities:    
Net income (loss) $ 3,124 $ (26,715)
Adjustments to reconcile net income (loss) to net cash from operating activities:    
Depreciation and amortization 17,910 17,260
Change in fair value of contingent consideration (12,170) 21,900
Non-cash compensation 11,499 10,466
Non-cash lease expense 5,860 5,467
Deferred income taxes (4,187) (7,250)
Non-cash debt extinguishment expense 3,669 0
Write-down of inventories and deferred preservation costs 2,911 3,726
Fair value adjustment of Endospan agreements (195) 5,000
Gain from sale of non-financial assets 0 (14,250)
Other 1,818 2,325
Changes in operating assets and liabilities:    
Accounts payable, accrued expenses, and other liabilities (5,237) 412
Inventories and deferred preservation costs (4,791) (10,592)
Prepaid expenses and other assets (4,758) (527)
Receivables (3,356) 765
Net cash flows provided by operating activities 12,097 7,987
Net cash flows from investing activities:    
Capital expenditures (9,763) (7,083)
Payments for Endospan agreements (7,000) (5,000)
Proceeds from sale of non-financial assets, net 0 14,250
Net cash flows (used in) provided by investing activities (16,763) 2,167
Net cash flows from financing activities:    
Proceeds from issuance of debt 190,000 0
Proceeds from revolving credit facility 30,000 0
Proceeds from exercise of stock options and issuance of common stock 5,285 3,467
Proceeds from financing insurance premiums 0 3,558
Repayment of debt (211,765) (2,063)
Payment of debt issuance costs (10,044) 0
Principal payments on short-term notes payable (1,027) (1,522)
Other (420) (945)
Net cash flows provided by financing activities 2,029 2,495
Effect of exchange rate changes on cash and cash equivalents (130) 1,481
(Decrease) increase in cash and cash equivalents (2,767) 14,130
Cash and cash equivalents beginning of period 58,940 39,351
Cash and cash equivalents end of period $ 56,173 $ 53,481