Please welcome Lauren Tengler.
Oh, wow. Thank you for that. Welcome, everyone. We are so excited about all of you being here today, both in the room and online. We have a great program for you today, and I'm really excited for our leaders to tell you more about our purpose here at Boston Scientific. Before we begin, we do have a few housekeeping items. We will be making forward-looking statements, so typical safe harbor applies. We will be talking about a lot of products that are not yet available in all geographies, and you can find that list here. We do have some financial disclaimers I'll just note too. First, all market estimates, unless otherwise noted, are internal Boston Scientific estimates. Second, you will notice some asterisks throughout the presentation, which denote non-GAAP measures, so things like organic revenue growth, adjusted operating margin, adjusted EPS, adjusted free cash flow, amongst others.
Finally, our agenda. We have a great program, like I said. We're going to kick off with Mike, go into MedSurg, followed by Q&A and a short break. We will finish up the day with Cardiovascular, including Finance and final Q&A. Our presentation and slides will be posted at the end of the day, at the conclusion of the program. Also, our replay will be available within 24 hours. Without further ado, I'd like to welcome to the stage Mike Mahoney, Chairman and Chief Executive Officer.
Oh, very nice room. Oh, that was the Boston Scientific clappers. Thank you. That was very nice of you. Welcome, everybody. Good morning. I'd like to welcome those of you who showed up in person, our shareholders that are online, and I do a quick shout out to our IR team for all the hard work, Lauren and Allie, that you put into this great event. It's such an honor to help lead Boston Scientific around the world with our leadership team here. I get the privilege to travel a lot, see a bunch of customers, spend time with all of our facilities, and see Boston Scientific and our culture on a daily basis.
I'm glad that you get to see a little bit of that from us today, beyond just a typical earnings call and so forth, to get to know our company and our team a bit more, because I think it's a really special place. As you know, we aspire to be the very best. We think we've been one of the best the last three years, and our goal is to do that for the next five years, for our shareholders, for our customers, and advance science for life. That's what today is about. I think it's really difficult as an investor, likely, to dig into culture or people, because you can't really put a number on it. I think it is one of the sweet sauces and special ingredients of Boston Scientific. Today, you're going to meet, not meet, but you know many of them.
You'll see these leaders present. This is just a snapshot of the depth of talent that we have around the world. We take talent management and succession planning very seriously at the company. I think we do it extraordinarily well. We do certainly bring in external talent from time to time. Our leaders are domain experts in their fields. They're extremely motivated to strengthen their businesses. Importantly, they live the Boston Scientific values every day. They also think about their division or function, but they always put Boston Scientific first. How can we best maximize our innovation and financial performance as a team? I'm excited to get to meet many of these folks today. Lots of companies have mission, vision statements. I'm biased because I like fishing. That's the only reason why. Advancing science for life is such a—I love that phrase because I can remember it.
It's really what we do every day. Now that I've had parents who have had lots of our products, a few competitor products, it's a privilege and honor to work in this industry and to really advance science for life. I think it's a motivator that drives engagement with our team. I think employee engagement is likely one of the biggest differentiators that you can have as a company as you continue to get larger and larger. Of these values, of course, we care about impacting patients. We impact—it's approaching 50 million patients per year. We want to make that number much bigger over this LRP period. We do all kinds of great things with our values on global collaboration, diversity, and meaningful innovation. You're going to hear a lot about meaningful innovation for the next five hours.
I do want to call out, we want to be a great place to work, but we are committed to winning, to leading in this industry. That's why high performance is on there, and the winning spirit of daring to try, trying new things, and really pushing Boston Scientific to be the best. For those who follow us closely, this is not a new slide, but hopefully a good reference for you. This is our first half results through 2025, through June. It shows you our full year guide that we did on our second quarter earnings call. We're really proud of the performance that we're seeing in 2025. As you recall, our guide for the full year is 14%- 15% organic growth off of a 16% organic comparison in 2024. As we do every year since 2014, some companies increase dividends a little bit.
Boston Scientific drives leveraged double-digit EPS growth. That's what we do. This year, we anticipate that range per the last guidance of 18%- 19%. On the left, many of you know these, are our eight business units that are organized across our MedSurg businesses led by Art Butcher, our Cardiovascular led by Joe Fitzgerald, and many of the BU presidents and Chief Medical Officers are here today to unpack the exciting, in most cases, category-leading divisions around the globe. On the right side is our regional breakdown. Quick shout out to Sam Conaway, actually, who leads our U.S. cardiology team, given the impressive growth of cardiology overall, but also the U.S. in particular. You see, we have terrific results in APAC Excellent growth in China, despite the complexities in China. Art will talk a bit more about that.
Our EMEA team is doing a heck of a job in a challenging environment in Europe. We continue to see great work out of our European teams and Latin America. This is what to expect. This is my fancy build slide. I have like one bullet that is going to build. It's going to be really exciting for you to see this. My 1980s PowerPoint came into play here. I just wanted to frame this up, and this seems like an obvious thing to say. We take Investor Day seriously. I know all companies take it seriously. When we take it seriously, it means we're actually going to deliver on these results. If you look backwards over the past six Investor Days, we have always delivered our Investor Day targets, and more often than not, beat our Investor Day targets.
When we talk about Investor Day, it's not some aspiration that doesn't have balanced upsides and downsides scenarios. It's actually a plan that we intend to at least meet, if not beat. I think our history of doing that over many, many years gives shareholders hopefully confidence, same confidence that I share. Here's when we frame out high level, and Jon Monson will talk more about our financials in his last section. You have to hold to the very end to see that. Over this next three-year period, we decided to provide, rather than a range, a 10+%. Historically, we have given ranges. Oftentimes, we've met or exceeded those ranges, so therefore pretty irrelevant pretty quickly. This time we said, you know what, we're going to give 10+% as our organic growth, outpacing our market CAGR of 9%.
As we always do, continue to improve operating income margins, target 50 basis points per year. We'll do more than that in 2025. As we always plan to do and have done, leveraged strong double-digit EPS growth. Over that 10+%, you'll see levered EPS growth. The key enablers, the values of the company, our global team, the most important job that I have in the company, lots of things to worry about, the culture of the company, the talent, and our innovation ecosystem. Those are the most important things that I spend my time on. Really proud of that. You're going to hear a lot about category leadership, which we've talked about for many years. What that means is we want to be the preferred supplier company partner to our customers in that physician call point. We don't try to be the broadest company in the industry.
We could, but we'd prefer to be the most meaningful to physician call points with a broad portfolio, unique innovation in there. Our team is incredibly savvy at finding adjacencies that have some type of leverage, either it be SG&A leverage, R&D, or operations, to continue to expand the call points and value props that we're in. We have a relentless focus on innovation and diversification. That's what in the high-growth markets, and that's what this day is mainly about. We have an excellent operations team who flies under the radar. They don't get to go to investor meetings. They work every day. They do great work. Our operations supply team, to stay ahead of the growth of the company, with excellent quality. Supply capabilities are terrific, and we respect those teams and honor them all the time.
We also, and you'll hear from Jon, have a pretty disciplined capital allocation strategy. As you know, we're very focused on tuck-in M&A, and we'll talk about that a bit more. That's the high-level three-year financial outlook that Jon will detail and the enablers. You know, really get, and again, I show this historical stuff because I sometimes think part of it is what can you expect from Boston Scientific. What you can expect is that we're going to continue to outgrow our weighted average market growth rate. Here you see a nice historical track record of the company as we've gotten stronger and stronger while investing more and more and more over the next five years. I'm proud that it took us five years, 2020- 2025, to go from $10 billion- $20 billion.
We're going to get the next $10 billion from $20 billion- $30 billion in a shorter time period than we did from $10 billion- $20 billion. Beyond the top line growth, here we go. Beyond the top line growth, again, proud of this track record. In this LRP period, we plan to improve operating income margins again on an average of 50 bps per year. It's something that we've done every year since 2014. Drive double-digit leveraged EPS growth. You see the track record here on the margins. Jon will talk about it. We used to view 30% as our aspirational operating income margin target. That is very much in our radar now, given the progress that the company's made. We'll continue to update those. That 30% goal is clearly on the horizon for us. Also, proud of the free cash flow conversion.
We used to sit with you, and you'd be a bit frustrated with our free cash flow conversion being quite a bit under our peer group. A lot of improvements in this area. I'd say we're right in the pack of our peer group in this area. This slide, what I'm also proud of, maybe this is a personal thing, we've done about 50 M&A transactions since I've been here. We have the largest venture portfolio in all of MedTech now, with about 45 venture bets. There hasn't been one instance where, in that quarter or that year, we've taken down our operating income margin goals or our EPS targets to absorb a deal that we've done. We don't ask our shareholders to pay for what you might perceive as risky investments.
We find ways to make trade-offs in the company that are smart, leveraging our ecosystem, to make sure we don't deviate from our commitments to you financially by pulling down our EPS or pulling down our margin targets for the year. I think our history of doing that is another good sign for the future. Our innovation ecosystem, pretty cool word, I guess, is an easy slide to replicate, I think, for most companies. Most companies would say, yeah, we do R&D, we do venture capital, we do M&A, and we have clinical. It seems like a basic slide. I think how we drive our innovation ecosystem, the processes that we have, this ecosystem, and the frequency it needs to be reviewed, looked at, challenged by a broader team, and the agility that we need to drive this ecosystem, I think, is very unique to Boston Scientific.
This ecosystem has to be within the DNA of the company. It has to be embedded within our leaders, our R&D leaders, and our global teams. An innovation ecosystem cannot take place by committee. It has to happen within the businesses, in the DNA of the culture of the company, and fertilized or given even more aspiration by the leadership team. This ecosystem works for Boston. Our teams are focused on third quarter 2025, but equally as focused on making Boston Scientific special five years from now, leveraging venture capital, which you hear about, M&A, which you know about, our R&D, which you're going to see a lot of today, and the clinical evidence to continue to expand our TAM. Not a great slide, but I created it. This is just a bunch of bullets.
This is an updated slide from what I showed in January on how we think about the next five years. You're going to see a lot of things at the company today. We have put in so much investment into making Boston Scientific special for the long term, for long-term investors in our five years out. You'll see some of that. Here's a snapshot of the programs that exist today. This is not a dream list, that either exist through our organic R&D efforts that, in many cases, have already been taking place for many years, or we have significant financial bets with our venture investments. Many of those venture bets we already have options to acquire or other kind of rights with that. We spend a lot of time on the ecosystem.
Here's a snapshot of things really almost beyond this LRP period that will continue to make Boston Scientific unique. This slide is a nightmare for me because I'm colorblind. Rumor has it, if you look at existing markets, I believe they're in blue. Whatever the next color is, green or teal, is $0- $3 billion TAM expansion. I think the next color they say is purple, which shows a $3 billion-$ 5 billion TAM expansion. The dotted lines show our VC investments.
What we've tried to do for you here is lay out some of the major programs at Boston Scientific that show you the power of our innovation ecosystem, the power of our clinical teams when we advance our clinical science to develop much stronger, bigger TAMs that you hear about from Joe Fitzgerald, in particular, in cardiovascular, and also the $50 billion TAM expansion that we see in front of us based on current investments that are going on in the company. I think hopefully this gives you the confidence that I feel that I have that Boston Scientific will continue to highly differentiate itself from our peer group based on meaningful innovation and a great passion for this business. Here's my wrap-up slide. Advancing science for life is always the foundation. It drives employee engagement.
We have a highly engaged, strong, talented leadership team who cares deeply about their teams. They're open-minded to new ideas. They're not afraid to try new things. They're humble. We also have a team that thinks about Boston Scientific first. I think when you combine a strong culture, a strong talent, a deep focus on innovation, and doing the right things for the long term, we will uniquely deliver differentiated performance again over the next five years versus our peer group and reward our shareholders. Thank you very much. I look forward to the Q&A session 19 hours from now, the very end. With that, I'd like to turn it over to our talent leader, Art Butcher, who leads our MedSurg and our APAC businesses. Thank you.
Thanks, Mike. Good morning, everybody. I'm Art Butcher, Group President for MedSurg, as well as our Asia Pac businesses. I'm very pleased this morning to be able to share with you some perspective on the incredible opportunities we have internationally in our highly underpenetrated international markets. We'll focus also on some of the key capabilities that we're developing within the regions now that are helping to accelerate global growth. I want to do a particular spotlight on our China business, where we're delivering outsized and differentiated growth. I want to share with you how we're going to continue that momentum in China. I'll wrap up with a quick introduction to our MedSurg businesses and the category leadership strategies that we're employing there. You'll get to hear from our great MedSurg leaders about the bright prospects for our MedSurg businesses.
Let's start by taking a look at the $30+ billion international market that we serve. Between EMEA, APAC , and Latin America, these geographies represent about 35% of our revenue in 2025. We think it should be higher. With the teams that we have globally highly engaged to drive these businesses, we're aiming to outpace these markets and grow the percentage of international revenue at Boston Scientific. Historically, these markets grow 7%- 8%. Boston Scientific has been able to grow at pace with them or outpace them. With the plan that we have in place that you're going to hear about today, we're highly confident that we can continue to outpace these important international markets. They're not just sources for growth for the company.
At the scale that we've achieved, we now are getting great capabilities that come up in the regions that are supporting higher performance for the company globally. That's a real resource and competitive advantage for Boston Scientific. Starting with research and development, we used to do almost all of our research and development in the United States. Several years ago, we made the planful strategy to move our R&D into the plants around the world so they're closer to production. This strategy is working. It just makes everything go faster in terms of product development, having the R&D engineers close to the process engineers. We're going to keep that going. Manufacturing, we continue to grow our manufacturing footprint globally. In the last few years, we opened up new plants in China, in Costa Rica, and in Malaysia.
We're specializing in those plants, and that specialized operations allows us to develop really advanced processes more quickly around the different technologies that we have across the company. We're infusing AI and automation throughout our manufacturing network, and that's allowing us to grow faster and faster. In terms of functions, we're putting functional centers of excellence in the geographies where they make the most sense, where the talent is there for us to leverage. For example, in India and China, we now have large presences in our finance function and our global business services function, with over 400 employees in India and China, economically driving efficiency throughout the whole company. Our aim is to continue to bring distribution closer to the end customer.
In the last few years, we've opened up distribution centers in Malaysia, in China, in Korea, so that we can better serve our customers and reach more patients. Bottom line, these enhanced capabilities, in combination with our great portfolio, pipeline, and team, are allowing us to outgrow these important international markets throughout the long-range plan. Speaking of outgrowing an important international market, let's transition to China. China is now the second largest single medical device market in the world. It's a very important market for Boston Scientific, and we're committed to this market. In 2025, we'll do well over $1 billion in revenue. In the last five years, we've more than doubled our revenue in China. Not many companies could say that. More than doubled our revenue and our employee base in China, substantially outpacing our competition and the markets.
I'm responsible for China, and in that responsibility, I'm in China three or four times a year. I'm proud to say that the leadership team that you'll hear from today also visits China multiple times every year. That's one of the reasons. When we go, we can see the momentum, and we can see the opportunity. When we come back, a lot of people often ask us, how are you able to deliver such differentiated results versus your competition in China? I want to take a couple of minutes and just give you three things to remember that I think are different about Boston Scientific. Number one is our incredibly talented and tenured team. Our leadership team in China is very connected to the leadership team, the global leadership team that you're going to hear from here today. They talk frequently, and our team visits there. Right?
At the same time, as being connected and aligned, they're also empowered to be able to make decisions quickly. They don't have to fight through multiple layers of bureaucracy to explain how quickly things are changing in China. They have the power to make decisions. Connected, aligned, and empowered is a huge differentiator for Boston Scientific in China. The second point I would want you to know about our China strategy is around our localization strategy. While many of our competitors have been pulling back from China, because it is a dynamic and complex and sometimes challenging market, I get it. We have taken a different stance. While they have pulled back, we have leaned in and advanced. Over the last several years, we have invested, and we now have equity positions in multiple local innovative China companies that support and augment our global portfolio.
Having this combined portfolio that leverages the China innovation ecosystem, as well as our global innovation ecosystem that Mike just outlined, is another huge competitive advantage. It's a competitive advantage when we have to bid on some of these very aggressive tenders. This portfolio is also proving to be valuable even outside of China and augmenting our portfolio globally. Speaking of competitive tenders, I think everybody in this room has heard about VBP, volume-based purchasing, which is a big challenge, and it has caused many of our competitors to pull back from China. I would submit VBP as a third point in our China strategy that is differentiating. We now have five years of experience with VBP, starting with the DES VBP that some of you all will remember in 2020. Our team has learned a ton about how to survive and thrive in the VBP environment.
What we're able to do, we're able to absorb some of the price pressures that happen with VBP, but we also get expanded access to much larger parts of the China health care system. With that access, we pull through the rest of our global portfolio and our localized hybrid portfolio. Boston Scientific's ability to do this successfully has proven to be unique to us. I think that is one of the things that is allowing us to demonstrate such remarkably differentiated performance. Bottom line, based on that strategy, which has proven to be resilient, we're committed to delivering mid-teens growth in China through the LRP. Let me shift gears for a minute and talk about our category leadership MedSurg businesses. Together, neuromodulation, urology, and endoscopy compete in a robust $20 billion global market that's growing 7% through the LRP.
Based on the very robust pipeline, as well as our strong category leadership portfolio and the teams you're going to hear from today, we're committed to growing above market across our MedSurg businesses through the LRP as well. Each of these businesses has broad category leadership portfolios and large global teams. They operate as separate business units, but they benefit from synergies of aligned capabilities. I just want to touch on three of those quickly. For example, in R&D and manufacturing, and there are many, but I'm just going to touch on a couple here. Urology and endoscopy benefit greatly from a shared R&D and manufacturing presence in our imaging portfolio. You may be familiar with products like Spyglass, DS, EXALT Model D, Spyglass Discover, LithoVue, LithoVue Elite.
All of these products share a lot of expertise, manufacturing know-how that allows us to benefit from economies of scale, driving down cost and advancing our innovation. In our direct-to-patient skill sets, a lot of the products in MedSurg benefit from direct-to-patient marketing. We share best practices across our MedSurg businesses. This allows us to reach and activate more patients in highly underserved categories like Parkinson's disease, erectile restoration, overactive bladder, obesity. You're going to hear about all of that today. That shared skill set allows us to accelerate in these markets where we can really provide life-changing therapy to many patients who aren't aware of these therapies yet. Last is strategic portfolio sourcing. Mike mentioned our supply chain team. Our global supply chain and sourcing team is world-class in sourcing complex componentry and raw materials.
We've been heavily focused on this in the environment over the last few years that's been inflationary, to be able to continue to bring down cost of goods as we grow. Bottom line, with these capabilities and with the teams that you're going to hear from, with the category leadership positions that we already have and the robust pipeline that we're about to deliver, we're really excited to be able to commit to above-market growth in MedSurg throughout the LRP. I'm really excited for you to hear from the leaders of these businesses. We'll start with Jim Cassidy, our President of the Neuromodulation business. Jim.
Thanks, Art. Excited to kick us off with neuromodulation. It's a dynamic space, and there are big unmet needs. We see those needs only growing as patients live longer, are more active, and want better quality of life. These therapies just do such a great job of enabling that. We are currently in two categories. We operate in chronic pain and in movement disorders. Our goal is to grow at high single digits over the LRP, driven by the breadth of our portfolio, the depth of our R&D pipeline, which I'll spend some time on, and our strategic use of BD. Really, the combination of homegrown, creative R&D. A great example from this month is we published our five-year data in JAMA Neurology on our DBS platform.
That homegrown R&D coupled with complementary category-enhancing BD, our Brainlab partnership in Brain Stim, and our leave-in acquisition in chronic pain, that combination has really set us apart and made us different. If you look at our markets, first three here are interventional pain. They add up to $3 billion. There's a range of tailwinds here from a demographic standpoint to really the rise of percutaneous therapies over and above surgical therapies. Our aim is to be the number one partner in interventional pain therapies. We've got a unique position with a leadership spot in SCS, where we've got a differentiated platform and a reinvigorated pipeline. We're pioneering Intracept, which is really the most exciting therapy in interventional pain. Today, we've got a robust RFA platform, which is the bread and butter of pain specialists around the country.
This breadth, I think, makes a difference when it comes to customer access, when it comes to market development, contracting, just overall scale at the customer call point. That's a big part of our strategy on the interventional pain side. Rounding out the slide is Brain Stim, which is a $1 billion space, Parkinson's and other movement disorders. It's underpenetrated, life-changing therapies. We've really innovated in this category to simplify the workflow, but also to improve overall outcomes. As I look across the slide, there's a lot of room for growth. What I'd want to do is spend time on our three big growth drivers within neuromodulation over the LRP. I'll start with SCS or SCS Cadence. A lot has changed in SCS over the past decade. What has not changed is that every patient goes home with a fixed waveform or waveforms, right?
That's the same frequency, the same pulse width. It doesn't matter which therapy, whether it's high frequency or ECAP-based closed loop. That stimulus, that consistent stimulus, has a challenge, right? You see the same stimulus over and over again. It's like getting up every morning and doing the same treadmill workout every morning. You get used to it, right? We've been looking over the past decade at ways to shift up that stimulus and vary it and mix it up really on a pulse-by-pulse basis so that you've got this concept of a pulse pattern. We've published on that over the past five years. This is like your treadmill that's moving incline and going faster and slower. You can't get used to it, and you're kind of surprised in some way what's going on. You kind of ask, like, what's the point of that?
What we've seen, and this is what's been interesting to us and powerful with this pulse patterns approach, is three things. One, increased overall fiber recruitment, which is enhancing pain inhibition. The second is dramatic reductions in energy consumption. Almost as you kind of vary the stimulus, you need less. Thirdly, patient preference. As patients are given options between pulse patterns and other therapies, they prefer pulse patterns. We're excited to launch our mosaic study imminently. That data should be presented in 2027. In conjunction with that, we'll launch our next-generation platform. I think these pulse patterns will play a bigger role, not just in pain, but on the brain side. It's early days, but they could be transformative for neuromodulation therapies into the future. Second big growth driver is the Intracept therapy. This is a therapy that's targeted at chronic low back pain patients.
These are folks that have inflammation around the disc. It's an ablative therapy. It's a special therapy because it's minimally invasive, non-surgical. There's no implant. It's one and done. You've got five years of controlled data. You've got great real-world data. It's super early innings. We've treated 50,000 patients with this therapy. There are 5 million patients conservatively estimated in the U.S. that could benefit from this therapy. If you talk to customers or pain specialists, this is the breakthrough therapy of their careers. I think it's because of what it does for patients that have few options. We are accelerating our investment in this category in multiple different ways. On the pipeline, we have three next-generation products in development. We've just launched one that's in limited release as we speak. We have a next-generation generator that will launch in the next 12 months- 18 months.
We are looking to expand the indication and go up the vertebral column above L3. A lot is happening on the pipeline. Focus on the market development as well. We've doubled the number of commercial coverage lives since the last time we were all together. Over 50% of commercial lives are now covered on the therapy. We've launched a large global registry called the IMPROVE study that will further our real-world evidence for the category. Lastly, global expansion. This is going to be a great therapy in international markets. We've launched in Europe. We're plotting out further expansion of the therapy. It's a $200 million category, but it's so early. As we train more clinicians, as we further the commercial coverage and drive overall awareness, this is going to be a growth driver for many years to come.
Lastly, on the Brain Stim side, we've just launched two brain technologies over the past six to nine months. There's a battle that's going on in Brain Stim right now. The question is, how do you get the best outcomes for patients? Do you target the right brain anatomy, or do you track the right brain signal? I think what's important to remember is that when you target the right brain anatomy, you get phenomenal results in DBS. All it takes when you're in the brain is movement of a width of a fingernail, and you can go from a bad outcome to an outstanding outcome. Our efforts have been around ensuring that we target the right brain anatomy. That's what you see in these two technologies. You've got the Cartesia X lead, which is doubling the stimulation points on an individual lead.
It's the first and only lead with this level of resolution. It makes it easier to place the lead. It makes it easier to program the lead. You've got fundamentally more shots on goal so that you're able to target the right brain anatomy. The second technology here is the Illumina 3D algorithm. It is a painstaking process to program a DBS patient. It has gotten easier over the years. This algorithm really allows you to just basically say where you want to stimulate in the brain, and this takes care of all the rest. We're seeing dramatic improvements in the time it takes to program patients, even above and beyond the image-guided element, 5 minutes- 10 minutes now to program patients, and outcomes that are as good or better than what we see from expert programmers. This technology is just saving a bunch of time for movement disorder neurologists.
It fits into our broader strategy of simplifying DBS, providing more access to DBS by freeing up surgical time, freeing up neurology time, so this incredible therapy can get to more patients. I'll close where I started. Big unmet needs in this category. We are focused on leading in interventional pain with our portfolio breadth, but also with a reinvigorated SCS pipeline and a huge opportunity with Intracept. We have a highly differentiated DBS platform that's simplifying things, making things better for patients, neurologists, and surgeons. On a go-forward basis, that combination of homegrown R&D with complementary BD, this category enhancing, is our focus. We expect and we hope to be able to treat more patients with these life-saving therapies through that approach. I want to thank you for your attention this morning. I want to introduce Meghan Scanlon, who is our President of Urology.
Thanks, Jim.
All right.
OK. We're going to talk about urology now for the next 10 minutes- 15 minutes. As Jim introduced me, I'm Meghan Scanlon. I'm very fortunate, along with thousands of other employees around the world, to serve this very large, dynamic, and complex market, both for physicians and, most importantly, for patients. The urology market is estimated to be a $7 billion market, growing approximately 7% over the LRP. We expect over the LRP, we will deliver high single-digit growth. For us, this really continues to be fueled by taking an extensive portfolio and driving it around the world with exceptional commercial execution in what remain to be highly underpenetrated markets. Every one of you, either yourselves or you know somebody who is dealing with a urologic condition, most likely. We are the broad category leader in urology. We have the broadest product portfolio of anybody in the marketplace today.
We also have a very diversified business across a number of urology subspecialties, which I'll show you on the next slide. For us, execution across the LRP really has to be fueled by three things: focused innovation. Mike talked a lot about meaningful innovation, and I'm going to give you a double click into some of that today. We also have investments in patient activation, which Art mentioned. When we are trying to reach patients who are suffering from OAB, other forms of incontinence, erectile dysfunction, we have a real obligation and opportunity to unlock these markets with continued investment in how we educate patients. Lastly, globalizing our business. We are still wildly underpenetrated in international markets, and that remains a huge runway for us with the portfolio we have today and the portfolio to come. It doesn't stop there.
Mike highlighted a bunch of venture capital bets that we have placed across Boston Scientific. Urology is no different. He highlighted a couple of categories where we've made some venture bets, notably urologic cancer and then prostate therapies. Those are the future bets that also tee up really nice M&A opportunities for us in the future. Here's the market we serve. I'm not going to unpack this in all of its beautiful glory. There are four subspecialties: endourology, prostate cancer, prosthetic urology, and pelvic health. You'll see across the top, these are the size of the markets and the approximate growth rates. My takeaway that I want you to take from this slide is as follows. We serve diversified markets, so lots of diversified growth opportunities. We also have a very diversified portfolio across each of these subspecialties.
We're only showcasing a smattering of the products that sit in each of these categories. Lastly, down below, you also see a diversified source of innovations and just an inkling of what our pipeline looks like across the urology markets, both near term as well as sort of through and beyond the LRP. Diversification and breadth is really, I think, two of the takeaways about our urology business that I would like you to take from this slide. I'm going to double click only into two of the urology subspecialties today. One is endourology, and the other is pelvic health. Endourology, hopefully for those of you who have participated in this IR day before, this seems a little familiar. This is our stone-smart ecosystem that aims to create a connected environment to redefine how flexible ureteroscopy is done. Now, why are we working on this?
We're the category leaders in stone today. Investing in redefining the way endourology procedures are done allows us to strengthen that category leadership, but also unlock additional value in meaningful innovations that we can sell at higher ASPs. The aim of it is twofold. First, and most importantly, sort of patient-focused, increasing stone-free rates. With unlocks and innovation, physicians can now do a lot more complex surgeries in minimally invasive fashion versus having to go percutaneously into the kidney. Second, as they tackle these more complex procedures, the cognitive burden on the physician and the staff is very real. We aim to reduce that cognitive burden through the stone-smart ecosystem that's shown here on the right. I'll unpack briefly the three pillars. LithoVue Elite is a technology we launched in 2023. This is the first pressure-sensing disposable ureteroscope available in the market.
Over the last couple of years, it's seen really strong adoption. Importantly, we just published real-world data comparing hundreds of patients who have been treated where the physicians were able to use pressure sensing scope, LithoVue Elite, to physicians who were just using disposable ureteroscopes. We showed a statistically significant reduction by about half in postoperative infections out to 30 days. This is the first evidence of its kind, which is really reinforcing why we invested in this technology. Second, Asurys. Asurys is now available in some markets in Latin America and Canada, and it currently sits with the FDA for review. As we've gotten the connection of LithoVue Elite and Asurys into the hands of physicians, what they're now allowed to do, this is a fit-for-purpose fluid management system built for urology procedures.
They set a level of a pressure they do not want to exceed, and they let the fluid management system do the rest. I was talking to one of our physicians in Canada who had the opportunity to finally use this connected ecosystem. He just sort of said to me with this almost like, oh, it just works, right? That is one of the best compliments you can get as an innovation team. For him and his staff, it just alleviated so much of the dial turning and fussing about that can happen during ureteroscopy procedures. Lastly, we have our MOSES laser platform, which came to us via the Lumenis acquisition in 2021. Next year, we're going to be introducing some of the first intelligent functionality from that platform.
That three-pillared ecosystem, combined with seven other launches in endourology over the LRP, further fueled by AI innovations and iterations that allow us to kind of unlock this interconnected ecosystem, is what we believe will continue to help us drive that expanded category leadership and capturing the value from those meaningful innovations. All right, there we go with stone. I'm going to take the rest of my time with you to unpack pelvic health. Incontinence is an enormous market opportunity. You see, just with OAB alone, we have 46 million patients who are suffering from OAB. 21 million adults suffer from fecal incontinence. This is just in the U.S., right? Usually, you can at least two or three exit for the global reach. Incontinence is not all created equal. There are sort of two reasons for incontinence. One is mechanical, right?
You've carried humans, birthed those humans, and you also get older. Your pelvic floor can weaken. Or you've had surgeries that may have actually caused some weakening of the pelvic floor. That's the mechanical solutions where we have slings, and we have our bulking agent that came with the Axonics acquisition. Then there's the neurological causes for incontinence. This is really when your bladder and your brain are just not communicating effectively. We need to intercept that and kind of cause the system to start working again. When we look at the Axonics business, big opportunity for us to unlock the significant investment in our urology business with the acquisition of Axonics last year. There are really three things that we're looking to drive our growth and acceleration in this space. Our strategic thesis for the opportunity here has never been stronger. First, innovation.
I have one example here, which is an external trialing system. You're like, what the heck does that mean, Meghan? Today, when patients are assessing whether they want to move to a permanent implant, there's a trial that they undergo. Oftentimes, what that means is they'll place the leads in the small of the back to be able to stimulate the sacral nerve. Those leads sit external, and the way that they are sort of contained means the patient cannot shower during the critical three to five-day trial period. We have a submission with the FDA right now for re-envisioning that external trial system where you can actually now put it in a watertight fashion on the lower back of the patient so that trial doesn't become an impediment to engaging in the therapy.
Oftentimes, when patients are told they're not going to be able to shower for five days, I don't know about you, that can be a bit of a hurdle for them choosing this therapy. Second, focused globalization. The Axonics business that we acquired is like 93% revenue from the United States. The opportunity for both Bulkamid and for the sacral neuromodulation portfolio is vast. We are under MDR review for the F15 in Europe. We already have the R20 there. We're looking forward to getting that full S&M portfolio into the European market. We recently got reimbursement for both technologies in Australia, and that team is off to the races. Lastly, evidence. We estimate about 80% of patients who get S&M therapy tend to be women. That's not because it's just women who have OAB. Men suffer from OAB a lot. Sometimes men are treated for BPH symptoms.
They don't know why they're not getting better after that procedure, and it's because the underlying OAB was probably unrecognized and undertreated. We have a clinical trial underway to generate that evidence. It's already indicated, but to generate that evidence to unlock this market more so we can educate patients and physicians. Now, 2025 has been a year of transition for us with this acquisition. We've combined the bag with our slings and our Bulkamid technologies into a pelvic floor dedicated selling organization. We continue to maintain simply an enormous footprint of sales representatives, clinical specialists, and field marketing experts to activate and unlock this market. There are really four things I want to highlight to you, which are our focus areas to drive acceleration in this area.
The 450 people that sit in the United States alone are meant to provide exceptional clinical support and experience to physicians and patients. We have only made that team bigger since the acquisition. Second, patient activation. We've talked about this a lot. Huge opportunity for DTP. Axonics had some great capabilities here. Boston Scientific has done this really well across cardiology and MedSurg and urology. We will continue to pour investment into this area. Health economics and market access. Health economics, what we call HEMA, it's a superpower in Boston Scientific, and urology is no different. Pointing this expertise and capability to the pelvic health market and OAB in particular to expand our geographic coverage, but also really work with the prior auth complexities that sometimes can exist, which can be an impediment to patient care. Lastly, professional education.
We have the broadest urology portfolio that's really attractive for residents and fellows to come get their education from Boston Scientific. We've invested in mobile labs that literally will pull up into the literal backyard of hospitals to allow residents and fellows to come out and get hands-on training from BSC and our faculty. For us, the 14,000 urologists out there in the United States, not all of them are always directing OAB patients to the right specialist. When we first came into this market, I was operating under the thesis that the big impediment to OAB and unlocking the market was educating patients. Yes, that exists, right? There are too many patients who suffer with incontinence and live in silence and/or shame and/or embarrassment, loosely the same thing. That's why they're not getting treatment.
However, there's also an issue of how do we activate and educate the physician population to speed along when patients share their symptoms, get them to the right treating physician quickly. This is the perfect segue. I want to share with you the story of Karen. I'm going to show you Karen's video in a second. Karen is a woman who had been suffering from incontinence that ultimately was urinary incontinence and fecal incontinence. She suffered for that for 10 years. She was telling her primary care physicians about her symptoms, but she was being treated mostly with medication. It wasn't until she finally made it to the right urologist that urologist slid the patient brochure for S&M across the table to her, and she started to cry, right? We in Boston Scientific, we have a magical opportunity to unlock that disconnect. Let's take a listen to Karen.
I used to get up early in the morning and go for a run. I stopped doing that because I couldn't get out of the house. I had overactive bladder, which led to frequent incontinence. When I would need to use the bathroom, it was the dominant force in everything in my life. When I got the device, normalcy just came back. All this noise went away. I just wanted to do everything all at once. It seems basic to just live a life, but it's not basic. It's huge. I am able to be active. I am able to care for my neighbors. Really, now I want to do everything I can for as long as I can. I'm back. I don't know how else to describe it, but I'm back, baby. My name is Karen.
I got my freedom back two years ago when I got the Axonics device. I am able to care for myself, care for my neighbors, take care of my dogs, take care of my family. That's what Axonics lets me do.
Hopefully, it sort of activates in you what motivates all of us in this beautiful urology business to come to work every day. I'll end where I began. You already read this slide, so I'm not going to unpack it. What's amazing to me about Karen is too often we talk about urology procedures as quality of life. What Karen said to me a couple of weeks ago, we had her come speak to our employees at our Everybody Makes an Impact Day. Karen said, it's not about quality of life. It's about life. Her life changed meaningfully for the better. She lost weight. She reconnected with her community. It's not just OAB patients who suffer from that. It's patients who suffer from urologic conditions all across the board, all across the world.
With that, I will wrap up with Karen, and I will turn it over to my colleagues in the Endoscopy division. I introduce Adam Smith, the Divisional President of Endoscopy, and Dr. Brian Dunkin, its Chief Medical Officer. Thanks, guys.
Thanks, Megan. Good morning, everyone. My name is Adam Smith. I'm the General Manager for our global endoscopy business. I'm joined here today by Dr. Brian Dunkin, who serves as our Chief Medical Officer. We're pretty excited to talk to you today about endoscopy and what makes that division of Boston Scientific such a special business for us. You can see here from the slide, to start, we operate in an $8 billion market. That market's growing around 6% across the long-range plan. We will continue to outpace that market growth, and we'll also deliver accretive operating margins back to Boston Scientific. We've got a few things to cover with you here today, but we have two primary objectives. The first one is, of course, we're going to talk to you a little bit more about our portfolio.
We operate in a very broad category, and that's certainly true for our portfolio. We cover a lot of different disease states, many different procedure types. We'll try to clarify that for you and show you some of the areas that we're really focused on. Secondly, we want to talk to you a little bit about our history in this category and why we see that as an advantage for us. Before I get into the details on the portfolio, I thought it'd be helpful just to talk a little bit about how we approach our portfolio, our portfolio strategy. It's always been anchored in some highly preferred, physician-preferred proprietary technologies. These are one-of-one technologies that oftentimes support other devices in our portfolio that are oftentimes used in the same procedure. From that proprietary base, we're constantly looking to push into adjacent markets that will help us expand our field.
You'll start to see that theme in other parts of this presentation. The second area was that history. We want to talk a little bit about that because we've been in this category for over 40 years. We have a deep understanding of this space. We know these patients. We know these disease states. We know these customers. We've developed a tremendous amount of trust in this category through years of innovation and pushing this category forward. We'll always remain humble about that past. All that history gives us a lot of confidence in our right to win in this category. We're hungry to push this field forward. This is the exciting slide. This is when we start talking about the actual technologies. As I said already, we operate in a very broad category.
To try to simplify how we think about our endoscopy portfolio, let me just start with this. The vast majority of our devices in the endoscopy category are flexible instruments that pass through endoscopes and work in the GI tract. It's as simple as that. We would include in the GI tract the liver and the pancreas because we access those organs transorally through endoscopes. If you start there, we're talking about flexible devices. They're single use. They go through an endoscope. We're in the GI tract. You can further start to understand this category by segmenting them into one of these four areas you see on the screen here. I'll touch briefly on a few of these. All of them independently represent large parts of our portfolio, and each of them are powerful in their own way. The first one is pancreaticobiliary.
Pancreaticobiliary is where we're treating diseases of the gallbladder, of the pancreas, of the bile duct. What's exciting about this category is we have created markets. We've had a long history of creating markets in this category. We introduced single-use scopes with Spyglass over 20 years ago. Single-use scopes have become a far more accepted device in our world today. We started this all the way back 20 years ago. That product's gone through numerous innovations throughout that period. Even more recently, we've introduced a new category with EXALT Model D. AXIOS is this revolutionary technology that Dr. Dunkin will talk a little bit more about that's really changed the way numerous GI disease states are currently being treated. What's more exciting about pancreaticobiliary is that we see numerous opportunities for continued advancement.
Next year, we'll launch a capital platform that will allow us to introduce some enhanced imaging technologies with artificial intelligence into some of those single-use scopes. We believe that we can continue to differentiate scopes versus the more heavy capital burden scopes that are out there today that they'll displace because we're operating on faster innovation cycles than those capital platforms. There are really exciting opportunities to continue to bring meaningful innovation to this category. The next one is endoluminal surgery. This is an exciting category. It's exciting for us, but it's more exciting for patients. Endoluminal surgery is literally disrupting the way general surgery is treating certain GI disease states. Mike Mahoney started earlier with what you see up here. We are about advancing science for life. You heard Meghan talk about the patient with fecal incontinence and how that's changed her life.
Endoluminal surgery might be the most clear example in the field of endoscopy around how we're advancing science for life. These are patients that were once going to the operating room to have surgical resections. They're now migrating into endoscopic therapies where we can spare that organ. They can get back to recovery faster. They can get out of the hospital sooner. They can get back to living their lives faster. Endoluminal surgery is a very exciting space for the field and for these patients. That migration out of the operating room into endoscopic therapies has primarily been enabled because we've developed better tools. We've got better cutting tools that are treated endoscopically. We've got better closure tools and even endoscopic suturing tools now. You'll continue to see this field really advance. I mentioned our interest in pushing into adjacencies.
Endobariatrics is that current adjacency that we're very focused on right now. Endobariatrics is an endoscopic approach. It's a volume-reducing procedure of the stomach. Certainly don't need to talk to this group about the size and scope of the obesity market and the attractiveness of that opportunity. We believe that an endoscopic approach here will play a role with the treatment of this population. Lastly is our core business. This is GI strictures and bleeds, infection prevention, a whole host of families of products that help support those and continue to deliver profitable growth back to the division. When you put all of this together, like I said earlier, each of these represents powerful parts of the portfolio. When you put it together and you offer this in combination, it's a real advantage for our endoscopy business.
All right, next slide here, I just want to talk a little bit about, you know, we talked about the technology. We talked about the portfolio. This is really what differentiates us in this category. This is how we win in this space. I'll start with the gear imagery because it's intentional. Each one of these gears represents a different element of our go-to-market strategy. They work in combination with one another to support our top priorities. The first gear there is innovation. We talked a lot about that already. It's always been about innovation. It will always continue to be about innovation. We are well positioned to deliver meaningful innovation across all four of those categories. After you develop the technology, it doesn't stop there. We've got a history of physician education that drives procedural adoption. We've got investments in clinical programs that expand the indications.
Our health economics team, you heard from Meghan, this is a superpower of the overall enterprise. In endoscopy, those health economics teams are working side by side with GI and surgical societies to ensure that appropriate reimbursement is in place to continue to expand adoption. We've got these big commercial teams out there that are operating with this big portfolio. They're well-trained, and they're delivering very diversified global revenue for us. When you get all these gears working together, that's exactly how we've established this market leadership. When we get this market leadership in place, we've also been fortunate enough to put some very powerful long-term contracting strategies in place that really protect us from any sort of dynamic movements in the marketplace. This is exactly how we've delivered that market leadership. It's exactly how we plan to keep it and how we plan to expand it.
I'll turn it over to Dr. Dunkin to talk to us a little bit about some of the work we've done to create some categories in this space.
Thanks, Adam. Again, good morning to everybody. It's really a pleasure to be in front of you today. Let me bring to life a little bit about what Adam was just talking about. In the 40+ years of Boston Scientific endoscopy, it's not just about bringing a new device to market, it's about creating new markets, new clinical ways, less invasive ways to care for patients. I'll use AXIOS as an example on this slide. AXIOS is a specialized stent. It really allows an endoscopist, an endoscopic ultrasound physician, to connect the intestinal tract, say the stomach, to another structure outside of the intestinal tract. That's revolutionary. That's a form of endoluminal surgery that Adam just talked about. When we introduced AXIOS into the endoscopic ultrasound market, it transformed practice. I'm a surgeon. Things that I used to do surgically were now replaced with an endoscopic procedure.
We introduced that kind of technology to market. We wrap it with all those things that you saw in that gear slide, not the least of which for AXIOS was in expanded indications. Started with that one indication, wrapped it in clinical evidence to prove to the clinical community that this was the real.
to use this device and then expand beyond there. Last year, we got our fourth clinical indication for AXIOS, which was for gallbladder drainage, to be used in the U.S. This year, we've gotten our fifth expanded indication, and that is using AXIOS to relieve intestinal obstruction. That indication is achieved in Japan. We're in the midst of an international multicenter trial to get data to support that regulatory clearance in the U.S., Europe, and other places as well. An example of really developing a new market, a new way of working, expanding that through expanded indications, and we don't rest on our laurels there. Next year, we're bringing [EUS] to market. [EUS] is going to give endoscopic ultrasound physicians another new way to access the biliary tree, to access the liver essentially through the intestinal tract, and then extend even beyond [EUS] into further years.
Whether it's endoscopic ultrasound and AXIOS, or it's in the pancreaticobiliary space with introducing single-use imaging, or the endoluminal surgery space where we're really disrupting general surgery and moving these procedures from the OR into the endoscopy suite to be done in a less invasive way, we have a strong track record of creating new ways of doing clinical work, new markets, and we'll continue to leverage that expertise as we move forward. In fact, endobariatrics is another example of building a new clinical way to work, a new market in endoscopy. This is an exciting area to be. We are in the midst of a virtual pandemic around the world in obesity. Having multiple options for treating patients with obesity, which has a complex multifactorial disease, is very, very important.
We're excited to enter into the endobariatric space with OverStitch, which is an endoscopic suturing device that allows us to basically suture the stomach into a smaller configuration so patients eat less and stay full longer, or the intragastric balloon Orbera, which has the same impact on the stomach. A common question is, where does endobariatrics play in this world of GLP-1 type medications? We would say that the short answer is it serves as a gap therapy. It fills that gap between non-surgical intervention for obesity and surgical intervention for obesity. Let me give you an example. If I was a patient suffering from obesity just five years ago, and I went into my doctor's office and I said, "I need medical advice on how to manage my obesity," I would have been given two options: lifestyle modification, which is essentially diet and exercise, or surgery.
While lifestyle modification is foundational to any weight loss strategy, it, as a standalone strategy, is not effective, and that's been shown in many clinical settings. Surgery, very effective. The surgical community has worked hard to make surgery safe, but patients aren't opting for surgery. Less than 1% of eligible patients for bariatric surgery actually choose to have that intervention and go through with it. This left a very large treatment gap between lifestyle modification and surgery. Now, GLP-1 type medications come to market. They help to fill that gap, and that's a very important contribution. They're going to help millions of patients. They're going to activate these patients to re-engage with the healthcare community and say, "Tell me about these new interventions for treating obesity." That's a good thing. They're not a panacea.
Over half of patients that start GLP-1 type medications for the purpose of weight loss stop it within 12 months. Over 70% stop it within 24 months. There remains this treatment gap between non-surgical and surgical intervention. That's where endobariatrics plays a role. We're excited about that opportunity. I'll say the things that you see in the lower part of this slide are those things that we wrapped this technology portfolio around. Reimbursement. We were in front of the AMA advocating for a CPT category 1 code, which was granted and will kick in in January of next year. That's helping to break down reimbursement hurdles to get access to this technology. It's been exciting to see what's already happening in that space. We have government coverage in the U.S. with CMS. We have coverage by the NHS in the U.K.
We have commercial payers coming to the table and offering coverage even before the CPT code has kicked in. That shows you that they're looking for an alternative to the GLP-1 type medications. Society support. We have multiple publications now, guidelines, position statements, and white papers by both GI and surgery societies that are advising their members that an endobariatric approach is an effective approach for treating patients with obesity, and advising them on where it fits in as this gap therapy. The last thing I'll say is about patient awareness. We're leveraging the experience of our WATCHMAN colleagues, of our urology colleagues, and talking to patients directly now, educating them about the advantages of endobariatrics.
We're doing that with direct-to-patient marketing campaigns, call centers where you can talk to a real human about this, and connecting them to qualified physicians to further advise them and offer them a high-quality procedure. Multiple examples, including this endobariatric space, where we're excited to develop new markets. With that, I'll give it back to Adam to bring us home.
Great, thanks, Brian. Definitely a lot of interesting work going on to help develop this endobariatrics market. We do believe that many patients will see this gap therapy as an attractive option for them. I'm just going to finish this off here. Again, like you've seen now all morning, we'll finish where we started. Hopefully, you've got a better understanding of the endoscopy portfolio. Hopefully, you have a better understanding of this kind of broad, multifaceted go-to-market strategy, our deep understanding and history in this space, and how that sets us up favorably. I will just say to remind everyone, we will continue to outpace the market growth in this category. We will continue to deliver accretive operating margins back to the business. You can see at the bottom of this slide, we're very proud of this innovation pipeline that is coming. We've got a lot of innovation coming here.
We think patients across our portfolio of pancreaticobiliary endoluminal surgery and endobariatrics will be benefiting from these meaningful innovations that we'll launch over this long-range plan. Thank you for your attention this morning. I'll turn it back over to Lauren for some Q&A.
We're going to open up for Q&A for the next 15 minutes or so. Please raise your hand, and we have mic runners in the room. We can also take questions on the webcast. If you are not in the room, please feel free to ask a question that way. All right. Great. All right, Joanne Wuensch. When you get the microphone, please say your name and your firm.
Good morning, and thank you for taking the question. This is Joanne Wuensch from Citibank. I was looking at your last slide, and there is something in 2028 that was entitled PFA for Type 2 Diabetes. I know you don't want to talk about PFA until another session in the future, but that did catch my attention.
Yeah, I can take that. It's an interesting area. If you think about treating obesity, there are kind of two components to it. I just talked about one component. Hey, can we help patients lose weight through the endobariatric strategy that we talk about? There's another component that's associated with obesity, and that's the comorbidities. In particular, Type 2 diabetes is one of the most important comorbidities that goes along with it. We are very excited about the potential for an endoscopic approach for treating Type 2 diabetes. There are different strategies for doing that in the duodenum, which is the first part of the intestine the stomach is connected to. We're a company that has expertise in energy, RFA, cryo, pulse field ablation.
Being able to bring that expertise, particularly in PFA, to really what's called a reconditioning of the duodenal mucosa in order to change patients' insulin profile and sensitivity, we've got some exciting work going on in that area.
Thank you.
I'm going to take one from the webcast. This is Chris Pasquale from Nephron Research. Meghan, this is for you. What are your thoughts on implantable tibial nerve stimulation for OAB, and do you anticipate near-term competitive headwinds as your competitor rolls out their device?
We talked a lot about the size of the OAB market and how underpenetrated it is. Generally speaking, our perspective is innovation in this space is good for everybody. We do think that tibial can play an important role with patients at different stages of the continuum. In terms of headwinds, there have already been competitive tibial technologies on the market for a couple of years now. They will continue to battle some reimbursement headwinds while they fight to get CPT-I coding. Currently, it's covered under Category III coding. There will be some headwinds that they have to deal with. I kind of think of this like when you see a bunch of six-year-old kids around a soccer ball, there's such a bigger field out there versus trying to go fight with the six-year-old kids around the soccer ball. The OAB market is enormous.
Any technology that brings patients into the conversation, I think, is a rising tide that lifts all boats.
Thanks. Rick Wise.
Thank you. Rick Wise, Stifel, maybe a question for you. You made some great comments about the OUS market opportunity, and I expected to be nervous hearing you talk about international markets today, but it was very soothing to hear what a great job you're doing, the team, the innovation. Everything horrible, even VBP, turns out to be something wonderful for Boston . I got it. My question is, I get up every day, and you know, the world is even more complicated from a competitive point of view. Maybe help us understand, today 35% of the business is OUS. What is that higher percentage you're aspiring to do or you're dreaming of? Seriously, you know, should I be worried that you're so complacent and happy and things are going so well internationally? It's a silly question, but you know.
No, Rick, thank you. I appreciate the question. By no means do I intend to convey that VBP is wonderful. It's quite a challenge, actually, to manage. In terms of target percentage, I don't think I'll give you a target percentage. Let me just say this. For many years, our endoscopy business, for example, was 55/45 and each division will be different. I think what we've seen is that a lot of the technologies that we've launched in the U.S. market in the last few years have really taken off and made that proportionality shift more weighted to the U.S. What I was trying to highlight with the 35% is to say, you know, in a perfect world, could it be 50/50? I think it'd be very hard to get to that.
Gosh, if we can get to 60/40 or 55/45, it just highlights what an incredible opportunity there is across all divisions, and you'll hear from Cardiology this afternoon as well, for some of the technologies that have taken off in the U.S. to penetrate more into these international markets. I think it speaks to the delayed opportunity that we're going to be chasing for many different technologies. I certainly, again, I don't mean to paint too rosy a picture. Doing business in China in particular is a very dynamic market. I do think we're uniquely well positioned because of the things that I mentioned, the team, our localization strategy, our VBP strategy. It is challenging. What happens is, in a given year, VBP will hit one segment of our business. That segment of our business may get hit pretty hard.
What we're proud of is that we take that and we adjust, right? We adjust the P&L, we adjust the staffing in that section of the business, we may adjust the portfolio, but we're committed to staying and leveraging the access that we get into more accounts to pull through the rest of our portfolio that hasn't been VBP'd yet. The thing that I will add, it's really critical for the long term in that market. Yes, the localization piece, but two, is bringing your new technologies to market as quickly as possible in China because that increases the proportionality of your non-VBP'd business as you go forward. It's always a race, but what I'm proud of is that this whole team gets it and we're executing a plan and we know what our strategy is and it's not like a runaway strategy. I hope that's helpful.
Front row here. There you go.
Dave Rescott with Baird. Thanks for taking the questions. I want to follow up on China and VBP, and I think the last analyst day, you called out this mid-teens CAGR in China. We're two or three years past that growth outlook. Now you're still laying out kind of this mid-teens CAGR over the period, and VBP is more than it was back then, or we now know that there is more VBP that has come since then. Can you help us understand how much of the portfolio maybe has seen an impact from VBP? How much still potentially will see an impact from VBP in the future? As you think about getting beyond some of the headwinds, is there a point at which you get past price and now VBP becomes a, or the absence of VBP becomes a tailwind to something better than that mid-teens growth?
Yeah, it's a little bit of a complicated answer, but I'll try and keep it tight, which is let's say it's roughly 50% that has been through VBP, but the portfolio continues to change. We're always bringing new technology into the portfolio. That changes the total size of the business, if that makes sense. There is a point after which VBP settles. If you think about the first VBP that we experienced, it was drug-eluting stents. It was 2020, and the price reduction was substantial. I think the government learned also that that level of reduction put a number of companies, local companies, out of business. They changed their percentage that they're looking for. It has become not as extreme. I'm not telling you that it's pleasant, but it's not that 80%- 85% price reduction that we saw in 2020.
In fact, in the second round of DES VBP that came a couple of years later, there was a 15% price increase. We did benefit from staying the course, and we benefited from the increased access that we got through being committed in that first round. It actually became a tailwind because we had access to so many more accounts through the VBP. We got a price lift, which allowed it to be more a tolerable price point. We were able to pull through important parts of our portfolio, like IVUS and WOLVERINE and Rotablator, into a number of accounts that's in the thousands that we weren't in before. It's dynamic, it's ever-changing. What I like and what makes me feel better is that our team is tenured and experienced and has been running this strategy, and they understand the marketplace very well.
Jason.
we're confident in the outlook for 2024 and beyond.
Say your name.
Oh, Jason Bedford, Raymond James. I think Mike used the words challenging environment to describe Europe, and I'd love for someone to maybe comment on the environment in Europe, and is it a bit more structural, transient? Would be helpful. Thanks.
Anyone want to take that?
I could do it.
I think, yeah, one of the things that Mike's probably referring to in terms of, especially for our MedSurg businesses, some of the challenges in Europe are that the low-cost Chinese manufacturers are looking for new markets outside of China for their product lines. That is particularly challenging in the MedSurg space where a lot of our products are 510(k) regulatory pathways. It's a lower hurdle to get in. Those are places where we've had really strong competition that we've had to overcome. How do you overcome that? You overcome it through the category leadership strategy where you have a broad line, the broadest line of highly differentiated products that pulls through the rest of the portfolio. It's challenging in that way. I think we have the right strategies in place. Mike.
Can you hear me?
Yes.
All right, great. Sorry, part of it, if you look at our European business, has grown prior to this year, prior actually till April, it's grown double digit. Our team in Europe continues to execute at a high level. The impact in 2025 is quite frankly a bit self-induced. It's primarily driven by the withdrawal of Accurate, which is well over, slightly over $200 million, and some backorder challenges that have hit some MedSurg businesses primarily in Europe. The underlying strength of our European business the last few years is, I think it's been 9% or 10% growth, is very strong. Our growth in emerging markets is strong double digits, and Western markets has kind of been mid-single digits. Overall, we're very happy about the performance of our European business and the outlook. In 2025, those two things, you pull $200 million bucks off the European business.
If we excluded that, I don't know what the number would be, Allie, but it'd be higher. That's really the primary driver. There's no macro things that are unique in Europe that are brand new.
Thanks. All right, we'll take Pito.
Hey, yeah, thanks. Peter Chickering at Deutsche Bank. Looking at brain stimulation, the market growth is much lower than I would have thought a few years ago. As you look at the upcoming product launches, do you see them as evolutionary enough to start really accelerating the adoption of brain stimulation therapies? Just sort of curious how we can get out of this really single-digit growth in the category.
Yeah, no, thanks for the question. I think some of the dynamics with the market growth have been just a replacement cycle that's happened where we've shifted. The average DBS patient maybe used to get a primary cell device five years ago, and today they're getting rechargeable devices. That whole replacement dynamic has really shifted. It's less impactful to us because our business is 80%+ rechargeable. Certainly, that's been added pressure to the broader market because of that replacement mix. In terms of the question of these new technologies, I think, as you know, DBS has been a category that's been academic medical center driven for quite some time. What I like, what I'm seeing in terms of these new technologies is that we're getting them out into the community. Community neurologists are able to program, and 10 years ago, that just never happened.
I think that there's a promise that as we kind of get, it's not just an AMC dynamic, it's a broader community dynamic for DBS. These are the technologies that open that up. Now that takes time, though. It's the time of that. That's a big focus for us, how do we get a bigger tent outside the AMCs for DBS.
Thank you. We have time for one more question. Travis? Sorry.
Just curious if you could spend a little more time on BPH. There's a lot of dynamics in the market, a lot of technologies out in the market, competitive technologies, and also talk a little bit about your next-gen BPH product, if you can.
Oh, BPH.
Yeah, sorry.
Oh, BPH.
I thought he was talking about your vertebral body. Okay.
BPNA.
Sorry. Yeah, the BPH marketplace has been a pretty dynamic and fickle one for actually many, many years. You see technologies that kind of take off like a boom and then see rapid declines. When we look at our portfolio, we have a diversified portfolio of BPH therapies, whether it's Rezum, which has been a darling of growth for us in international markets in particular, but also GreenLight or using our lasers for enucleation. We have a diversified offering because every prostate doesn't deserve the same technology. Every prostate in different geographies doesn't deserve the same technology because you have different health economic considerations at play. For us, we have some intelligent venture capital bets in this space. I'm not going to get into the specifics of what they are, which would be customary for us not to disclose those details.
We also have some next-generation capital infrastructure that's actually going to strengthen our Rezum footprint around the globe. I'll stop there and see if there's anything else you'd add or nope, good. Okay. No.
Thank you so much to the MedSurg team. We're going to take a 10-minute break. Please come back in 10 minutes and we'll get started with cardiovascular.
All right.
In this space, there's been challenges with on-med trials. This is an off-med trial design. This is a two-to-one randomization to sham control. Enrollment will complete in 2026 with anticipated data release in 2027. If we go to the next slide, I want to show you a little bit more about the device. Anything in med tech has to be safe and efficacious. Safety in renal denervation is pretty good. It's a very safe procedure in everything we've seen in the data to date. Efficacy, we're hopeful that our pivotal trial will demonstrate what we saw in our first-in-human experience. Ease of use is what drives physician adoption and repeated use of a technology. This is what excited us about this investment and why we brought this into our portfolio. In this picture, what you can see is a physician holding a handle.
There's only one moving part to this device, simply a lever. That's very unusual in interventional cardiology to have one moving component. What that moving component does, if you look at the end of the catheter in that circle, you will see these wings, these copper-colored triangles that are coming out, which surround the transducer. That is what centralizes the energy element that delivers energy to the artery and to the nerve. This device is delivered femorally with a future application radially. It's delivered over a wire. It takes seconds and minutes to perform this procedure in terms of the energy delivery. Very easy and simple to perform with a single catheter and very simple and efficient workflow, as Lance alluded to as well. We're very excited in terms of this being part of the usual workflow and efficiency in the cath lab, which is getting busier and busier.
All right. If you're not excited enough, and I am trying to talk slow, we'll also talk about Vitalist. This is our fully funded internal R&D program for our Circ support programs, which is three programs in one. It's high-risk PCI, it's cardiogenic shock, and it's also for the heart failure patient that needs 30 to 45 days support. It's all built on the same platform of technologies, which I'm going to walk through. It's the same console, a lot of the same sheath and delivery system, same type of impeller design. There are slight differences as you have to extend duration of runtime, but essentially, it's the same platform that we're leveraging across all three disease states. Today, I'm just going to focus on high-risk PCI and cardiogenic shock. You can see by 2028, this should be a $2.5 billion market growing in the mid-teens.
I want to share with you very specifically why and the reasons to believe that this can be a very disruptive entry to the market. First of all is this idea of set it and forget it. That's what the physicians say when they set this. You've heard about other devices on the market where they tend to move, alarms go off, you have to have a lot of clinical support in the ICU, hemolysis because the device moves out of plane with the flow of the blood. This device, we've spent a lot of time, effort, AI as well, with thousands of CT images to model the aorta to put the right double bend. It looks kind of simple.
You can see on the chart there the double bend, but that double bend allows the device to stay basically fixed in plane in the ventricle to keep laminar flow, reduce hemolysis, no alarm situation. It is amazing when you see it in action in a procedure. The second reason we believe that we've got a differentiated product is that we do not use a purge line. There's no purge line setup because this is in an enclosed housing. It's an enclosed motor housing where the motor and the impeller are connected by a magnetic coupling device, so no fluid gets in. Again, it's going to get to durability, hemolysis, less setup, no purge line issues with controllers, another huge advantage. The other thing that, you know, we just kind of dispelled some of the myth.
I don't know who has a fluid dynamics PhD in the room, but if you do, a lot of games can be played with flow rates across pressure gradients. When you see this pump work, it's 4 liters per minute, easily even in low-pressure situations or low EF situations. Some people will talk about higher flow rates, but you really have to ask the question, at what pressure gradient or what EF is that operating at? We are very confident with our flow rates and that we've got the right design there. Also, sheath access. Many of you are well aware of the vascular access complications with current technology. We have the best sheath technology on the market in terms of what we've done with our structural heart portfolio and other technologies. We know how to reduce the bleeding complications.
We've got very novel sheath designs that we'll be showing as we move through the clinical trial process. The good news is we're basically simultaneously imparting on the trials for high-risk PCI as well as cardiogenic shock. I'd like Janar to walk through the first trial design with high-risk PCI.
Yeah, thanks, Lance. I'm going to take this in two phases because there are two different clinical applications, as Lance mentioned, for this product. We are starting with high-risk PCI because that is the regulatory pathway that we have to follow. For us, similar to what I mentioned with the toolkit approach, this is another tool for supporting interventionalists in the cath lab doing coronary intervention. Patients are getting sicker, older, more comorbid, and circulatory support is needed. We have completed an EFS study already last year, which showed the benefits of this device in a small cohort of very sick patients. Importantly, I think we saw a very reassuring safety profile in that very early series because this is a space where safety has been a concern with these devices to date.
That will be followed with an IDE study randomizing against currently commercially available circulatory support devices early next year. That's to get an indication for high-risk PCI. We're simultaneously also exploring a trial design in shock because shock is a major unmet clinical need, as this room knows. You have a third to a half of patients that suffer from major morbidity or mortality when they present with shock. We're excited for those two separate workstreams from a clinical data perspective.
Thank you. All right. As we wrap up, before I go through some numbers, we've covered a lot. I thought, [Janar], what are you most excited about?
Lance, quite frankly, I think you can appreciate from the presentation, there is a lot of new things that are coming in our division, which is incredibly exciting. I think it speaks to our culture of innovation investment, speaks to the fruits that have borne even this year alone with two acquisitions coming into our division from our VC portfolio. I am incredibly excited about the different trials we're doing because that is what drives practice, is data that changes guidelines and evidence and practice. I'm excited about the five or six trials we have coming up. For me, what resonates the most is, like I think Joe showed a slide, you know, we've got potentially 2 billion patients that we can impact with our devices as Boston Scientific in interventional cardiology, which is really exciting. Our real goal is to treat the most patients we can.
That is what category leadership looks like. That is what advancing science for life is. That's what really excites me. For you, you know, leading our division, Lance, what excites you?
It's tough. It's like trying to choose your favorite kid. I would say it's the team's just winning spirit. We're humble, but we're tenacious. It doesn't matter if we get a VBP or we have drug-eluting stent pricing headwinds. We find a way to innovate. We find a way to leverage that innovation ecosystem, and we will keep investing in our portfolio. That's why we are the market leaders in coronary therapies. It's why we've got some really exciting game-changing technologies that can be very disruptive in IVL, renal denervation, and circuit support. We've got this VC investment portfolio that's going to come after the structural heart space in a big way, as well as leverage other new heart failure therapies that are coming.
I'm most proud of the fact that we delivered on our commitments from the last Investor Day, and I'm super confident we are going to deliver again, double-digit growth. We will exceed the market growth rate, and we are uniquely positioned to be the best interventional cardiology company on the planet.
Thank you. Next, Scott Olson and Dr. Ken Stein.
Thank you, Lance. Where do you want to go, Ken? All right. Good morning, everybody. My name is Scott Olson. I get the pleasure of leading our Cardiac Rhythm Management and Diagnostics division, and I'm joined by Dr. Ken Stein, our Chief Medical Officer. Today, I am honored to lead a very passionate, dedicated, and committed global team, and really excited to be here with you today to talk about the future of CRM. We compete today in a $12 billion market that will grow about 4%. As Joe had mentioned, it's a pretty penetrated market. What you'll see from us is a very aggressive focus and cadence within our pipeline.
We will be moving from below-market performance, as we've had a little bit of that in the past, to on-market performance, thanks to a recent investment within the conduction system pacing that has put us into a highly competitive position, as well as entering the leadless market in modular therapies that Ken will discuss a bit here. Additionally, you'll see a big investment in our transvenous, both brady and tachy platforms, as well as our subcutaneous platforms. Every few years, more like every 15 years- 20 years, you have to revamp an entire platform. That time has come. We've invested heavily in it, and we're excited to get that into the market in the LRP here, about mid-range in the LRP.
Finally, we've made increased investments in heart failure around our Diagnostics division, specifically around heart failure, to get into a very large market that has some real needs for patients around the world. You'll also see us invest in some adjacencies with long-range plan investments around leadless pacing. We're very excited about what we have today. We're extremely excited about the pipeline to come, as well as adjacent investments to grow this business. I'll hand it to Ken to give a bit more detail.
Yeah, thanks, Scott. I want to walk you through the reasons that we firmly believe in what Scott said in terms of our ability to regain our mojo, if you will, in cardiac rhythm management, and it is going to be driven by a consistent cadence of meaningfully innovative product launches. That cadence includes the launch of our modular or mCRM system. That's our Empower Leadless Pacemaker, and it's very important for us to just get into the leadless pacing business. I'll say more about the combination of Empower with the SICD in a moment. Also, as Scott mentioned, we're investing to accelerate the leadless pacing portfolio with some true next-generation technologies that will hit beyond the LRP. Scott said we're announcing a true generational refresh of our CIED, our implantable electronic device platform, across brady devices, across tachy devices, CRT, and the SICD. We're calling that Precedent.
Precedent brings with it dramatically enhanced patient connectivity, getting better patient applications, in addition, ability for remote software download and upload to devices, and ultimately to bring true remote reprogramming to the cardiac rhythm management market. Precedent is a true transformative technology. It's built now, but built for the future. We recently acquired, as I think you all know, the BioEnvelope business from Elutia. We plan to expand that into more U.S. markets once the deal closes into Q4 this year, and again, really get into the market of anti-infection technology as a complement to our devices. We'll continue offering enhanced conduction system pacing tools. I want to emphasize that beyond enhancing our conduction system pacing tools for pacing, we are also going to bring a highly innovative CSP product into our high-voltage technologies in the coming years.
On the diagnostics side, as Scott said, [LUXAir] will pair with our LUX-Dx implantable cardiac monitor, and we'll pair that with our AI-enhanced BeatLogic deep learning algorithm, using artificial intelligence to improve accuracy in this platform. Finally, we're very excited about some of the really important investments we've made in heart failure diagnostics that will incorporate into our LUX-Dx portfolio. Again, I'll unpack that in the future slide. As I said, our differentiated leadless pacer offering, Empower, will be commercialized both as a standalone leadless pacemaker and, critical for us to become players in that market, offer that capability to patients, but also as part of our modular cardiac rhythm management system launch.
Empower and the SICD, which make up what we call modular CRM, are designed to be able to work not only individually, but also have the ability to coordinate together to provide painless anti-tachycardia pacing therapy to patients at risk of sudden cardiac death without the risk of leads placed into the heart itself or under the sternum. We've already presented and published very positive 12-month data from our modular ATP clinical trial, and we continue to anticipate the launch of the system in 2026. Approval, importantly, will extend the role of the SICD in clinical use by establishing a clinical pathway for ICD-indicated patients who are at risk of, who physicians are concerned may in the future develop a need for pacing or who might benefit from anti-tachycardia or anti-bradycardia pacing.
We also plan to continue to expand our very broad and successful cardiac diagnostic portfolio for arrhythmia monitoring while simultaneously moving into adjacent disease states like heart failure. I really want to emphasize that heart failure is a huge and largely untapped market for diagnostics with what we see as at least a $2 billion market opportunity. Clinically, management of chronic heart failure is a major problem. In fact, I would tell you, in my view, the major problem in cardiovascular disease today. Heart failure is the second leading cause of all hospitalizations and all rehospitalizations annually in the United States. As a company, we have already developed unique technology with our AI-based Heart Logic platform that we know can identify impending heart failure decompensations with a high degree of sensitivity and with, on average, about a one-month notice prior to the decompensation.
It's been limited because it's been tied to our ICD and CRTD devices, and the majority of heart failure patients either have no device at all or have devices that are paraded out across the entire ecosystem. What we have done now has been to run a clinical trial, LUX Trends, that gives us great confidence that we can take the Heart Logic algorithm and enable it in a LUX-type implantable cardiac monitor form factor that could be applied across the wide spectrum of patients with heart failure. We've achieved a breakthrough designation from the FDA that gives us a quicker path to reimbursement as well as to approval. We do recognize that beyond providing a less invasive diagnostic option, winning here is going to require for us to deliver on proving through long-term clinical evidence the benefits of this system. We have already run our LUX Trends clinical trial.
We are currently enrolling patients in a randomized trial called Dan Logic to establish the value of the use of heart logic algorithm and will be initiating a second randomized trial using the feature in our LUX devices that we're calling LUX Alerts. Again, looking further beyond this long-range plan, we continue to invest in the ability to monitor additional physiologic sensors, again, to better enable physicians to proactively monitor and improve long-term outcome for these patients. Scott?
Great. Thanks, Ken. I hope all of you see the excitement we have for cardiac rhythm management and the opportunities we have within the heart failure space. As I said before, this significantly increased innovation cadence will drive us back to on-market, if not better, performance over the LRP. Near-term growth, we've been investing heavily into the conduction system pacing world. You'll see that both on the brady side as well as the tachy side of the business. You'll see us get into the leadless pacing as well as the modular therapies here in 2026. We'll have a steady launch of new platforms. We've mentioned this a couple of times, but the excitement around the new platforms will be game-changing, in our opinion, for the industry, and most importantly, for physicians and their patients, providing very unique technology that we feel will be wildly differentiated in the market.
We'll continue to have internal investments as well as VC investments in large adjacent markets that will continue to fuel our growth. Thank you for listening to the CRMDx portion. With that, I would like to pass the presentation over to Angelo DeRosa, who is the President of our WATCHMAN division, as well as Dr. Brad Sutton, our Chief Medical Officer for AF Solutions.
Good morning, everyone, and welcome to the WATCHMAN portion of our day. My name is Angelo DeRosa. I am the Global President for the WATCHMAN business at Boston Scientific. I'm joined today by Dr. Brad Sutton, who is our Chief Medical Officer for AF Solutions businesses, so WATCHMAN NDP. Welcome, Brad.
We are thrilled to talk to you about our category-leading WATCHMAN business, which is and will continue to be one of the fastest growing businesses at Boston Scientific. Today, we compete in a $2 billion market that we anticipate will continue to grow at 20% annually. This is really a truly exciting business, growing consistently, at the same time delivering strong margins that are meaningfully accretive to Boston Scientific. Today, we serve a population of about 5 million globally.
Based on what we will share with you, we see the potential to expand the indications to more than 20 million patients by 2030 and beyond. We will do this by further building out our body of clinical evidence for this amazing therapy, leaning in new areas of growth like concomitant procedures. Brad will talk about that. Of course, we will continue to innovate our technology and our workflow capabilities. If you think about it, you want to oversimplify a pretty straightforward strategy based on three main pillars: technology innovation, clinical evidence, and market development. We are incredibly proud of leading the LAC market for over two decades. Over the last 20 years, WATCHMAN has defined the therapy standard in left atrial appendage closure.
Starting from our initial approval in 2015, about 10 years ago, we really started with our first generation of WATCHMAN, going to 2020 with our WATCHMAN FLX, which was the first big jump in technology, up to our third generation WATCHMAN, WATCHMAN FLX Pro in 2023, together with our TruSteer, the first and unique steerable sheath specifically designed for LAC procedures. More recently, the CMS reimbursement for concomitant procedures, all the way up to the OPTION data release and labeling update. As you can see, we have never stopped defining what's next in LAC. In all honesty, you know, other companies at this stage might have slowed down innovation. On the contrary, we are completely obsessed and really committed to make this therapy better every single day. That's what we will continue to do. Today, we are proud to share with you another major milestone reached by the WATCHMAN team.
We have now treated more than 600,000 patients successfully with the WATCHMAN therapy. Delivering the best patient outcome remains at the center of our mission for the next 600,000 and beyond. As we look at 2026 and 2027 with our key clinical trial readouts and our plans for our next generation device, you can see that we are really working fervently to maintain and grow our leadership. This journey clearly shows you our relentless commitment to this incredible therapy. WATCHMAN is for sure the most implanted device worldwide, but it's also the most studied LAA device that exists today. Positive clinical data enables meaningful market expansion. As I mentioned before, our current patient population includes an estimate of 5 million patients with atrial fibrillation globally, and we have a pathway to quadrupling this number. Of course, the cornerstone of this pathway is our CHAMPION-AF trial.
You may remember that CHAMPION-AF is a randomized head-to-head trial designed to evaluate the safety and efficacy of the WATCHMAN FLX device within a broad population and will compare with NOAC. Brad will talk more about that. What I would like you to understand is that a positive result from the CHAMPION trial, followed by reimbursement and regional guidelines update, will unlock a significant patient population. We anticipate that our indication could expand upward to 20 million patients with atrial fibrillation by 2030 and beyond. With this expanded indication, we estimate that the LAA market could reach up to $6 billion in that time frame. On the other side of the slide, you see the geographical split.
From a geographical standpoint, the 2030 plus market is a split across four major international regions: U.S., about 8 million patients; Europe, Middle East, Africa, with about 10 million patients; China, conservatively around 1 million; and Japan, about half a million patients. On top of that, we all know that the global prevalence for atrial fibrillation continues to rise, continues to grow as well. As we shared today, we estimate that in about 60 million patients across the globe. It is important to realize that the CHAMPION-AF impact will not come overnight. The growth across the different regions will materialize based on local guidelines updates and reimbursements and many things that need to happen after the publication of the results. Now, having said that, we're still incredibly excited by bringing the WATCHMAN therapy to more and more patients across the globe.
I'll pass to Brad to talk more about CHAMPION-AF, our clinical portfolio, and the concomitant procedures. Brad.
Thanks, Angelo. Good afternoon, everybody. Let's talk CHAMPION-AF. I've been with the WATCHMAN franchise for six years now. When I think back three years ago and when we launched this clinical trial onto today, the sort of belief in the therapy, the adoption of the therapy is in a fundamentally different place, so much so that I believe appendage closure is part and parcel of a comprehensive AF management strategy. I'm going to say that again because I think this is important for you all to hear. Appendage closure in the setting of atrial fibrillation is foundational to a comprehensive AF management strategy. We've come a really long way. We've spent now years invested in tens of millions of dollars, Mike will tell you, in the CHAMPION-AF clinical trial. As Angelo mentioned, this is a randomized study pitted WATCHMAN FLX versus NOACs in a head-to-head fashion.
The goal here is to position the therapy as a first-line alternative for stroke prevention in the setting of atrial fibrillation. This is a big task taking on pharma, right? Remember, while NOACs are effective at reducing the risk of stroke, they're not perfect. They have side effects. In fact, 40% of patients on OAC remain unprotected due to nonadherence. That is, they can't take, for whatever reason, their medication as prescribed on a regular basis. Today, LAA closure is indicated for patients who can tolerate short-term OAC but not long-term anticoagulation. We believe, however, that there's a huge patient population that can tolerate long-term OAC, are at elevated risk of stroke. That's exactly who the CHAMPION-AF trial proposed to study. We expect data in the first half of 2026. If positive, as Angelo mentioned, it unlocks significant indication expansion, potentially influencing guidelines and reimbursement around the world.
We're not stopping there. You see on the bottom of the slide a robust compendium of clinical trials. I would call out the U.S. IDE upcoming to study our fourth generation device. Our nearest competitor, I think, is working on generation two. We continue to try to disrupt ourselves in this space. The Simplified trial, an ongoing three-arm randomized study looking at on-label dual antiplatelet therapy versus aspirin as a standalone therapy or half-dose DOAC. What are we trying to do with this trial? We're trying to reduce the risk of post-implantation bleeding. We're studying concomitant and FARAPULSE and WATCHMAN procedures and their clinical outcomes. We have targeted investments in all the major geographies. Finally, LAOS-4, which is studying high-risk patients, patients at high risk of stroke, is looking at the combination of WATCHMAN plus oral anticoagulation versus anticoagulation alone to show hopefully superior results with the combination therapy.
You can be sure there are many unanswered questions still in the space. We're committed to continue to drive clinical evidence generation for this therapy for many years to come. Now I want to turn our attention to something that's a really exciting trend we've been following for the last year. That is the idea of concomitant ablation and appendage closure, or what we're now calling Therawatch procedures. You can imagine there's benefit across the health care continuum and clear value to patients by getting one procedure or two procedures at one time rather than staged procedures. Imagine one vascular access exposure, one risk of exposure to anesthesia, one transseptal puncture, clearly a win for patients. If you roll back the clock a year, we had this interesting convergence of the OPTION clinical trial data.
Then we had the concomitant DRG from CMS, which made hospitals essentially financially whole for the concomitant therapy. What we saw is really a smattering of cases a year ago, and what's now become 25% of all WATCHMAN cases done in the U.S. concomitantly with ablation therapy. We expect that to double by 2028. A full half of the patients undergoing AF ablation today are at high risk of stroke and are potentially Therawatch candidates. When you think about our category leadership in appendage closure, in pulse field ablation, as well as our commercially focused AF Solutions team, we're really uniquely positioned to lead in this space. Additionally, we're developing a sheath specifically designed for Therawatch procedures, which we believe offers safer, more streamlined workflows. Now I'll hand it back to Angelo to talk about our technology innovation and evolving portfolio.
Thank you, Brad. As I mentioned earlier, we remain obsessed with continuing to drive innovation in this space. We are super excited to announce here for the first time our next generation WATCHMAN device. You heard Joe mentioning that. I'll just give a few hints on what you would expect from this device. First of all, obtaining a complete closure of the appendage independently from the complexity of the anatomy is and remains the number one goal of any LAC device. When we launched our WATCHMAN FLX in 2020, we had a team of engineers that right after started really thinking how to further enhance the sealing capabilities of our already highly performing platform of WATCHMAN FLX.
Do not think that the next generation WATCHMAN device is something that we have developed in the last couple of years because we truly accumulated all the learning of the last five and more years from the WATCHMAN FLX and FLX Pro generation. All really comes together in what we call now the next generation WATCHMAN device. This device will provide enhanced stability and unprecedented adaptability to each possible anatomy. We truly believe, bottom line, this is another revolutionary device, probably as it was when we launched FLX after the 2.5. We believe the next generation WATCHMAN device will really bring the sealing capabilities and the therapy to the next level. We plan to begin our ID enrollment for this device next year and aim to launch it in the second half of 2027 or early 2028.
While we are investing, of course, in our core technology, we are also expanding our portfolio. We strongly believe that innovation in LAC imaging will be a critical element to further expand the therapy adoption. If you think about what Brad said and the potential of CHAMPION-AF, CHAMPION-AF will, if positive, generate more patients, but for sure, we will need more implanters to support to implant all these patients. The imaging remains a critical element of a successful WATCHMAN delivery at the implant. Thinking about an interconnected imaging ecosystem that is designed to give physicians actionable insights, of course, enabled by artificial intelligence, that will definitely enhance the pre-procedure planning and the overall workflow. Today, most of the WATCHMAN procedures are done using transesophageal ECHO, T.E. We are working on ways to enhance those workflows for more efficient procedures and improve patient outcomes.
As you probably have seen, we are collaborating with Anumana, a leading company in the space of artificial intelligence for medical applications, on their generative AI imaging and visualization technologies designed to integrate into the clinical workflow and offer a fundamentally new approach to intraoperative decision support. At the same time, we are also working on intracardiac ECHO, ICE. You all know that ICE represents an emerging modality in the WATCHMAN space, especially for thorough WATCHMAN procedures that Dr. Brad Sutton just elaborated on. There, we are exploring 4D innovative ICE solutions designed to minimize catheter manipulation and enable automated guidance and measurements. We should emphasize that we are determined to build on continuing to progress our therapy. It is our commitment to lead the way in making the LAA closure therapy better for hospitals, for physicians, and ultimately for all our patients.
In conclusion, ladies and gentlemen, we are extremely enthusiastic about the future of WATCHMAN. If there is one thing for you to remember, it is that we view our current success as a catalyst to achieve even greater impact in the near future. Our team is committed and capable of continuing to grow and lead this attractive space through technology innovation, clinical evidence, and market development. We are confident that we will unlock considerable growth over the next three years. Thank you very much for your time. Now we have a [thora]watch video. Thank you.
It's great for the patient.
More and more are demanding.
Ongoing better effectiveness, better decisions.
To show up.
We can do in terms of eradicating atrial fibrillation.
Atrial fibrillation is a major medical problem. It's almost on an epidemic magnitude at this point in time. We used to think that it was an innocent bystander in older patients, but now we understand that it's a fundamental component responsible for cardiovascular morbidity and mortality in more patients than we had previously imagined. Now we have multiple new therapies to manage AF.
One is PFA and the great work that we're doing with ablation. It's safer, it's more effective, it's more operationally efficient. The other is in the left atrial appendage or WATCHMAN procedure. Those types of innovative approaches are what allows us to take better care of a greater number of patients.
FARAPULSE exceeded all previous expectations. We're seeing far better success rates. The safety standpoint is dramatically improved, and the patient experience is phenomenal. We would never go back to radio frequency or cryo. This is the future.
With the WATCHMAN device combined with pulse field ablation, it also frees patients from the specter of bleeding risk and from some of the restrictions associated with chronic systemic anticoagulation.
The WATCHMAN device, at three years, felt as good, was not inferior to oral anticoagulation. That is the OPTION trial, which took patients who are undergoing or just underwent an ablation. The next question is, does the same apply to a patient population who is not undergoing ablation? That is the CHAMPION study.
CHAMPION-AF, to me, is kind of the holy grail. If this trial fulfills the primary endpoint expectations, it will undoubtedly change the priority of treatment for atrial fibrillation in a much broader population. This changes everything.
The ability now for our physicians to have two great tools, PFA and WATCHMAN, at their disposal and to be able to appropriately combine those into one procedure, if that's clinically validated, why wouldn't you do it? The two procedures share a lot of common workflow. You can reduce the exposure to oral anticoagulation in those patients. You can reduce the duplication of the risk that is associated with the procedure and potentially reduce the cost of having two procedures versus one. I believe that the market for concomitant procedure is going to increase quite significantly.
The fact that the two top-line therapies to manage what is the most common disease in cardiology are resident within a single company is powerful. You're leading now, but you have a chance to even distance the field even more in the future. I mean, this is going to transform the way we manage the disease.
Please welcome Nix Badea-Anello and Dr. Brad Sutton.
Hi everyone. For those of you that I don't know, I'm Nix Badea-Anello, and I lead the exciting and innovative electrophysiology business here at Boston Scientific. You've already met Dr. Brad Sutton, who helps us from an AF solution standpoint support both the WATCHMAN and the EP group. We're excited to be here today because I'll take you back two years ago to Investor Day, where we shared a very ambitious and bold vision that we wanted to transform the field of electrophysiology. We were sitting on the precipice of some significant growth.
I'm really proud of what the team was able to do to not only allow us to realize that vision, but the hard work that they're doing to evolve it with a brand new portfolio that we're going to share with you all here today that we believe can continue to transfer the opportunity for patients and customers that we call on throughout the world in a much more meaningful way and give us more meaningful growth in this electrophysiology business. We're going to cover a couple of key things here today that I think are incredibly important. You're going to hear it throughout our presentation. First and foremost, advancing innovative solutions to drive better patient outcomes. Second, to simplify this cardiac ablation procedure and the workflows associated with it. Third, to enhance operational efficiencies.
We think that's really important because it's resonating in a very, very meaningful way today with FARAPULSE in this really, really competitive marketplace for AF centers that are starving for more efficiency. We're doing this with FARAPULSE in a meaningful way. What we like is that our leadership is really, really significant in pulse field ablation. Many of you are saying, what has changed the last three years since we last met? I'll tell you, I'll begin with we have become and established ourselves as the world leaders in pulse field cardiac ablation with our FARAPULSE PFA system. FARAPULSE is clearly driving meaningful clinical benefit from a safety and efficacy standpoint and most certainly from an efficiency standpoint. I will tell you that I'm excited to publicly share with all of you today for the very first time what this means.
That is that we have now treated 500,000 patients with our FARAPULSE PFA system. This is significantly more than any other offering to the tune of hundreds of thousands of more patients that we've been able to treat. FARAPULSE is the number one PFA prescribed product across the world for electrophysiologists. We are going to deliver clear, meaningful growth with this technology as we expand our overall portfolio. We did all of this in what is a large $13 billion EP market. We see this growing approximately 15% in the long-range plan. Further, we see the AF patient population being significantly larger than we originally anticipated. New estimates point to approximately 60 million AF patients exist throughout the world.
We're making key investments in our engineering, manufacturing, clinical evidence, and our commercial capabilities to really be able to outpace the market, as Joe had mentioned earlier in his comments, and really continue to take more share across the world as we launch and go deeper and deeper into other markets. We're really excited about what that means. Our new vision is not just to be a leader in pulse field ablation, but to be a leader in overall electrophysiology. We aim to do that as fast as we possibly can with what is an all-encompassing EP portfolio that we think is going to be significant to offer. Let us take a quick look at this market and the dynamics and how we have it segmented and how we plan to unlock and expand our global expansion efforts across the world with FARAPULSE. Let me explain first.
The market grows 15% overall. We have the market segmented into two revenue categories: the larger AF segment, which grows approximately 18%, and we also have the smaller non-AF segment, which grows 8%. This puts the dynamics for the market to grow approximately to $20 billion in the year 2028. Large market getting even larger. Let me now turn your attention to the middle, where there's some key growth drivers that really hinge on how we've modeled this growth. First, a number of new innovative technologies really need to come to the marketplace. We'll show you a number of new things we're going to be doing with FARAPULSE over the course of the next several years. They need to be safe, predictable, and effective, and most importantly, continue to be efficient. We need to have efficiency as we're going to be treating a lot more patients.
Second, you'll hear a little bit from Dr. Brad Sutton on the clinical evidence, expanding indications for the ability for more patients to be able to receive this therapy. Third, site of service. We believe that hospitals are expanding their AF cath lab centers to be able to really meet the full potential of the large, growing population of AF patients. We also see it as an opportunity with CMS recently proposing to reimburse ablations in the ablation surgery center suites. We see that being a really big opportunity moving forward. Lastly, in terms of global geographies, we're diversified across the globe. I'll specifically call out Asia Pacific. I was in Asia a few weeks ago in Japan and a couple of months ago in China. These are large markets, over $3 billion in electrophysiology potential, where we have historically had low market share.
Since we've launched FARAPULSE, we have seen significant new growth opportunity. We see that happening over the course of the next several years as we go deeper into those specific geographies. As you look to the right here, you can see the product segments that we have here for the market specs. The largest product segment that you see here is cardiac therapeutic ablation. That offers us a tremendous opportunity with our FARAPULSE catheter portfolio that we're evolving. That's where we're leading, and that's where we see ourselves continuing to grow and grow in a meaningful way. Second, you've got an imaging and diagnostic market of $2.5 billion. Joe mentioned it. We're going to now be launching an ICE product in 2026, where today that is an entirely new revenue opportunity as we move forward to try to capture some share and opportunity for new growth there.
Lastly, as you look at the access solutions business that we acquired from Baylis a number of years ago, we're category leaders in this $1 billion market. As you see more ablation procedures and more WATCHMAN procedures, we see this being a big opportunity to continue to grow in that segment as well. A lot of new growth opportunity as you move forward. I think it's important to really look at this all-encompassing electrophysiology ecosystem and what it has to offer. All of these products that you see in this portfolio here today are new as in the last three years. We really are going to leverage at the top line, taking advantage of our ablation catheter portfolio with FARAPULSE and having that integrated with our OPPL mapping system. All of the products you'll see that are going to be coming out with FARAPULSE will be integrated moving forward.
We think that that's a really, really meaningful opportunity for us. It'll also be complemented by a suite of AI offerings. Cortex AF, that's our source mapping. That's a differentiator. Dr. Sutton will get into the details of what that means. That is a very, very big opportunity as it relates to persistent patients that need to be treated with better solutions, as well as redo patients. That is something different. We made an
Acquisition a year ago, and we think adds to our mojo in our mapping strategy. We'll also have a new mapping catheter. We think it's time to really offer the field something that's a little bit more in tune with what people want to have, a better diagnostic tool. You see a suite of diagnostic capabilities there with ICE. Dr. Sutton will also speak to the things we're doing to have a cadence of ICE delivery over the course of the next three years that we think is going to be truly opportunistic. You see a lot of access solutions products that we're going to be evolving. All of these products will have integration into our OPAL mapping system. We also have a concomitant sheath. You heard about [FARAWATCH] from Angelo and the concomitant opportunity.
We think that this is going to bring a lot of new revenue and leverage opportunity as people do more concomitant procedures, and providing them tools that will simplify the procedure is incredibly important. Let me now move to, let me grab a little bit of water here. Thank you. To what is our greatest advantage? That's the FARAPULSE advantage, with a cadence of a number of new products that we feel will continue to evolve our growth journey. On the left, you see the FARAWAVE NAV catheter that we introduced to thousands of customers around the world. You saw the prescription over the past 18+ months, what we've seen in terms of new products that we've introduced. Late last year, we introduced the FARAWAVE NAV catheter. We put navigation capabilities on this catheter.
The little glowing marks on the pedals or the splines of the FARAWAVE catheter there allow one to now have integration or navigation capabilities so one can take a catheter that they love from a therapeutic standpoint and start to have some mapping capabilities in that catheter. As you look to the right there, FARAPOINT and beyond, we've got a number of new things we're going to be introducing the next year, plus 2028 plus, where we can continue to evolve the success that we have with our FARAWAVE and FARAPULSE technology with the proprietary waveform. If there's one thing I want to leave you with in remembering is that not all PFA is the same, and the waveform technology and the engineering that we have truly differentiates this product portfolio from others.
You'll see that we have a number of new things from FARAPOINT to our next generation FARAWAVE to Faraflex. We're working already internally researching a beyond next gen FARAWAVE catheter that we think can revolutionize once again the electrophysiology PFA market. I want to take a minute to really highlight the FARAWAVE next generation catheter, which the launch is expected in 2027. The FARAWAVE catheter today with navigation capabilities has one active spline. The splines will now have four active electrodes, which is a total of 20 active electrodes, giving physicians increased signal capabilities. This will give more information, more control, and more precision.
It'll allow one to understand pedal deflection, whether the catheter is in a basket shape or a flower shape, and really understand where they're going to be electro operating and whether or not the contact sensing of that catheter is at the distal tip, the medial tip, or the proximal tip. We've also updated the handle where it's a lot more ergonomically designed to be an extension of the operator's hands. All of this is going to improve the customer experience in not only having a therapeutic catheter that one really, really loves, but also having high definition mapping capabilities that can differentiate the product and keep us competitive in this space. The next big frontier in the FARAPULSE journey is Faraflex. This is a large map and ablate catheter. It's designed for complex and VT anatomies and procedures. It's designed and built for PFA.
It has both monopolar and bipolar capabilities that allow an operator to customize the lesions that they desire, whether it's a complex ablation they want to conduct or maybe a VT ablation. The depths that we believe in the waveform that this catheter can provide us can be meaningfully different than what is being offered today with a wide area form factor. It also has superior mapping capabilities. This is a next level map and ablate catheter as a wide area form factor that we think can truly revolutionize this growing space. Today, we estimate this market to be in the neighborhood of $200 million- $500 million. It'll keep growing, but we feel that we have a really good option as a second generation wide area form factor that can take meaningful share as we enter this in our planning window.
I think what's really important here is to really understand what is happening in mapping. This is probably one of the most common questions that I get. We are aggressively expanding to complement our full EP ecosystem with our mapping portfolio. Mapping is truly the cornerstone of our vision. We're investing to scale and to differentiate our capabilities. Doing all that can only go so far. You need to invest in mappers. We have thousands of mappers across the globe that today are positioned and prepared as we enter the market with all of these catheters that are going to be integrated with our OPAL mapping system. We will have a relentless cadence of contact sensing software that will be introduced. We introduced contact sensing with FairNav this past week in the U.S. market. We plan on introducing that in Europe here in the coming months.
We also have an opportunity to enhance contact sensing as we introduce next generation FARAWAVE here in the coming years. We also have a next generation mapping catheter that we think can really offer another opportunity to grow in that diagnostic market. Last, we have Cortex AF, which we believe is the transformative technology that can really help us grow and grow in a meaningful way. We're harnessing an AI-driven opportunity with a lot of these tools, whether it's with ICE or whether it's with Cortex, but it really offers us an opportunity to differentiate ourselves as it relates to mapping. What I want to do now is hand things off to Dr. Sutton, who was recently a practicing electrophysiologist, and he can talk a little bit about what does ICE mean and what does this transformative Cortex technology mean, Brad?
Yeah, thanks, Nix. I think in a word, the ICE journey for us is a key accelerator to number one. Think about this: 97% of FARAPULSE cases have intracardiac ultrasound. Today, we get none of that business. Here's a $1.3 billion market opportunity going to $1.8 billion in 2028, and we don't play in this space whatsoever. On the theme of internal development and tuck-in acquisitions, this acquisition for us is critical to rounding out this ecosystem. We have clinicals in every one of these cases, essentially, especially in the United States. The call points established, the complement to the ecosystem that we already have is one that's quite obvious. In 2027, we'll introduce our NAV-enabled ICE catheter, followed on later that year with what we think is a differentiated next-gen AI-enabled technology in partnership with Onomata. Onomata is a company that's quite innovative.
They develop accurate generative AI imaging technologies, predictive algorithms that we think will enhance our 2D ICE portfolio as well as our TEE offering for both ablation and LAA. Now I want to turn to Cortex, and I want to take you back two years to when we stood on the stage and we talked about our vision for persistent AFib ablation. Remember at that time we were launching the Advantage AF trial, and we talked to you about the differentiated form factor of the flower catheter and how it was uniquely designed to really deliver good PVI lesions, but also posterior wall ablation. Advantage was exactly that. It was persistent AF ablation, prescribed PVI posterior wall lesion set with excellent efficacy, and in fact, it's become the standard of care.
Over 80% of patients undergoing a de novo persistent AF ablation with FARAPULSE today get a PVI posterior wall lesion set on the heels of that data. There's an open question about what you do beyond that, particularly in redo patients, and this is where Cortex really comes to bear. We've invested aggressively in AI to elevate mapping and visualization of AFib. The first step in doing this is Cortex, which uses a software algorithm as well as a wide 64-pole basket catheter. We map both the left and the right heart, which is unique, and I think one of the interesting things about this technology.
The goal here is to find sources beyond the pulmonary veins that we believe drive or sustain atrial fibrillation, target those sources for ablation, on average one to two sources per case, so a very efficient workflow, especially in this space, and then significantly reduce the downstream burden of atrial fibrillation. If you follow this space for a long time, there's a lot of skepticism in the world of persistent AF mapping. We're committed to doing the science to meaningfully show good clinical outcomes, and to that end, we're excited to announce the now FDA-approved clinical trial called Optimize AF, which is a randomized study using Cortex. The goal is to have a first patient in before the end of the year and further validate the capabilities of this technology. Together, Anumana and Cortex position us to develop safer, more precise outcomes and to redefine electrophysiology with data-driven AI-powered insights.
Boston Scientific, as you've seen, is leading not only in PFA sort of commercial execution, but in evidence generation. We have more than 45 active clinical trials. We have over 35,000 patients' worth of clinical data. That's a huge body of data. You can rest assured that we understand exactly how our patients do over the long term. We know exactly what the rates of complications are, how to mitigate those. What you see here on the slide is a snapshot of our clinical strategy. On the left side of this pie chart is the breadth and depth of the data we've collected with both FARAPOINT and FARAWAVE across persistent, paroxysmal, and redo patients. On the right side, you see our strategy to unlock and expand into new markets, leveraging the versatility of our portfolio beyond PVI and posterior wall. This effort's global.
We've got a huge footprint around the world. We've got 150 clinical sites and partners and meaningful targeted investments in Asia, specifically Option A, which looks at concomitant workflows and clinical outcomes in China, South Korea, and Japan. The FARADISE China study is a very large post-market registry in China, and PromptAF2, again in China, a large 600+ patient randomized study looking at persistent patients and complex lesion sets in that patient population. This evidence package here is foundational when it comes to accessing this multi-billion dollar high growth market. Finally, just to deep dive into a couple of these trials that I think are meaningful for you guys to know. Number one, Avangard. We expect the data from this trial to read out in the first half of 2026. Recall, this is our frontline persistent AF trial.
What we're seeking to do here is move the therapy upstream in the disease process so patients no longer have to try and fail an antiarrhythmic medication. We know those drugs are fraught with side effects. They're not particularly effective, and we're excited to see this data in the first half of next year. DISRUPT-AF is a very large U.S.-based registry allowing us to collect real-world evidence. Now we've got over 3,000 patients enrolled in the study and have a very good understanding of the safety and efficacy and efficiency story in the real world with our system. REMATCH is a dedicated redo patient population study. Persistent AF redo patients using FARAWAVE for PVI posterior wall and FARAPOINT for linear lesions as indicated with a potential label expansion for the FARAPOINT catheter. Finally, ASCEND VT, which is a pilot study I'm very excited about.
This is looking at patients who need ischemic VT ablation. This is a group of patients that have very poor clinical outcomes, very long complex procedures. These procedures tend to be concentrated at academic medical centers. We hope to democratize VT ablation in the same way that we've democratized AFib ablation. We've got work to do, but this pilot study is head-to-head against traditional radiofrequency catheters, and we expect that to kick off again before the end of the year. I know that you share our excitement about this data, right? I hope you appreciate the deep commitment we have to continuing to lead in this space. We look forward to sharing these results of the studies with you over the months and years to come. With that, I'll hand it back to Nix to close out our EP section of our program.
Thanks, Brad. A lot of excitement happening in the clinical evidence strategy to help us continue to grow. Just really recapping a lot of things that we said here that I think is critically important. We've got an EP market that is meaningfully large and rapidly expanding, and we see strong adoption of PFA. We see that adoption moving from 50% today globally to 80% in 2028 with FARAPULSE. We're uniquely positioned to lead and backed by our deep experience and the continued evolution of our PFA catheter portfolio that you saw here today. Our growth is globally diversified, creating meaningful new revenue opportunities as we expand into large international markets and adjacent product segments such as ICE. In terms of our innovation and ecosystem, Boston Scientific is committed to advancing its comprehensive EP offering as it integrates all of its FARAPULSE PFA catheters with its OPAL mapping system.
We think that further strengthens our leadership position. Last but not least, you heard about the clinical evidence that Dr. Sutton highlighted. We think that can expand indications. We're leading in the clinical science, and we're excited about how this can really fuel our growth journey. I want to thank you for your time and attention today in learning more about our electrophysiology business. Thank you. I want to now introduce Jon Monson, our CFO.
All right. Thank you, Nix. Thank you again to all of you for being here today. I hope you've gotten a sense from Mike and the rest of our leaders why we're so excited about the trajectory of Boston Scientific over the next three years and beyond. What I'll do is provide further detail on our financial goals, and then we'll wrap up the day with a Q&A session. I'll start with the top line. For 2025, we expect to deliver another outstanding year of differentiated performance with 14%- 15% organic revenue growth. Looking ahead over the 2026 through 2028 period, we're targeting 10+ average organic revenue growth. What you heard today from our leaders on their innovation pipelines and their execution strategies should provide confidence in our ability to deliver growth at these levels. Longer term, you should expect us to consistently outpace our underlying market growth.
Moving down the P&L to margins. Over the LRP, we expect to expand our operating margins approximately 50 basis points each year. That will put us right on the doorstep of 30% adjusted operating margin exiting the LRP. That margin trajectory reflects the same disciplined approach that we've had for many years now. We continue to expand operating margins each year, every year, but not at the expense of funding innovation. We've proven that we can reinvest back into the business for growth while still increasing our profitability, and we'll continue to do that on into the long term. On adjusted EPS, over the LRP, we'll grow our earnings per share faster than organic revenue growth. That continues the trend of leveraged growth that we've delivered for many, many years now.
Longer term, we'll remain focused on delivering sustained, strong double-digit EPS growth as we leverage top-line performance with operating discipline. Finally, free cash flow. In 2025, we expect to generate $3.5 billion of free cash flow. That represents very strong double-digit growth and achieves free cash flow conversion of approximately 75%. Over the LRP, we'll maintain conversion between 70% and 80% in line with our MedTech peers. The takeaway here is simple. Not only are we delivering here in 2025, but we're setting the company up for differentiated profitable growth over the next three years and beyond. Now I'll go deeper on each of our financial goals, starting with margins. Operating margin expansion is part of our DNA. Over the past decade, we've consistently driven meaningful operating margin expansion while reinvesting back into the business for growth through targeted investments and strategic M&A.
Looking ahead, we aim to expand our operating margins approximately 50 basis points each year. That will be done predominantly through SG&A leverage and operating margin improvement. Sorry, gross margin improvement. On gross margin, we see product mix as a tailwind for us as we continue to shift the mix of our business into higher growth accretive areas like WATCHMAN and FARAPULSE. In addition, our manufacturing teams continue to drive costs out of the system to reduce our standard costs. While tariffs will put near-term pressure on gross margin, we do expect that gross margin will contribute to our operating margin expansion over the course of the LRP. On SG&A, we'll maintain our disciplined approach to discretionary spend while driving efficiencies as we scale the business. I'm going to touch on SG&A more in my next slide.
On R&D, we'll continue to invest at a high level between 9% and 10% of sales for sustained innovation. This is the formula that we see as fueling our operating margin expansion, again, while reinvesting back into the business for growth. On SG&A, you can see in the chart here how we've consistently reduced SG&A as a percentage of sales. Looking ahead, we'll continue to do that while channeling investment back into areas that drive growth and productivity. We continue to optimize our org structure. We're scaling our centralized shared service support functions, and we're investing in our next generation ERP system that will enable enhanced automation and efficiency over the course of the LRP. We're also investing in AI capabilities. We're taking a purposeful approach here with a focus on increasing efficiency, enhancing the customer and the employee experience, and capturing opportunities to contribute to revenue.
For example, we are proactively using AI to review customer contracts and pricing. What this has done is it's taken administrative burden off of our commercial teams, it's enhanced the customer experience, and it's helped to support compliance. Collectively, all the SG&A initiatives you see here, and there's many, many more that we're driving across Boston Scientific, will help us to scale the business efficiently and drive SG&A leverage. Turning to cash flow. This is an area where we've made significant progress, both in terms of growth and conversion. At our last Investor Day, we committed to 70% conversion by 2026. In 2024, we delivered 71% free cash flow conversion two years ahead of that goal. Here in 2025, we're on track for 75% conversion.
Looking ahead over the LRP, we expect to drive double-digit growth in our free cash flow and maintain conversion between 70% and 80% in line with our peers. The growth in free cash flow will be driven by operating margin expansion, as well as a continued focus on working capital efficiency. Conversion between 70% and 80% strikes a prudent balance between free cash flow conversion and reinvestment through acquisitions. M&A, as you know, is an important part of our growth strategy, and we fully integrate acquisitions. While that drives near-term headwinds to cash flow, over the long term, it helps us to drive optimized operating efficiency. Bottom line on free cash flow, we're confident in our ability to drive strong free cash flow growth. Over the LRP, we expect to generate over $13 billion of cumulative free cash flow to execute our capital allocation strategy.
To that end, our capital allocation priorities remain unchanged. Number one priority, strategic tuck-in M&A, followed by share repurchase. While M&A opportunities have crowded out share repurchase in recent years, it remains a part of our strategy. That strategy is underpinned by a very healthy balance sheet, our strong investment-grade credit ratings, and the significantly enhanced free cash flow profile. On M&A, our approach requires both strategic fit and financial return. We have a well-established, proven integration process that allows us to capture both the value and the promise of the companies that we're acquiring while leveraging the global scale of Boston Scientific. We have a large, active venture capital portfolio that continues to feed our M&A pipeline, highlighted by the three companies that we've acquired from our VC portfolio and the 16 new ones that we've added to it since our last Investor Day in 2023.
Stepping back, over the past decade, we've completed over 40 acquisitions with deals ranging in size from small companies out of our VC portfolio to multi-billion dollar publicly traded companies like Axonics. When you think about how we'll enter into new high growth adjacencies, how we'll compete in key global markets, and how we'll drive top-line growth, M&A will continue to play a very important role for us. I hope you leave today not only confident in our ability to deliver on our financial goals, but in the strength of the Boston Scientific team behind them. We have a highly engaged, highly focused global organization that's driving the innovation and the execution that's fueling our growth. That is what gives me confidence and the rest of the team here confidence that Boston Scientific will continue to deliver differentiated performance over the next three years and beyond.
With that, Lauren, I'll hand it back over to you.
Thank you so much. I'd like to invite the Cardiovascular team to the stage for Q&A for the next 40 minutes or so. Yep, you're up there. Cardiovascular plus Mike and Jon. All right.
Should we begin with the spelling test?
Yep.
Okay.
No.
Oh, wow.
All right. We're going to start with Matt Miksic right here in the middle.
Thanks so much, Matt Miksic, Barclays. I wanted to follow up, Jon, to your comments on margin expansion. It's a question we get often, and I just thought you might want to take an opportunity to talk through how to think about upside to this 50 basis points, depending on the pace and ebbs and flows of businesses during the planned period. Does that get us to 30% faster, or is that something you'd think about reinvesting? Thanks.
Yeah, thanks, Matt, for the question. First of all, I think the 50 basis points of operating margin expansion will put us right on the doorstep of 30%. I feel that's differentiated as we look across the peer set. If we see upside materialize, we'll do what we've always done, and we've done a nice job of that over the past couple of years. We'll balance dropping some through to the bottom line with reinvestment back into the business to accelerate growth and accelerate some of the growth drivers that you heard about today.
We'll go to Larry.
How long is the Q&A? There's a lot.
Larry Biegelsen from Wells Fargo, thanks for taking the question. Nix, I have to ask you a question. I think arguably one of the biggest concerns investors have is your share within the PFA ablation catheter segment as competition increases. Where do you think your share of PFA is today? What are you assuming for your PFA share over the LRP? Your slide said you aim to be the EP market leader. Do you expect to get there by 2028? Thank you.
A couple of things. First of all, we don't share specific details on market share. I hope that, seeing the number of patients we've been able to serve and the portfolio that we have, today's workhorse catheter is the FARAWAVE catheter. The simplicity of it, the versatility of it to do multiple lesions, whether it's PVI, posterior wall, and persistent or paroxysmal patients, we think as we evolve that even further with all of the mapping capabilities integrated and the portfolio to offer other tools, we can do a lot of things there that continue this growth journey into the foreseeable future. We feel very confident about that. You're going to see other strategics. The good thing is that we were first with PFA. While other strategics had other energy modalities that they did very well in, they came a little bit later.
That waveform in our catheters today, the engineering behind that is meaningfully different in every one of those catheters. As we move forward, we feel very confident that we can continue to do well.
Yeah, what I would add to that too, Larry, is if you look at that 500,000 number, if you take every competitor in the country, we are multiples ahead of everybody else in terms of clinical experience. As Dr. Brad talked about, our clinical evidence is miles ahead of everyone else's. Obviously, when we were 100%, near 100% of the pulse field ablation market as we launched first in Europe and first in the U.S., people have trials, they get products approved, et cetera. Our confidence in it, and I think Nix did a great job on his slide, it's FARAWAVE, FARAPOINT, the OPAL, it's the ecosystem that Nix talked about, which is super important to understand. The other thing is with this move to ASC reimbursement, FARAWAVE is the only catheter, the only system in the world that can be done any way you want.
If you want to use a pure fluoro Germany type of approach, it works. If you want to use fluoro combined with ICE, it works. That particular point is really important because the economic picture is different. When you see ablations done in an ASC, they're probably not going to have every bell, whistle, trick, and pony that they like or enjoy in the U.S. hospital-based system. That emboldens our confidence because that site of service change is going to happen for sure.
Alex, do you want to give it to Danielle? She's right behind you.
Thank you, Danielle Antalffy from UBS. Just a question on the market growth given for the electrophysiology business, but also WATCHMAN and just thinking about the concomitant procedure, but also separately. I mean, what is the rate limiting factor? Because you look at the TAM numbers and growth feels like it could be even faster and more aggressive than what you guys are laying out there. Curious about how you're thinking about capacity ramping to take in all these patients, but also things like pricing as this becomes a bigger ticket item for hospitals. Thanks so much.
Maybe I'll take the ablation part of that and then we'll hand it off to Angelo for WATCHMAN. First of all, a lot of cath labs or hospitals are expanding the number of cath labs in their AF centers today. We're seeing that happen in a lot of big centers to really fuel that. We also see site of service with these ASCs that are going to start up. To Joe's point, we have that flexibility. When we introduce pulse field ablation with FARAPULSE, we see the average cath lab doing 30+% more. That's not all of the operators that are getting trained today to be able to do these procedures. As we expand and we go deeper and we introduce this to more centers around the world, we continue to see that.
It's dynamic, Danielle, but we see a lot of new growth just in the introduction to new centers and cath lab capacity expanding as well as ASCs opening.
Yeah, and just to, you know, complement on Nix on the WATCHMAN side, we see a similar picture. As I said, we have estimated at 20% market growth. Of course, the results of the CHAMPION-AF trial will play also a big role, even if when we look at our long-range plan, the potential, you know, impact of CHAMPION will probably come at a later stage. I think today, really, there is a big driver of growth, which is the concomitant procedures. This is, as Nix said, this is where we need capacity in the U.S. market and where the ASC, you know, ablation moving to ASCs for PVI and PVI and posterior wall isolation could free up capacity in the hospitals to do concomitant procedures.
One good point also is that, as you probably have seen it, the reimbursement, the CMS reimbursement for ablation and concomitant is going to go up between 8% and 10% by next week, basically. That's also, you know, an economic attractive element for hospitals to drive more in the direction of these therapies.
I would add that this capacity, if you look at the large centers, nobody can do instantaneous ablation or WATCHMAN. There's usually somewhere between a one-month to a six-month wait. The concomitant procedure where you can do both of them at the same time helps address that capacity issue in a big way.
Great. We'll go over to Ravi.
Thanks, [Ravi Marquez], JP Morgan. Mike, I wanted to ask this one for you. It's incredibly impressive to see not just the breadth and depth of the current growth drivers, but of the portfolio supporting it behind. I know you and your team have spent a ton of time the past probably 10 years putting together this portfolio of assets, building the venture portfolio. Maybe just spend a minute and walk through your process of Boston Scientific's team's planning, not just for today or 2028, what's all behind that? How do you plan to sustain all this growth over the future? What are you and your team doing to get there?
Good questions. A long question trying to figure out an answer in this Q&A. I'm trying to think what's different from my opening comments. We're relentless on delivering in the quarter and in the year, and relentless on thinking about five years out. Anybody can grow a company quickly for a year. Anybody can grow EPS quickly for a year or two. You just cut down, shut down programs, and it's easy to do that. We really feel like we've proven that we can walk and chew gum at the same time and deliver a third quarter, a full year of 2025, and position ourselves for unique differentiation in 2030. You saw probably two-thirds of what we have, because a lot of stuff we have, it's for competitive reasons that we don't want to share in the venture portfolio and different things.
That's the process that we have across the business units that's embedded, as I said before, on looking at our internal innovation, our VC portfolio, M&A targets, doing spin-outs, a variety of tools that are available to anybody, but it's the lasagna that the BUs work on that we're very much involved with that puts that together. It also comes with trade-offs. You can't invest like we are in electrophysiology and WATCHMAN on that impressive portfolio you see in electrophysiology and that leading clinical, and the same thing in WATCHMAN. You can't do that across every division with all the products. We're very selective about where we're really pouring huge gas on things and where we have to make tough cuts. We have leaders, we don't have managers who run these businesses. They're able to make these decisions.
They're able to take highly dilutive venture acquisitions like we're doing right now with a disruptive IVL. We'll see what happens with hypertension, potentially very disruptive there. Our biggest organic program in the company is Vitalist. Those don't come for free, but yet Joe's business and all of Boston Scientific still drives margin improvement despite hundreds of millions of dollars of dilution in combination by those products. We're able to do that because we plan ahead. We always want to improve operating income margin. The question that I was asked really is to what level? We're always looking at that. We want to ensure our shareholders are getting the right EPS growth that they deserve, but we also know our shareholders want the best long-term growth. I think it's, as I said before, I think it's easy to put it in a slide, all the different levers.
What's hard is the durability of that and the culture that's needed within the BUs and the oxygen provided by the leadership team to dare to try to make that happen every day. I think that's tough to replicate. Probably didn't answer your question, but the best I could do.
We'll go to Anthony.
Thanks for all the information.
Name.
Oh, Anthony Petrone. I love the lasagna. The lasagna comment, by the way, was great. Maybe a little bit on the competitive landscape in electrophysiology when you think of complex cases versus single-shot cases. There's a little bit of noise out there that competition may be gaining in complex cases. Maybe a little bit on that and the competitive response in complex versus simple cases. Regarding renal denervation, you quote a $1 billion opportunity. Can you go through really the target in that uncontrolled hypertension market? What is the blood pressure measure and the medication utilization intensity in that $1 billion? Thanks.
I'll answer the market dynamics and ask Dr. Ken Stein to address some of the complex procedures that are done in electrophysiology.
Right now our play with complex procedures, which is a smaller segment of the pulse field ablation market today, will grow over the course of the next several years. The vast majority of the market is going to be pulmonary vein isolation and posterior wall, and that's going to be in paroxysmal and persistent patients with the tools that we have that will evolve. As you look at the complex opportunity, we've got Faraflex that we think is going to really revolutionize the experience to go after complex arrhythmia. As I've mentioned in my presentation, the ability to have customizable lesions with monopolar and bipolar to get deeper when you need to go deeper.
Other wide area form factors that are out in the market today were born as RF catheters, and pulse field was placed on them because the movement was happening so fast and that would have missed a tremendous opportunity. We built a ground-up pulse field ablation catheter for complex and deep tissue to give you deeper lesions, and we're going to corner that market. We also have, for more challenging cases, Cortex that you heard from Dr. Brad Sutton. We've got a suite of offerings that makes us really competitive, not just in the workhorse area of the market, but also the complex areas. Maybe Ken, you can elaborate.
Yeah, I want to maybe shift the question if I could a little bit, Anthony, which is I don't think it's useful to look at it as single-shot versus complex. I would look at it as there are straightforward patients and complicated patients. The reason I want to get away from the single-shot terminology is that FARAWAVE is being used for a lot more than just single-shot PVI. In fact, as Dr. Sutton said, the vast majority of its use in persistent AF today and a surprisingly large number of its use in paroxysmal AFib is this paradigm of pulmonary vein ablation plus posterior wall ablation. It's not just single-shot, but the catheter design is exquisite for doing that. It's such a straightforward approach that it is really hard for more complicated technologies and more difficult catheters to use for the operator to sort of unseat that as the incumbency.
Who are the more complicated patients? I think the more complicated patients are the redo patients. That's where our Cortex acquisition, again, as Nix and as Brad laid it out, I think could potentially be quite disruptive in terms of actually bringing a very simple ablation approach to target ablation in these formerly very complicated redo patients. Let me shift a little bit, Lance, if I could. Do you want me to answer on the RDN? The target population is the population that we expect to get coverage based on the draft NCD out of CMS. We do expect, should the trial be successful, and we're certainly optimistic that it will be, that we would get the same labeling as the competitors have.
That gets beyond just resistant hypertension, which is failure to control hypertension despite being on three medications at their maximally tolerated doses, to uncontrolled hypertension, which is inability to achieve control despite trying or inability to tolerate three different medications. It's a very broad class. It's maybe somewhere around 100 million Americans who have uncontrolled or poorly controlled hypertension. As I think we've said in other sessions, it will take some time to develop the referral chain and the evidence and actually get penetration into that population.
We'll take Mike Polark here in the front.
Thank you, Mike Polark with Wolfe Research. I have an OPAL question. There was a stat one of three FARAWAVE accounts today is using OPAL. In the future, nearly all FARAWAVE accounts are expected to use OPAL. My question is those accounts that are using it today, what's the attach rate, give or take? Can you provide an estimate? As we think about the LRP the next three years, as you implement this broader EP vision, what's a reasonable expectation for attach rate for OPAL in 2028?
We're not going to share specific details on how much utilization we're seeing with OPAL, but here's what I can tell you. Two years from now, our presence in mapping will be meaningfully larger. It's because of all the investments we're making. When we introduced FARAWAVE NAV, we had a lot of customers that saw the portfolio and everything that was coming. They had to make some decisions on do they invest in another mapping system and who. Quite frankly, the uptick in OPAL adoption the last six to twelve months has been exceptionally high for us. As we introduce these other catheters, you're going to see more and more utilization. Plus, we have hired a lot of mapping specialists. You can't be successful in mapping unless you have the mapping specialists. We've hired thousands of those people. They're going through their training.
Sam Conaway, who can speak more specifically and is in the room, is getting them to an experience level that differentiates us. Quite frankly, as you look around the world, that's where we see an opportunity. We'll be sitting in the room two years from now. Just like we said two years ago, we were going to transform the space and grow meaningfully. I think we've proven ourselves there. We're going to prove ourselves again in two years as it relates to mapping. That is going to be the secret to our success in being number one in the future.
What I would add to that too is, again, back to the FARAWAVE utility. Let's say it's not 100% that every FARAWAVE is used on our OPAL system. It's not impossible, and it's being done today, where it can be used on competitive systems. As you look at the utility of the FARAWAVE, then FARAPOINT workflow, we have the highest utility across the ecosystem of how EPs like to do procedures. That's not a bad thing for us.
Great. We'll go to Josh Jennings.
Thanks, Josh Jennings from TD Cowen. I wanted to ask on the WATCHMAN franchise, just to understand the remarks around, you know, being careful to wait for coverage and guidelines and maybe label expansion. Wanted to just figure out, I mean, what can you do in advance? I mean, assuming you'll have the data prior to it being presented in the first half of 2026, when can you get to work with CMS and private payers? The second part of the question is just on back to capacity. It's hard to ignore Dr. Leone up on the screen and the LAAC session or summit at New York Valves this year. How do you, how are you guys working on gaining a mind share with interventional cardiologists and how big is that channel in terms of providing capacity, assuming CHAMPION is positive and WATCHMAN moves to first-line therapy? Thank you.
Yeah, I'll start and then I'll pass to you, Ken. Just to answer on that, a couple of things. You have seen, of course, with Option, we have been really diligently working not only on the reimbursement for concomitant, but also the labeling update. We got it in almost six months after the data release. I think CHAMPION is a bit of a more complicated story because the potential uptake, as you saw, it's pretty substantial. We expect more scrutiny on the CHAMPION side after the data will be released. Second, the adoption of CHAMPION indications will require also the reopening of NCD, which is another step process that will require more time. This is really what substantiates the idea that it will require more time for local approvals. The second part of the question?
Facilitating capacity and.
Yeah, the capacity and how exciting the interventional cardiologist. I would say that two data points. First of all, even now with the major focus on concomitant, we continue to see momentum for the entire therapy. Our, you know, also the market is growing. If you just take the IC portion of the market, it's still growing substantially. That's really the positive data point in favor of the therapy. Next, again, CHAMPION really, in a way, rebalanced the Option results in a way that CHAMPION really covers both patients on the EP side as well as on the IC side. We also see that, you know, the CHAMPION result in a way will reinvigorate, you know, momentum also on the IC part of the business.
Yeah, I mean, Josh, I think I'd call out three things. We've already mentioned them, but I just want to reiterate them because I think they're important to take away. Right. One thing that solves capacity is moving the simplest cases out of the in-hospital cath lab into the ASC environment. Again, just from a Farapulse standpoint, we really do think we are uniquely positioned to take advantage of that move into that environment. Number two, it's continuing to iterate the technology for WATCHMAN, right? Creating an implant that is safe above all, simple, efficient. As you look to the next generation WATCHMAN that Andrew and Dr. Brad unveiled, right, that's one of the key things that it'll do for you.
Less that have a relatively low mix. The first point is how the concomitant adoption will evolve will dictate more than either case. The same for CHAMPION. Six different scenarios. It's the biggest trial ever done on LAA, 3,000 patients. Of course, we are extremely careful on the results. We have been planning different cases based on what the results will be. I would say based on those two components, the market could go above the 20%. Of course, in what we don't expect to be the scenario that CHAMPION will not hit the primary endpoints, it will be probably below that. Like I said, we think 20% is probably the best balanced projection with the information that we have today. We still feel pretty optimistic about the future.
To add to that, we can just try to control what we can control. We are clearly leading in all things LAC with the product portfolio and expanding market through clinical. We're the clear leader in PFA. We aim to continue to be the clear leader in PFA. I'd be disappointed if we're not number one overall in EP at the next investor day. We're the clear leader in concomitant. They're also the safe, incredibly safe and most efficient procedures that have incredibly high patient demand and excellent economics, unlike many procedures for hospitals. For us to pinpoint the exact market cater, you know, we give you our best shot at it. We'll see how it looks like a few years from now, but we'd like to stick our commitments and not, you know, throw out crazy numbers and come back.
We can control our clinical, our portfolio, safety, and our resources. I can't imagine the company being in a better position than we are right now in EP and LAC and concomitant together with the clinical trials that we're advancing.
Mike Matson.
Thanks. Mike Matson from Needham & Company. One of your competitors is running kind of a study of broad de novo use of a sirolimus coronary drug-eluting balloon, and the data is going to be presented at TCT. I guess two-part question. First, do you see potential for DCBs or DEBs to become over 30% of the PCI market, kind of become more of a mainstream treatment option? Second, does this particular sirolimus balloon represent a competitive threat to Boston Scientific? Thanks.
I'll take it in reverse order. We're respectful of different technologies. Like I said in my presentation, we think there's advantages to paclitaxel in terms of how you could adhere it to the balloon, that you can deliver it very efficiently. We'll have to see. There are differences that we could talk about offline in the trials. In terms of the patient population that we studied with our ISR indication, it was very complex, multiple layers of metal. There's nuances to their trial. It may be a bit of apples and oranges. We'll have to see. It's hard to predict if the overall market, even with the expanded indications, would be over 30% because there still is definitely a place for drug-eluting stents. It's been around for a long time, that technology. There are definitely areas where it makes sense, highly calcified lesions, ostium. There's things there that make sense.
I think it's hard to say it would go over 30%. Time will tell and data will drive those types of decisions and indications.
I'll go to Marie Thibault.
Hi, thank you. Marie Thibault, BTIG. Thanks for putting this together. My questions, I think, will probably go to Cat and Lance. I wanted to ask, I saw in the pipeline you're looking to bring forward VC investments in pulmonary embolism, as well as TAVR and mitral tricuspid. You're getting a second bite at the apple, I think, here with these investments. Those markets have evolved a bit since the last time you had investments in this space. Can you tell us where you think you still see unmet need with the incumbents? You know, maybe are leaving room for you to have some advantages there.
Sure, I can start and then hand it over to Lance. Similarly to the way that we've approached some of our other vessel beds or disease states, we see offering a portfolio of solutions as being really valuable, really valued by our customers.
For example, in the SFA, we offer a drug-eluting stent and a drug-coated balloon, and that's driven our number one position. As we think about treating pulmonary embolism, we think about it in much the same way. There are some patients that are great ECOS candidates, and there are other patients that are great mechanical thrombectomy candidates. One of the things that I think is our secret sauce that Mike talked about is this closeness that we have to the market. We're very deep with our customers. We deeply understand their needs. We watch the data very closely. We continue to look for ways in which we can continue to grow our portfolio, whether that's equity investments, tech and M&A, et cetera. We see a continued need for advancement in mechanical thrombectomy solutions, and we think that there's lots of opportunity to bring differentiated products to the market.
Yeah, so I think to answer your question from a structural heart broad perspective, mitral, tricuspid, TAVR, do we see other unmet needs or opportunities for innovation? Sure. I would say if you look at our investments in mitral and tricuspid, which we won't share a lot of details today, but I would say looking at safety and efficacy and procedural time and how simple the procedure is to democratize. Some of the bets that we have in that space, we've been in several cases reviewing them, and the cases are very efficient in terms of the imaging requirement. I think many of you probably know the echocardiography bar is very high to support those types of cases. If we can do, like I said, have technologies that are maybe more democratized, faster, safer, easier to use technologies, that's where we're placing our bets for mitral and tricuspid.
On the TAVR side, I would say we learned a lot, and as Mike said, sometimes we have to make tough decisions in terms of where we allocate our capital. We did not believe, we thought Accurate was a good product, but good maybe is not good enough to be a category leader or to vie for that category leadership position. The things we will look at in the TAVR space is we want to have a differentiated product that can compete. We do think there's some areas that can compete. Hopefully, we'll be able to talk about those in the near future, but we will be, it's a super important space. It's a massive opportunity. We do believe there's areas to innovate in TAVR, even with some proven incumbents that are in the space.
Great. We'll go to Matt Taylor.
Thanks, Matt Taylor from Jefferies. Just wanted to ask on the penetration PFA. You highlighted the slide that said 50% today going to 80% globally by the end of the LRP. I was wondering if you could segment that by geography or at least talk about what the U.S. is and could be by the end of the timeframe there. The follow-up is you also talked about these other arrhythmias like SVT, VT. I was just wondering if you thought there would be any start of PFA adoption to treat those before the end of the LRP.
First of all, we're not going to get real detailed about each geography. What I can tell you is the vast majority of the procedures given when we launched were both in the U.S. and the EMEA market. As I had mentioned, Asia Pacific just offers us a tremendous opportunity as we move forward. We're just getting started there. PFA adoption generally happens and is accelerating at a rapid speed when you have a little bit of time to market. We've been in the U.S. market now for well over a year and the EMEA market for over two. Those are the markets where you see the highest concentration. We won't give you that specific level of detail, but you can expect to see on average about 80% in 2028. That's a lot faster than we ever anticipated.
Fortunately, we invested heavily in two key things that I think are critically important to be who we want to be in the future. That's manufacturing, so we had ample supply of product to facilitate the increased demand, and our investment in these mappers. We invested in them some time ago, and as they become certified and experienced, that's positioning us favorably in that market. That is key to being successful in making your product or your portfolio work.
Nix, maybe on the question of other arrhythmias, I think beyond a doubt, we will see a utility for pulse field ablation, FARAPULSE, and potentially Theraplex in both atrial tachycardias. Absolutely, it's already, I think, pretty standard. And ventricular tachycardia. What we've published data on and shown is that, with Therawave and Therawave waveform, this energy source is much better able to penetrate scar tissue than is thermal ablation. That's been the real hang-up in being able to scale out and democratize VT ablation and get it out of the very specialized coronary care medical centers. I am excited to be launching the Ascend VT clinical trial. I absolutely do expect that you'll see greater use of PFA and Therawave in particular for VT within the long-range plan.
Great, thanks. We're going to go to David Roman right there in the middle.
David Roman from Goldman Sachs. You can obviously hear the extraordinary focus on FARAPULSE or EP and WATCHMAN here, just given the percentage of revenue and growth that that has driven for you. I think you've had an opportunity here in both categories to establish new therapies, change guidelines, change reimbursement, bring new indications. I think that's all playing out in your results. You've given us a lot to think about here today across different product lines and different geographies. As you look across the different opportunities, where do you have similar opportunity to shape and create new markets across what you've shared with us today that when we sit here in two years, maybe 80% of the questions aren't about EP and WATCHMAN, it's about something else. We can't say renal denervation, please. Your answer can also be, tell me to do my job too.
As you kind of talk internally, what are the things you'd really point us to that you would think would highlight the analyst, meaning if you fast forward a couple of years?
That's my second to last slide on my deck. That's where I try to lay out by business unit the opportunities that we're already investing in today that will not impact our LRP, this three years, except we're putting a lot of money in it now. That slide tries to cover that at a high level, and for competitive reasons, we don't want to put it all in there. I think you start our MedSurg business today. Great businesses, strong category leadership, upper single-digit growth capabilities. We continually defund that with organic R&D and tech and M&A to grow faster than those markets. We'll continue to do that. We expect strong double-digit growth in our cardiology business. The biggest upside areas, there's a few potential breakouts, and Dr. Dunkin talked about one with potentially type 2 diabetes and a few other areas that we have across our MedSurg business.
We're doing a lot with early investment in some other neuro disorders. I would say broadly, the bigger, bigger breakout opportunities are in cardiology in general. Lastly, through in 20 minutes, what is amazing beyond WATCHMAN, which we talked a lot about, concomitant EP, what is an amazing transformation of a portfolio in a huge market that's very global. Nobody has more bets in interventional cardiology than
We do. He went through maybe 70% of what we have here. Beyond that, I would ask you to just look at that one slide where we have active investments. You know, you cannot, you cannot believe this. I think we're going to be very competitive with Weidell Schoch down the road. Huge market. I think we really can disrupt some existing incumbents in these big markets because of unique technology and the breadth of our portfolio that, for contracting purposes and reputation, really, really helps us. You saw, you'll see a number of things in that slide that are new market opportunities. We're not talking about interventional oncology much here, but just the Mandarin trial in China alone will open that up. We're really encouraged by that glioblastoma trial. On that slide, it lays out maybe 15 different areas that we're making investments in today.
Not all of them are going to work out. I think as an investor, you see our gas tank of innovation has never been more full than it is now. We continue to do that for the long term.
What I would add to that is, and I won't say hypertension, but you heard Dr. Stein and you heard Lance say about heart failure. If you look other than CRT, there's really no therapies to help, especially the HFpEF patient population. Whether it be in diagnostics or interventions, Lance talked about a spin-out that we had done in that interventional heart failure. If you had to pick one, just given the size of the heart failure population and the basic nothing being done, you'd have to believe that interventional cardiologists, EPs, diagnostics, something's going to work. Something has to work, just given the size of the heart failure populations around the globe.
Great. We'll go over to Rich.
Hi, [Rich Neuwirth], Arcturus Securities. Thanks for hosting this. Just, Jon, maybe it's for you, just the long-range plan and kind of how linear we should think of these annual commitments. Is there anything that you can characterize for us on the front end or on the back end of the plan with respect to where the investments and/or the returns on some of these new product and indication expansion areas will have greater payoff to give us a sense of if you are going to either go faster and harder above the annual commitments or a little bit below or where would that be in the long-range plan?
Yeah, thanks, thanks Rich. We didn't go year by year. The 10%+ top line growth, that is an average over the period. I think it's particularly impressive coming off of two years of mid-teens growth here, 16% in 2024. Expect 14%-1 5% organic growth this year. We'll grow faster than our markets each year. On the margin expansion, 50 bps each year is what we're targeting, and we'll grow EPS faster than revenue as we've always done, to nicely leverage EPS over the period. There's nothing I'd call out at this time where I'd say, hey, you know, expect this in year one, that in year two, and another result in year three of the LRP.
Are there any other questions? Wow.
There's one right here.
Joanne's got one.
Yeah, we'll go back to Joanne.
Thank you for circling back. Joanne Winch, still at Citi.
Still at Citi.
John, this is for you and it's a follow-up on Rich's question, which is 10%+ . There are a lot of numbers that are plus. There are a lot of products that are up there and you guys have a much better view of when those start to accelerate. Are there years where you're like, we feel really good about 2027, I'm making that up, because these three things are going to come to market. Should I, in my model, just do 10%+ something straight across? How should I think about the next three years developing, at least on the top line? Thank you.
Yeah, I feel really good about each year. I mean, we've got great momentum in the business today that will carry into 2026. You've seen all the shots on goal that we have across each of the business. We've got launches each year of the LRP. I wouldn't guide you again one year or another of the model to put in a different level of growth versus what you have across all three years. It's an average that we're targeting. We view ourselves as a double-digit growth company on the top line. We'll continue to outpace the underlying markets. That's how we're looking at it. How do we continue to fuel growth each year? How do we overachieve the objectives that we've laid out here today? That's what we're focused on.
I would say I don't think we anticipate like a for three years. We don't anticipate a 2 years and a 20 years and a 10 years. We think it's pretty less variant than maybe you think.
Yeah. It's great. We have time for one more. We'll take Matt O'Brien.
Thanks. Excuse me. I got what Mike's got. Matt O'Brien, Piper Sandler. I kind of wanted to circle back to what Larry started off with on the share dynamic and EP. Because by my numbers, you're about 75%, 80% share of PFA at this point. I can think back to, although there's two of you in this space now, essentially at this point, right? You guys and Medtronic. I can think back to other categories like DES and CRM, where you've seen a lot of variability in share over time. What makes it different for you guys with PFA in your portfolio this time, where you can insulate yourself, keep that share versus what we've seen with some pretty big share movements in other areas of cardio historically?
Thanks. It's a great question. We're not going to be respectfully specific on share, but what's different about this is the ecosystem. You saw that slide. The ecosystem starts to take, call it PFA today, that it's going to have mapping capabilities and some of the things that I talked about that will be exclusive and unique to us. The Farawave catheter, third generation, with all those electrodes, you won't be able to get all those features and capabilities unless you have an OPAL mapping system that ties that together. ICE, which Dr. Sutton spoke about, which is a new opportunity with AI, as you think about the evolution and the cadence of the launch of ICE, that will all be integrated into our mapping system. You'll also have Cortex. We'll see how that plays out. We're very optimistic about that. That will be integrated.
We're insulating ourselves by having an entire ecosystem tied to our mapping system. We know that the hard way, because we lost when it came to RF and tying it together. We learned the hard way when it comes to now having a new energy modality where we're leading and leading big to capitalize on that and capitalize on that in a big way. That's how I'd answer that question.
Great. Mike, you want to say a few words to close?
Sure. Thanks everybody. We're a church choir up here. I'll stand up here. Just want to thank, I know it's been a long day and we saved SG&A by your boxed lunches. You're probably not going to be overwhelmed by those. I'll open it up where we started here. I guess close where we started. We're honored that you spent the day with us. Appreciate all the work that Lauren and the team did to pulling this day together. Hopefully you walk away as excited as we are. If it didn't come through in the videos and everything else, we are very motivated by Advancing Science for Life. We have an incredibly strong, deep team and employee base that's highly engaged. We are an attractor of talent.
You never want to be cocky, but we are an attractor of talent and people want to work for BCS because of our growth, because of our culture, and our focus on innovation. We are not a company that's arrogant. We take shots on goal. We learn from each other. We challenge each other. We talk about this innovation ecosystem. A lot of it's embedded in the culture and challenging each other and doing that, not being overly protective of things. We are pushing meaningful innovation all the time. Our commitment is to be, if not the best, clearly highly, highly differentiated versus our peer group over the next five years. I wouldn't bet against us. Thank you very much. I appreciate it.