Good afternoon, everyone. If you want to take a seat. Robbie Marcus, I'm the Medtech Analyst at J.P. Morgan, saving the best for last here to wrap up day one of the healthcare conference. Happy to present CEO Mike Mahoney of Boston Scientific. He'll do a presentation followed by some Q&A. Michael.
Thank you.
Good afternoon, everyone. Thank you for attending the 5:15 coveted slot for Boston Scientific. It's an honor to help lead the company with Dr. Stein and Dan Brennan and our colleagues around the world. I'm going to skip through the regulatory and financial disclaimers very, very quickly there. It's an honor to be here to talk about Boston Scientific. Here's just maybe a couple of takeaways from the presentation. You get lots of presentations today. We had an excellent 2023, followed by an even better 2024. We won't give our results until the first week of February, but an excellent performance across the board in 2024. We guided to 15% organic growth, quite a bit, 70 basis points of margin improvement, plus 20% EPS growth. We signed five tuck-in deals in 2025 and closed two of them. And really a great year for the company.
I think what's most importantly for what drives us besides advancing science for life and innovation and being a great place to work is our financial goal is we continue to aim to be the highest performing differentiated large-cap medtech company last year, this year, and that's our aim through 2030. And many key enablers for that. You'll see some of that presentation today: a relentless focus on innovation, consistently increase our weighted average market growth rate, which we've done year over year for many years now, highly engaged global team and this category leadership strategy. And so we'll detail this a bit more in these slides. You know, I'm proud of this one because it shows the consistency and the evolution of the company.
You know, years ago we struggled, we grew well below market, then we went through a phase where we grew at market, then we grew above market, and then we've really accelerated. As I said, our aim is to be the highest performing medtech company likely in 2023, potentially in 2024, and ongoing through 2030. So consistent enhancement of our revenue growth over many years. Same thing on the margin side, on the operating margin side. We used to lag about 19 points. We guided this year, this year being 2024 at least, to about 27% operating margin growth. So consistent margin growth year over year, typically in excess of 50 basis points per year. We delivered double digit EPS over the same time horizon. And this year, as I said, or last year, 21% growth. Also kudos to the finance team, our operations team.
We continue to increase our free cash flow and focus on our free cash flow conversion and put that to use in productive ways for shareholders and for Boston Scientific. I think this is a really important slide because it speaks to the strength of the company. And we show the slide every year, but there's actually some updates from our investor day 2023. In 2024, we believe the markets that we compete in had a WAMGR of about 8%. We've enhanced our 2026 WAMGR to at least 9%. So this is the weighted average market growth rate of the markets that we serve in. You know, this came from a negative WAMGR in 2012, about 4% in 2016. It's also interesting to note that since 2013, we have grown faster than our weighted average market growth rate every year.
So not every one of our businesses grows faster than the market, but most all do. And since 2013, our actual performance has exceeded our weighted average market growth rate, which again will be our goal in 2025 and beyond. And the big driver, as you look at 2024 and 2026, obviously the combination of the EP market, which has seen explosive growth, the Watchman market, which we created, and we think will be a $6 billion market, and two nice tuck-in acquisitions with Axonics and Silk Road further enhance that weighted average market growth rate. In the coming slides, I'm going to touch a bit more on FARAPULSE and a bit more on Watchman. It's difficult to cover the entire portfolio in 20 minutes, but here, if you look at our overall portfolio in 2025, here are the areas that will drive the growth and the differentiated performance.
I won't detail Agent DCB . We're really excited about being the first company to provide this technology with strong reimbursement, our imaging company. So the ICTX portfolio in general, I think, is maybe less understood or less focused on, but a strong double digit grower for the company. We'll talk about WATCHMAN and EP and CRM and our peripheral interventions and our interventional oncology business. Our IO business is a mid-teens grower. We have strong category leadership, and we're driving new clinical indications to expand that a bit more.
Really two powerhouse divisions, endoscopy and neurology, very accretive to Boston Scientific's operating income margin, grow faster than markets, and typically in the kind of the 6%-9%, 7%-9% growth CAGR range in neuromodulation business, which in 2024 through third quarter wasn't quite at expectations, but we expect 2025 to be a strong year for this division as we go organic with an acquisition of Relievant and the commercial changes that we made in 2024 take hold in 2025. You know, I couldn't be more proud of this slide. You know, it's very rare in medtech to have the largest market in the industry that we estimate here is going to grow 20%. The fastest market within that, the AFib market, we estimate growing 25%, but it's very rare to find the largest market that happens to be the fastest growing market transformed or disrupted.
We were the lagging number four player in EP, a distant number four. We expect to be the number two player by midpoint 2025, and our aim is to be the number one player in this global business over the coming years, and we have the solutions, the team, and the focus to execute just on that, remarkably, you know, we're only 10 months into our launch in the U.S., so there's many new accounts to open, many more accounts that we can add additional consoles and catheters to and open up new markets in China and Japan, but what's remarkable is the transformation in PFA adoption from the legacy radio frequency, not legacy, but the standard radio frequency and the standard cryo, so this is a bit updated, so globally, we estimate by 2026, at least 60% of all procedures will be done with PFA.
We think in 2024, that number is 20%, which is global, and likely more than 40% in 2024 in the U.S. So it's been adopted very, very quickly, and we're a clear market leader in this, and we intend to expand our market leadership position in 2025 and beyond through new account openings, launching in China and Japan, continuing to scale out our Opal mapping integration system, and new releases of clinical data where Ken Stein will be, he won't be doing it, but he'll lead it, presenting our persistent study at the Boston AFib Symposium later this week. We're also committed to leading this beyond 2025 and become the market share leader in this terrific field, and we'll do that through essentially strong portfolio investments that are outlined here.
We have three different venture investments in this field to complement this internal portfolio and also to continue to be the leader in clinical science. We're on this be the leader in clinical science as it relates to PFA, as you see the various studies that we're doing to continue to reinforce long-term clinical data with FARAPULSE, but also to broaden indications to persistent to first line and other capabilities. So big, big focus area for us to continue to drive portfolio execution, globalize this business, and continue to lead in clinical science, drive even more confidence with the physician community and the patient community. You know, this market, the LAC market, certainly is proud of, whereas in EP, we've disrupted and transformed a hot large market. In WATCHMAN, we created this market over many, many years, and it's really taking a strong root now.
It's a very common procedure. It's a very efficient procedure, very safe procedure. And I'll talk about concomitant in just a minute. We estimate this LAC market will continue to grow about a 20% CAGR. We have a very high market share, approximately 90% in the US. And we continue to fuel, just like the last slide, portfolio investments and clinical investments to continue to expand our advantage in this area with Watchman FLX Pro, TruSteer, and Access Solutions. We continue to drive market awareness and patient awareness with the affirmative physicians and will also anticipate even more physician training in 2025 and beyond due to the Option study results with EPs who are doing ablation, but not doing Watchman, likely wanting to be trained now for concomitant. And also same thing with interventional cardiologists. And also we'll leverage the recent concomitant news on reimbursement.
So this is also a really nice win for us. You take the fastest growing market in EP that's scaled, maybe the fastest overall market, which is LAC, but not quite as big as EP. And now we have the ability to do both those procedures at the same time for the same patient at a reimbursement code that's very favorable to hospitals. And the overall procedure is maybe an extra 10 to 15 minutes when you're doing this concomitant procedure. So it's a wonderful win. It's based on the heels of our positive Option results, which Dr. Ken Stein can further detail in the Q&A if you'd like, further reinforced with the US concomitant DRG reimbursement and our unique position with our Access Solutions, FARAPULSE capabilities, and WATCHMAN.
And so we expect to have a WATCHMAN label update in the second half of 2025, obviously driving a lot of physician education, referring physician education, and helping hospitals optimize their workflow. I think one of the few headwinds that we see in the future is just lab capacity, given the huge patient demand that we're seeing throughout this therapeutic area. So optimizing this and a concomitant procedure is a big winner for hospitals to optimize their workflow, have the patient have two procedures at one setting versus coming back multiple times for the appropriately indicated patient. You know, in addition to our organic efforts and our product execution launches, we have a nice strong history of tuck-in M&A over many, many years. In 2024, there's really no different.
We acquired these five companies in 2024, two of them, Axonics, have closed, which will make us really a perfect portfolio add to our leadership position in neurology and Silk Road for carotid artery disease, which is a nice adjacency for us in our peripheral vascular business. Cortex is an advanced mapping solution for EP and Intera Oncology to augment our interventional oncology portfolio and recently Bolt Medical, which is IVL treatment for treating a complex calcium, which will be into our vast interventional cardiology portfolio and further complement that business. So we're proud of these Tuck-ins, which are very similar, I would say, cadence and level that we've done historically, and our aim is to continue this momentum. One way we continue that is we're likely the most active VC investor in medtech.
We have a portfolio of about 45 venture investments that we've made, and we did 10 new venture investments in 2024, and I don't know the exact %, but I bet we acquire about 25%-30% of the companies we acquire come from our venture portfolio, so it's a great way for us to look at disruptive technologies to further increase our weighted average market growth rate, which is what this slide does. All five of these will continue to improve that WAMGR that I talked about a few slides ago. Also, good, I'm going to leave more time for Q&A, also, it's super important for us to focus on being a highly differentiated company for the long term, and we're proud of the growth that we had in 2025 and 2024 and 2023.
We're proud of the margin improvement, but we really are focused on leading this company for the long term with highly differentiated performance through 2030 and beyond. And this slide is not just a bunch of spaces that BSX is interested in. This is a slide that we have significant investments in already, either via organic R&D large programs like our Vitalist to compete in high-risk PCI and shock and the circulatory support space, or there are significant investments in our VC portfolio. And this slide, in combination with our organic R&D, is what gives us confidence to continue to grow faster than our weighted average market growth rate, even as that weighted average market growth rate continues to expand as a result of our BD and organic M&A activities.
So I have a lot of confidence in our global team, the depth of our leadership team, our winning spirit as a company, and we will likely bring many of these new technologies and adjacencies to market. So for those of you who are wondering, hey, is this a two or three-year story with Watchman and PFA? It's not. We'll continue to increase our WAMGR, and we have significant bets via organic R&D intervention portfolio across these almost 20 different platforms that we're excited about. So with that, I'll wrap it up for Q&A. It's a pleasure to be here. It's an absolute honor to lead Boston Scientific, and we are very committed to delivering strong shareholder returns and differentiating BSX in the minds of shareholders and our employees. Thank you very much.
I was going to apologize upfront for asking so many Watchman and FARAPULSE questions, but since you spent the entire presentation on it, I'm not going to apologize. And it's been an impressive year with FARAPULSE. The launch has gone exceptionally well, probably puts you, if not the best medtech launch, then top three, I would imagine. Still launching it, though. Still launching it. And you know, it's impressive because the number of adjacencies and new indications and accessory catheters are still coming out. So maybe you could talk about, you know, you talked about 20% AF, 20% of AF procedures were PFA in 2024. You're moving to 40%. And I would say the number one question I've gotten over the past six months has been, what does competition look like for Boston Scientific? And I always respond, I think it's the wrong question to ask.
It's what percentage of procedures are going to be done with PFA? But that said, how do you feel about your competitive positioning in the market to be able to maintain the leading PFA position? Well, we're always humble, but we're extremely confident that we'll continue to enhance our leadership position in PFA. We know there's able companies out there, but I would say I feel better about our strength now than I did a year ago, given that we're 10 months into the launch and we see the momentum that we're seeing across the globe with the adoption of FARAPULSE. And I think it's key, as you said, we probably have 40% adoption in 2024 in the US, but growing to about 60% global adoption. So you have a lot of procedures in China and Japan, other parts of the world that aren't in that number yet.
But we know there's healthy competition out there. We have a unique product. We have an excellent pipeline. We have a highly motivated team that's executing every day. And so we're quite confident we'll continue to expand our leadership in this market.
Dr. Stein, I remember, I think it was two years ago, you were saying not all PFA is the same, and we feel really confident in ours. We've seen one of your competitors voluntarily withdraw their PFA product in the U.S. from the market. How do you feel about your algorithm versus the competition, its safety profile and ability to continue to outperform?
Yeah, thanks, Robbie. And I think you hit the nail on the head, right? That everyone needs to understand that all PFA is not created equal.
And the results that you get with any particular system is just inherently dependent on the waveform, the energy source that's used, the catheter design, and the dosage recipe. Now, even though we're only 10 months into our launch in the US, months into our launches in China and Japan, we've already treated over 200,000 patients successfully with the FARAPULSE system. We've published clinical data and outcomes in almost 20,000 of those patients. And what I can tell you is our experience and our published experience has a safety profile that is second to none, an efficiency profile for physicians that is second to none. And now we're starting to see data published that actually shows efficacy when you look at atrial fibrillation burden that's superior to legacy ablation sources.
And that's why, you know, Mike was able to tell you, and that's what's behind the success of the launch. It's what's behind our leadership position today.
I think the old rule of thumb was, even if you had a catheter, you couldn't be successful in EP without a mapping system. You have arrhythmia, but really FARAPULSE on its own drove the success and, you know, is used with a lot of other mapping systems. How do you feel about that rule of thumb today? Clearly, you've done it without leading with the mapping system, but maybe if you flip it around, can you take the catheter and pull through all the rest as you're adding arrhythmia integrated mapping? You have a great access catheter with the Baylis.
Yeah, and we've refreshed our arrhythmia system now.
So our next generation is what we call Opal, has a software suite that's the first software suite that's specifically designed around pulsed field ablation and designed around the FARAPULSE ecosystem. Part of what we intend to do is to leave it up to physicians. You know, we don't need to force you to use our mapping system if you want to use our catheter, all right? And we want to be able to support all three ways of doing procedures. If you don't need to map, and that's done in the majority of cases in Europe today, you don't need a mapping system to get great results with FARAPULSE.
But if you're doing a more complex procedure or if you want to map, which is what we're seeing in the majority of cases in the US and in Asia, we will continue to support your ability to do it with one of the legacy mapping systems. But we are really early into the launch now of our FARAVIEW software on Opal, and we're really pleased with the reception that we're seeing as people have started to use the system.
Do you think you'll be able to materially increase your arrhythmia placements in 2025 with the addition of integra ted mapping?
No, I think we're certainly going to see more use of the, and again, the Opal system.
Opal, sorry. That's what we're calling it now. If I think about the PFA, this is one of your better margin products.
And Dan, along with Watchman, which we'll talk about in a bit, these are probably two of your higher, if not highest, gross margin products at Boston Scientific. It continues to ramp aggressively. I think we'll talk about Watchman, but that should also have a great year. How do you think about your margins moving forward? Could, you know, is 2024 as good as it could get on margin expansion, or is there potential to improve moving forward as these two high margin products are a bigger part of the business?
I mean, you saw on the slide that Mike presented, I mean, it's in the DNA of the company, the margin expansion that we've had over the last decade. That's not going anywhere. We're going to continue to do that. Watchman and FARAPULSE are a big piece of that. The rest of the company is as well.
What we try to do is strike a balance. So deliver margin expansion. So our guidance for 2024 was 70 basis points. That's differentiated versus, you know, our peer set, but it also allowed us to be able to invest in some of those things you saw on that last slide that Mike showed in terms of the different areas that are going to continue to sustain the top line growth of the company through this decade. And so that's what it's about, is striking that balance, making sure that we have differentiated margin expansion, which I think we have, and also making sure that we fuel the top line growth for the long term. And I think we have that as well. So that's the balance we aim to strike, and I feel like we're doing a pretty good job at it.
I guess we'll have to wait for fourth quarter earnings to get the official guidance.
Yes, first week of February.
Tying together Watchman and PFA, you got concomitant reimbursement starting October 1st, and I've done a number of calls where doctors were starting October 1st doing both procedures together, and even though it's not a Boston Scientific specific code, it clearly benefits your organization as you have the leading product in LAA and PFA, so maybe speak to the experience you've seen. I know you're not reporting the results out today, but maybe qualitatively what you saw in the fourth quarter once the reimbursement code kicked in.
Well, on the business side, and Dr. Stein can talk about obviously the patient and physician benefit.
You know, we're comfortable with what we call the 20% market CAGR, you know, with concomitant further supporting that and the release of Champion, which I didn't talk about, which will happen in 2026, which is a meaningful piece of evidence that hopefully will continue to drive the expansion of the market to $6 billion. So we think that 20% growth CAGR for the market makes sense. We continue to invest in, you know, we'll be on our fourth generation Watchman device likely before we see a new competitor in the market. But Dr. Stein, if you want to speak to the kind of the benefits you're seeing now.
Yeah, you know, when I was treating patients, you never call something a no-brainer, but the concomitant opportunity is as close to a no-brainer as anything ever gets in medicine, right?
You're taking, you know, two procedures that both involve essentially the same skill set and the same approach to the patient. And instead of having to have two procedures and have the attendant risks doubled, you can do it all at one sitting. It's great for patients, as Mike said, it's great for doctors, and it's great for the whole ecosystem in terms of relieving some of the capacity constraints, right, that we think we may run into otherwise as the indications for both of these procedures continue to increase. And what really makes it a no-brainer are the results from the Option trial that Mike showed, right?
And so Option we presented at American Heart Association, so in November, published in the New England Journal of Medicine, showed that in patients who need stroke prevention therapy after catheter ablation for atrial fibrillation, that the Watchman device provides equivalent protection from stroke as do oral blood thinning medications with significantly lower rate of clinically important bleeding complications over the long run. And so you sort of ask yourself, you're a patient, if I'm having an ablation procedure and if I know I'm going to need continued protection against stroke, why wouldn't I opt to have this done? And even though it's not unique to our technology, there are particular advantages to thinking about doing this on top of the FARAPULSE procedure. Because again, you take FARAPULSE with its safety and its efficiency, and then you add to that Watchman FLX and FLX Pro with its safety and efficiency.
As I say, I mean, it's as close to a no-brainer as you can come. You leverage Baylis and our access solutions technique for crossing the intra-atrial septum.
What's t he overlap of patients that have an AF procedure that are eligible for WATCHMAN after Option?
Yeah, I think part of this gets to the reason we expect to have an expansion of our label, right? Our label today still requires that patients have a rationale to seek an alternative to long-term oral anticoagulation. We would hope, based on the results of Option, that that would be broadened to include it as a first-line alternative to oral anticoagulation. When you get to that point, right, then it's, you know, how high risk do you need to be to need to think about doing something like this? In medicine today, we look at something called CHA2DS2-VASc.
Patients with a CHA2DS2-VASc score of two or greater are deemed to be at high risk. That's over 50% of the population undergoing atrial fibrillation ablation today. And even if you only look at even higher risk patients, say three plus, right, that still is close to a majority of patients undergoing AF ablation.
You know, when we talk to doctors, and obviously you would never market it this way without an approved indication, but a lot of doctors were saying, once we saw the data from Option, we feel really good about what Champion is going to show us because you're comparing it against oral anticoagulation. So how valid of a view is that in your mind? How similar are the patient populations as we think about comparing one trial to the other?
And so again, Option was our head-to-head trial against oral anticoagulation in patients after ablation.
Champion is an all-comers trial, right? So everyone who needs therapy with atrial fibrillation, oral anticoagulation versus the Watchman device. And so I think, you know, the results of Option give us some hope for what you might see in Champion. It's not exactly the same population. It's a broader population. I don't know the demographic results. It's likely to be maybe a bit older, maybe a bit more frail. That's why they're not all having catheter ablation. But you know, we've seen the results of Option. And one of the really important takeaways from Option is just how much bleeding there was in patients who were considered to be good candidates for blood thinners. I mean, nearly one in five had a clinically important bleeding event within a couple of years after the procedure, right?
We've also seen data from other trials like the Prague 17 trial in Europe, all of which gives us, again, confidence to be pretty optimistic about what we might see from Champion, and you know, we would hope to have the results of Champion available first half of next year.
Mike, you talked about this before the Champion trial and how important it could be in 2026, and I remember back to the Analyst Day slides where, what was it, something like Option doubled the addressable market for Watchman and Champion could triple or quadruple it when all is said and done. How do you feel, assuming the trial is positive, how do you feel about Boston's ability, both from the sales force and the manufacturing side, to be able to be ready to handle the potential increase?
Yeah, I think we've established a good track record there.
If you look at just the manufacturing side, you know, with what we've done with FARAPULSE to stay ahead of our forecast, to stay ahead of patient demand without any back orders, without any supply chain glitches in 2024. And we're obviously scaling up that capability even far more significantly in 2025 and beyond. I think that's a great proof point. Same thing with Watchman. We've been commercialized Watchman now for I don't know how many years, Ken, for a long time. So we know how to manufacture Watchman extremely well. We've already built into the plants capacity to assume a positive trial. So I have tremendous confidence in our operations team to continue to scale with great quality, both our FARAPULSE and our Watchman business, assuming we have positive results from the Champion trial. Commercially, I think that's almost easier.
We have great expertise with Watchman, with our clinical field teams, with our commercial teams. FARAPULSE has been a bigger jumpstart for us, given that we launched it 10 months ago. We built an excellent program and skill set there. We're making significant investments around the world in our PFA technology. So a lot of confidence in our commercial teams. But the manufacturing side is the one that I think we've really done a check plus on in terms of our capability.
Dan, maybe I could ask you a few financials. I know you talked, I think it was on the last earnings call, about tax potentially ticking up in 2025. You know, maybe you could just remind everyone what you said on that and with interest rates where they are, any update on interest?
Yeah, so relative to tax, it should be likely pretty similar in 2025 versus where it was in 2024. We'll see where 2024 sorts itself out. But it shouldn't be a huge increase in tax in 2025. Interest rates, we do have some refinancing that we have to do in 2025 with some maturities that are coming due. So we will have more interest expense. And we also have the interest from the bonds for the Axonics acquisition. But the good news is that almost one to one, the operating income and EBITDA from Silk and Axonics offsets that. So that covers that nicely hand in glove. Tax shouldn't be an issue. So I think those are hopefully helpful for modeling relative to 2025. Yeah, very. No change from what we said on the call in October.
Perfect. I know Boston Scientific doesn't just passively hedge, but sometimes actively hedges.
So it can be difficult from our side to accurately predict what currency will look like. Any early thoughts on mark-to-market for currency in 2025?
Yeah, we do have a very sophisticated hedging program we've had for over a decade now that seeks to minimize the impact. In 2024, you know, we had talked about $0.01 a quarter, about $0.04 for the year. The dollar has strengthened, but as I look at 2025 now, I would see it in a relatively similar range from what we saw in 2024. So not a significant headwind for 2025.
Great. TAVR, qualitatively during the fourth quarter, did you see any change in Europe after the clinical trial data came out at TCT?
I would say the European team continues to deliver nicely. What we're doing in Europe is launching a new device called Prime, which is larger size.
It's extremely easy to use, and they're having great success in converting ACURATE neo2 accounts to Prime. So the team in Europe is doing their job. They continue to grow nicely. In terms of the, obviously, the U.S. clinical trial was not what we wanted for all the reasons that we discussed many times in various calls. And there's no new update in terms of the plans in the U.S., but we'll hope to communicate that to you shortly once we are able to.
There's a lot of other products to walk through that you had up there. One of the more interesting ones from last year was AGENT DCB. That's a big opportunity, your first market there. You know, where do you stand in the launch? I know it's not just U.S., it's outside the U.S. as well. And progress on indication expansion as well.
Yeah, I can take that, Mike. Again, I think really outperformed our expectations ahead of getting the differentiated reimbursement that we now have for AGENT in the United States for its on-label use. Again, you know, we know outside of the United States, right, the broad types of lesions that drug-coated balloons are used for. Today, right, the indicated use in stent restenosis, about 10% of coronary interventions. We are planning to get indication expansion. The first will be to long lesions. That's through a nested study that's part of the AGENT IDE. But then looking beyond that into indication expansion into de novo treatment of small vessels and bifurcation lesions.
Let me ask you, you're coming this year third to market with a leadless pacemaker, but potentially the most interesting solution as it can talk to the S-ICD and create sort of a CRTD package.
Once we've seen Abbott and Medtronic launch theirs, their growth in pacemakers accelerated materially on a lot of mix, but also volume gains. Is that a good way to think about your low-power business once that launches in the back half of the year?
Yeah, I think it is. You know, there are a number of advantages to the Empower system purely as a standalone leadless pacemaker. You know, we've got the advantage of coming third. So we've seen what's gone wrong for some of the other devices. Very pleased with the safety profile of this device, ease of use of the delivery system. Again, the clinical data that we presented in the middle of this year, middle of last year, was again second to none in terms of safety for a leadless pacer device.
But also, as you said, I mean, the really exciting thing about EMPOWER is the ability to talk to S-ICD and I think serve to unlock the use of the S-ICD in a much broader population of patients.
Dan, if I look at my model and consensus models, there's a lot of cash being generated 2025, 2026. Obviously committed to doing M&A. You have a good track record there. Just refresh us on where the priorities are for capital allocation, how you'll use the free cash flow.
Yeah, it's been remarkably consistent in support of, as Mike detailed, the category leadership strategy. Our number one capital allocation priority is high-quality tuck-in, innovative M&A. We've done that. We've done almost 40 deals over the last 10 years. All tuck-ins of things that are adjacent to spaces that we're in or right in spaces that we're in today. No change.
That's our favorite use of the generation of cash.
I mean, you've already done one deal year to date so far with Bolt. How do you see the market evolving here? How do you feel about prices, especially with interest rates still a little bit elevated here? Is this a year you think there could be a good amount of M&A?
I think the great thing about our team is the world is our oyster relative to M&A. I mean, it isn't just, you know, public companies. It isn't just private companies. It's the creativity that they've shown and the ability to do unique deals across the globe, I think puts us in a little bit of a different place rather than it's just about interest rates or it's just about, you know, looking at mid-cap valuations.
We've been able to do, I think, a really nice cadence of M&A over time. And we're very disciplined on price. We don't chase things. We make sure that we have the right returns. And I'm proud of that.
I feel like endoscopy and urology has gotten overlooked the past year as EP and structural heart has just done so phenomenally well. But I was at SAGES earlier this year, and I mean, there's so much innovation happening in that business. So maybe just remind people where you stand in terms of some of the most interesting products coming over the next one to two years and how you feel about the sustainability of growth in those businesses and the high single-digit range.
Yeah, well, thanks for saying that. They're absolutely overlooked.
As standalone companies, they would be growing faster, clearly faster than the med tech peers with much higher margins and continue to do that very durably. So maybe start with urology. It's a fantastic franchise. It's a clear global leader in urology. I think the key spaces here that we're excited about for 2025 and beyond is one of the Axonics acquisitions. It was the largest segment that we weren't in across the portfolio. So that's terrific. You know, we're getting continued adoption of our StoneSmart platform for lasers and so forth. You know, we also continue to invest in our implant business, which we acquired from AMS years ago, which is a 3% grower now grows upper single digits, sometimes double digits based on the success of the device and broader patient awareness. So those are three areas.
We also have a number of interesting venture bets in that urology business. So a lot of, and also the obvious goal to globalize that a bit more. Same scenario in endoscopy. We're the global leader in endoscopy. We are the significant category leader, market share leader in that field. And there's hundreds, if not a thousand products that make up the endoscopy suite. But we're the leader with our single-use imaging devices, with our SpyGlass devices. We're the leader in ESG with the acquisition that we made of Apollo, which we think with all the focus on obesity and recent reimbursement wins with ESG, we think that'll be a really nice blooming business for us in the future. And our AXIOS products continue to get additional indication expansion and has really become a staple for customers.
So really with both those divisions, we have three or four very unique technologies. And we're able to work contracts with customers in a great way to partner with them to pull through the entire portfolio. So they're tremendously strong businesses, and we're confident in that high single-digit growth you talked about.
Well, that's probably a great place to wrap up here. Just about out of time. Thanks a lot for a great discussion. Thanks everybody for joining us today.