Good morning, everyone. Welcome. I'm Robbie Marcus, the med tech analyst at J.P. Morgan. Really excited to have our next session, Boston Scientific. Gonna introduce the CEO, Mike Mahoney, to come up and do a presentation, then we'll turn to Q&A. Mike.
Good morning, everyone. Hey, Robbie. J.P. Morgan, Wednesday, you're hanging in there. First of all, it's such an honor for me to help lead Boston Scientific. I've been with the company for 10 years now, and it's just an honor and a pleasure to work with the team. I appreciate the shareholders that are in attendance. Hopefully we're gonna give you a quick summary of the company in about 20 minutes here. You'll find the company as exciting as I do. Here are our safe harbors, our regulatory disclaimers, and our financial disclaimers. You know, when it comes to the company, that you have so many healthcare companies talking about their businesses here, you see a lot of slides like this.
I think what's great about the company is every year we do modify our strategies a bit based depending on the market, modify our operating plans. We build new capabilities. These values that we hold really don't change across the company in the 130 countries that we're in. Really, advancing science for life is what motivates our employees and fires them up every day to drive differentiated performance as well as helping patients. We keep this front and center with our employees. You know, in terms of what to expect from Boston Scientific, this is at minimum what we expect from ourselves in the company.
We'll show some slides here to continue to drive differentiated growth versus our peer group through our portfolio innovation, globalization of the company, commercial excellence, digital capabilities, and basically new capabilities. Really our relentless focus on getting better and our relentless focus on talent and depth of talent across the globe. Continued execution of our category leadership strategy, putting ourselves in faster-growing markets, you're going to see a slide on that, fueled by our internal R&D as well as our active M&A capabilities. Strong commitment to corporate responsibility is not a new thing for the company. It's really always been a focus of Boston Scientific. Importantly for shareholders, consistent differentiated financial performance. Not just consistent, but consistent differentiated financial performance.
Revenue growth at the high end of our peer group, 50 basis points of adjusted operating margin expansion, double digit adjusted EPS growth, and strong free cash flow. You know, I think it is important, that gets me as a father, some of the actions in the past, give more credibility to what you do in the future. We have a very exciting future of the company, and it's embedded by the consistent performance that we've delivered over many years. Really proud of this. Back in the early days, 2011 through 2013, we were a -1% growing company over those three years. What you see is as the portfolio and our capabilities evolved, we've enhanced our organic CAGR consistently over this 11-year period.
In 2021, we grew, you know, a big number, 20% versus 20, which is impacted by COVID. 6% organic over 19. This year we guided to approximately 9% organic growth for full year 22, which we'll give an update on the earnings call in February. Also importantly, something we're highly focused on is improving adjusted operating margins. We're roughly around 89%, actually lower than that in 2012. 2019, call it 19%. Pre-COVID levels, we reached 26%. We had a COVID year of 20 as well as 2021, we guided this year to getting back to pre-COVID level operating income margin of approximately 26%, again, which we'll update at our February earnings call.
You'll see our focus on improving our operating margin 50 basis points going forward. Our expectation is that we would exceed our operating margin of 2019 in the near future, in 2023. With adjusted EPS, similar, a goal of double-digit adjusted EPS growth. Importantly, this year, we guided to 1.71 and 1.74. That also includes a 0.06 impact from the R&D amortization policy that was put in place, which is a bit of a one-timer, which we will annualize in 2023. That performance is terrific. This is the slide I'm most proud of, besides the people in the company. Every company wants to improve their weighted average market growth rate. It's not easy to do unless you're a start-up. We're not a start-up.
Years ago, we were less than a $7 billion revenue company in markets that grew -1%. Over this kind of many years here, every quarter, every year, this can't be done overnight, we focused on improving our weighted average market growth rate through our organic R&D, where we spend our money, what projects we take on, how we drive our remote or global capabilities in our core business for sustaining engineering, to drive a lower cost R&D, focus our higher cost R&D on fast-growing markets, a lot of tuck-in M&A. I'm really proud to say this year in 2022, the weighted average market growth rates of the markets we compete in are 6%, approximately 6% coming from -1%.
Approximately $13 billion in revenue this year with big expectations in our LRP. We expect in 2024, you know, that weighted average market growth rate will be closer to seven than it is to six, based on the product launches that we have, the acquisitions that we've done, and really the lower scale of DES and CRM across our portfolio. This is a just quick breakdown of those markets. We could play in a $55 billion approximately served market. This is the average market growth rate by segment of our 8 divisions within the company. Through third quarter, which is what we expect of our team, proud to say that 7 of our eight businesses have outgrown their market peers through third quarter of 2022.
We have pretty simple metrics at the company, outgrow our peer group, deliver operating income growth faster than sales growth for leverage, and hire great people and free them up to run. This is the market growth rates that we have as a company. This is really difficult to do 'cause running Boston Scientific can be. It's first of all a privilege, but you really can be distracted in many different areas. What we focus on, the center of our focus is on people and talent and portfolio innovation. You do people and talent to retention and succession and depth and agility and winning spirit of people, with a common mission, and you focus on innovation, a lot of other things get figured out.
This is just a snapshot of our business units as quickly as I can do. At least there you have the information of our business units and what some of the key innovation drivers are for the next three pages. I'll try to do this pretty quickly here. Starting with MedSurg, which is our endoscopy business, urology and neuromodulation, and it's run by Art Butcher. He also runs Asia and China for us and some other corporate functions. Our endoscopy business is a terrific business. It grows accretive to Boston Scientific. Margins very accretive to Boston Scientific. Clear market category leadership in this business. Some exciting new announcements in 2022, none of which have closed yet. On the acquisition side, we signed M.I.Tech, different stent capability, a Korean-based company.
We also signed but not acquired Apollo Endosurgery to expand us into endoluminal surgery, as well as the obesity business, with some terrific technology there. Both of those acquisitions we expect to close sometime in the first half of 2023. If you turn to urology, very similar characteristics as endoscopy. Clear global number one share leader. Very much a global business accretive to Boston Scientific growth, accretive to operating income margins and very strong category leadership. The Lumenis integration, the Israeli-based company that we acquired in 2021, has gone extremely well. That gives us tremendous capabilities across the different urology segments in stone, prostate and prosthetic urology.
We'll continue to advance, to invest at the high end of the R&D profile for urology and endo, primarily 510(k) businesses where we do tuck-in M&A, have very strong contracting advantages and globalization skills. Neuromodulation is a business that's been the market growth has been not quite as strong as it had been prior to in 2019 through COVID. We're calling kind of a low to mid-single digit market growth rate, call it 5% range for neuromodulation, which consists of pain and brain. Starting with brain, really proud of this business. Started off not in this business eight years ago. Now we're the number 1 de novo share player in Europe, and number two overall given with change outs and the number two player in the U.S.
Just a terrific job, great innovation here. Great partnerships with BrainLab and terrific products to treat Parkinson's, tremors and other movement disorders. In the pain business, again, number one or number two, depending on whose survey that you look at, globally, led by our WaveWriter Alpha program, as well as tuck-in acquisitions that we've done in RF and Vertiflex to give doctors, pain doctors and neurosurgeons a more continuum of portfolio. This business, Did we show through third quarter? What did I gross? 3%. Thank you, Lauren. Good save from the bullpen. 3% through third quarter, and we expect increased results in 2023 out of this business. Turning to cardiovascular.
Our PI business, similar to endo and neuro, strong category leadership in arterial interventional oncology and Venous, Eluvia Ranger, our two PMA products with excellent data, excellent capabilities, and the number one share player in the arterial business globally. Interventional cardiology. A couple of years ago, we talked about this acquisition of BTG. This has gone fantastic with Y-90, our cryo product. We just acquired another company called Obsidio last year, which is a gel embolic, which is a very differentiated, which we'll launch this year. Venous is the segment that lags our growth profile in this business. Of these three segments, Venous makes up about 15% of our sales growth, and we've got some great products with Varithena, but an area that we're improving on with our Devoro acquisition that we made in 2021.
Interventional cardiology is really transforming on the right-hand side here. Coronary therapies, as many of you know, our non-DES coronary therapy business. Our complex coronary calcium imaging capabilities are significantly greater in size than drug-eluting stents, nearly two or three times larger. That business has a nice growth profile with it. Importantly, we just received approval in Japan for what a product called AGENT Drug-Coated Balloon for in-stent stenosis and small vessel disease. This is a terrific opportunity for us to further differentiate our coronary business with AGENT DCB, and we've enrolled and expect approval for AGENT DCB in the U.S. in early 2024, which would be potentially up to about a billion-dollar market with greater price capabilities as well as category leadership contracting capabilities. We think AGENTs will be a game changer for this coronary business.
couldn't be more proud and happy of our structural heart business and what we're doing with ACURATE. We're growing, albeit off a smaller base, clearly growing faster than our market competitors in Europe with ACURATE neo2. We will complete enrollment in the 1st quarter of 2023 of our trial for high risk, medium risk, and low risk. We will seek approval in the U.S., which we believe is a valve that's a supra-annular valve that's differentiated with its hemodynamics, very low pacemaker rate, and importantly, a platform that we can continue to enhance and improve with great agility with our R&D teams, with excellent repeatability and quality in our manufacturing. This is a very competitive valve in Europe, and we're putting a lot of attention on this, and we're excited to enter the U.S. market with this.
Turning to our last slide, where we have maybe the most breakthrough transformation for the company, CRM, EP, and WATCHMAN. Starting with Core CRM, this business has performed very well in 2022 through 3rd quarter. You see our portfolio with our EMBLEM S-ICD, which continues to do quite well globally. HeartLogic and RESONATE with the longest-lasting batteries, reliability, and excellent global commercial team growing faster than market. When you include our diagnostics business. We expanded our portfolio to leverage our implantable loop recorder. We acquired Preventice a couple years ago, which gives us MCOT, Holter monitoring, two week Holter monitoring, and combined with our LUX-Dx, a terrific, vast diagnostics portfolio to help pull through business. You'll see a lot of our focus on clinical trials in the bottom. I won't go through those.
An area that I'm so excited about is in this middle category. Our company in my 10, 11 years here has not been quite, frankly, not very good in this business in electrophysiology. We are in a fantastic disruptive, transformational position as we speak now. I think this is the best market in med tech at over $8 billion in revenue, clear double-digit growth and also new innovation. This is not at all a mature market, and we are poised to really do extremely well here. We're the only company in the world that has approval in Europe for a differentiated cryo platform, which is approximately almost $1 billion globally, where there hasn't been any new innovation in over a decade. We're gonna disrupt the market with cryo.
We're doing extremely well with this product in Japan and in Europe. That product finishes enrollment in second half of 2023 in the U.S. I'm sorry, it'll be approved in the U.S. second half 2023. The product that we're most excited about is PFA with FARAPULSE, where we're leading the industry. We did about 10 or thousand cases or so in 2022, primarily in Europe. The doctor reaction for the safety, number one, the speed and the efficacy potentially of this is something like I've never seen in medtech in my career, the enthusiasm for this. We think this PFA will be very, very disruptive to a fast-growing, large global market. This is one where Boston Scientific is leading in terms of data.
We'll be giving our ADVENT ID, which fully enrolled. We'll be presenting that data in the second half of 2023 and seeking approval. We're seeing excellent results in Europe, whether they be cryo users or point RF users who are adopting and wanna adopt to FARAPULSE. We also have a full suite of other products I won't have time to go through. Also in WATCHMAN. Really proud to see just the continued excellence of this platform. We're excited to say that we nicely crossed the $1 billion revenue mark in 2022, which is terrific.
Also importantly, we are focusing on leading this category for a long, long time with portfolio innovation through our next gen steerable sheath, through our next gen WATCHMAN FLX Pro, which will launch either the end of this year or early 2024, as well as VersaCross Connect, which is the capability that we acquired through the acquisition of Baylis Medical. We are leading in clinical trials, and we had the CHAMPION trial finish enrollment almost one year faster than we expected. The CHAMPION WATCHMAN enrollment happened at the end of 2022, which is really impressive, and it shows the confidence and enthusiasm that physicians have.
If you look at, to me, that maybe the two best markets in medtech right now, are I think our EP, and WATCHMAN clearly is the fastest-growing sizable market that exceeds $1 billion and has the potential to be a 5 billion or 6 billion market with CHAMPION-AF and with Option. Okay. All right. On the M&A front, we've been pretty active here, focusing on tuck-in acquisitions to drive, improve our weighted average market growth rate, and we have an excellent way to integrate acquisitions within the company. In 2021, we had about five acquisitions that were really terrific ones, and I won't hit them all probably, but Baylis Medical, FARAPULSE, Preventice Solutions, Lumenis, and probably others that Loren will Devoro Medical, sorry.
In 2022, we closed one, which is Obsidio. We signed two that I mentioned in our endoscopy business with M.I.Tech and Apollo. We also signed a really strategic partnership in China with Acotec to be approximately a 50%-60% share owner of that company as a standalone public company to really drive unique capabilities for Boston Scientific and was a terrific market for us in China. We'll continue to focus on tuck-in M&A as our number one capital allocation priority. We realize interest rates have gone up. Our hurdle rates go up. We're very selective about what we buy. If we do have excess cash, we will use like we have in the past, but not in a significant way for share repurchase.
I think we've really spent your shareholder money wisely to improve our growth rate and performance and outlook for the future leverage in our M&A. Similar to globalization, last year through third quarter, through third quarter 2023, we've grown our emerging markets over 30%, which is terrific. The focus of that is on China. China's a complicated, complex place. There's lots of macro discussions you can have, but we view China as very unique. We'll continue to invest in China. New capabilities we have in China with R&D, with some manufacturing, with joint ventures that we just recently signed with Acotec. We continue to like this market. Importantly, the proof's in the pudding. We'll grow, you know, through third quarter and for full year over 20% in China in 2022.
Yeah, there's some tenders and some other things, but we have a terrific team there, and we will continue to grow double-digit in China and invest there. Lastly, sustainable innovation, a bunch of data on the slide. Really proud of our team's focus on diversity and inclusion in the company, on our pay equity, which is almost about 100%, 99.8%. Our focus on the environment. We win many awards in this area, really again, it's back to the people. Inspiring our employees, doing the right thing for our communities, doing the right thing for the planet, making Boston Scientific a great place to work, where employees are proud to be at. Not all of our employees really care about our stock price.
Our employees care about being a company they're proud of, they wanna tell their family and friends about it, they wanna help us recruit, and they wanna go the extra mile for the company. We really work hard to create a culture where employees really enjoy working and are proud of Boston Scientific. To wrap it up, 20 seconds left here. Threading the needle perfectly here, Lauren. For 2022, you know our guidance for the full year. We're gonna give all those results in February. Our longer term goals are very consistent. We wanna continue to grow at the high end of our peer group. We have the portfolio to do that, and we will do that.
We also don't wanna listen to some of the noise that you hear. We think you can improve operating income margin. We did it, we will do it in 2022, and we will do it in 2023. Our goals will continue to be 50 basis points annual margin expansion, double-digit EPS growth, and strong free cash flow. Super proud of the company. I'm a little bit over, I think, but really appreciate your time, and have a great conference. You want me here. Where do you want us?
Why don't you guys sit there? You sit here. Well, thanks. It's great to see we're in a much better spot for med tech and Boston Scientific this time versus a year ago, and amazing what a year makes here. It looks like global markets are stabilizing and normalizing. We've seen a lot of macro pressures, but at least they've stabilized and look like they could improve in 2023. Would love to get your view of what you see around the world in terms of patient volumes, healthcare systems, healthiness and willingness to pay for medical treatments, and any views on the macro situation as it relates to Boston Scientific.
I mean, I'll take a few of those slices.
Sure.
You can jump in, Dan.
Absolutely.
By the way, this is Dr. Ken Stein. We recently announced, with the retirement of Ian Meredith, Ken is the chief medical officer for Boston Scientific and also focuses, besides that role, on corporate clinical and a lot of emphasis on our EP and CRM portfolio. Dr. Stein. Just, maybe two areas, and Dan can mention. On the demand side, you know, through third quarter, which is gonna say a lot, I guess, today, we saw fairly pretty good demand despite the nursing shortage in the U.S. As you saw, our growth rates through third quarter were year-to-date about 9% organic growth. You see pockets of impact of the COVID still.
We have seen pockets of continued bumpiness in Japan, obviously, as we look at 2023, we expect some lumpiness in China, especially in the first quarter here, you know, based on what we're seeing there. Even given that, we have a lot of confidence that our China team, just like they have every year, will drive double-digit EPS, double-digit organic growth in China. We expect some COVID impact in some of the Asian companies. We think the hospitals do a remarkable job despite the nursing shortage. We think volume demand is pretty good. As you know, many of our products move to an outpatient facility or ambulatory surgery centers. That's a good product mix tailwind for Boston Scientific.
Hospital administrators wanna get patients obviously fixed, but in and out of the hospital. Our portfolio being an interventional medicine business, where you can have a left atrial appendage closure done in your heart and be home five hours later is pretty remarkable. I think that our portfolio and those trends really point to what the healthcare system wants and needs going forward. Dan, if you wanna touch on some of the macro, inflationary insurance...
Sure. I would just say, reiterate what you said. I mean overall, to summarize, I think it's a very supportive backdrop for revenue growth. You saw that in our results through the third quarter, at the 9% and obviously the full year guidance at 9%. Consistent performance through last year with a supportive backdrop. The inflationary headwinds, they're real. We've documented them as $375 million of headwinds versus where we were in 2019, largely in the gross margin area. We're trying to power through that as a company and really with a grit and a winning spirit to say, you know, we were 25.3% operating margin in 2021. We wanna grow that.
We wanna go north from there, from 25.3. Our guidance was approximately 26%. That also gets us back to pre-COVID levels if we were to do that. It's really, you know, not looking at the inflation environment as an excuse, but really trying to drive through it and work through the entire elements of the P&L to try and offset it, and that's the goal.
Pre-COVID, your long-term goals were actually what you were delivering. Is there any reason I look at sell-side numbers for 2023, and it's not far off of your long-term goals? Is there any reason 2023 and beyond couldn't be a return to your historical performance?
No, I mean, that's the numbers that Mike showed the slides are still up on the screen here. I'm not sure if it's up for the folks on the webcast. Those have been our long-term goals. Really the only thing that interrupted that was COVID in 2020 and 2021. Our goal as we start off each year is what you see there, to grow at a high-end peer group, expand operating margins approximately 50 basis points, deliver double-digit adjusted earnings per share growth and strong cash flow. That's those are tried and true goals that, as you said, I mean, we had a very good track record of achieving those pre-COVID. Look to get back into that routine.
What I find really impressive about Boston Scientific is you're in some of the best med tech end markets. You're number one or two in most of them. Despite being in these very competitive, high-growth markets, you're also your R&D page and your productivity and your acquisition track record continues to allow for top-end innovation. How do you balance the need for growth in these very difficult markets and being able to still provide the R&D growth engine while growing margins? It's not an easy thing.
It's not, but it's a fun kind of a Rubik's Cube.
That's what you pay us for.
What's that? That's what they pay...
That's what.
I was gonna say that.
It's like doing sit-ups. They're not fun at all.
Exactly.
You gotta do it.
There is a fun element. We have different pods and areas to be able to fuel the top line, right? We have our venture capital portfolio, which spawns predictable M&A over time. We have the more opportunistic types of M&A, and then we have internal R&D. We look at that landscape, and we place bets very intentionally across that continuum to fuel growth. The slide that Mike showed, that he said he was most proud of, I would add to that, I think I am as well, is increasing the weighted average market growth rate of the company over time. That's been a...
It's been a 10-year journey, but it's great to look back and see something that was -1, now be six, and look forward and say, "You know what? That could be closer to sixcloser to seven than six." That's what you do every day, every month, every week, you know, every year, is just continue to get into faster growth markets and innovate and-
That is the hardest part of the job, I would say, is this portfolio prioritization and what to delay, what to pour more fuel on, what to acquire, how you may have to absorb some of the dilution with that. That is the trickiest thing. We work together as a global team on that. We have global business presidents that are maniacal about growing faster than markets and delivering great patient care, but also with the Boston Scientific hat on. We work as a team to drive prioritization, whether it's tuck-in M&A or large PMA programs for 510(k). I think we do it pretty well.
I may want to add, I mean, yes, it's hard work, but, you know, I mean, it's not like we've solved all the problems there are for patients in cardiovascular disease or interventional oncology or neuromodulation. There are some major unmet medical needs right now. That's why, again, something like WATCHMAN, preventing stroke in patients otherwise unprotected. FARAPULSE, which we expect will revolutionize ablation for atrial fibrillation. TheraSphere with Y-90 for interventional oncology. Yeah, it's hard work, right? There are major benefits we can bring to patients and benefits then that'll be rewarded to shareholders in the company.
You talk about FARAPULSE revolutionizing atrial fibrillation ablation. It's probably the most anticipated data set we'll see in medical devices this year. Maybe you could put a finer point on what revolutionizing means. Is it better efficacy, better safety? How does that pull through the entire portfolio of products for Boston Scientific if it is as successful as that?
Thanks, Robbie. The key here with FARAPULSE is, honestly, I mean, maybe not just this year, I mean, 20, 30 years I've been doing electrophysiology. This is the single most exciting thing that I've seen in the field, and I think any electrophysiologist you talk to will agree with that. Pulsed-field ablation with FARAPULSE brings three promises, right? The promise of greater safety for patients, and safety trumps everything when you're doing elective procedures, but also the promise of greater efficiency, so faster procedures. That's good for the system. We talked about shortages of nursing, et cetera, but it's also great for patients. You know, the less time you're undergoing a procedure, the better off you are. Then also, we hope to be able to show greater procedural efficacy with it.
You know, it is almost never the case that you get all three of those things with one product. I think the one key point, though, that I really wanna emphasize as we talk about FARAPULSE and pulsed-field ablation is that not all pulsed-field ablation is equal. All right? That there are major differences in the platforms, differences in terms of catheter design, differences in terms of waveform that's used to ablate tissue, and differences in terms of the recipe, the dosing strategy. You know, it's in the development of all three of those areas that we think puts FARAPULSE in front of everyone else who's trying to do this.
There's two large competitors in atrial fibrillation that have a dominant position. Do you think a disruptive catheter will be able to break in and make Boston Scientific number three or two or one player alone, bringing through the rest of the portfolio?
Well, yeah, I mean, I think that's our anticipation, right? You know, when you have a procedure that's safer, when you have a procedure that's faster, and when you have a procedure that is at least as efficient.
Right? For those arrhythmias that can be targeted with the FARAPULSE system, you know, I don't see in the long run why anyone would ever use anything else.
Mike, you cited the other product you're most excited about is WATCHMAN, and that's $1 billion, still growing strong double digits. You're growing geographically. We're gonna have indication expansion probably in the next three, four years or so.
Yep.
How should investors think about the reality of the near term to midterm? Does this still have legs to be a strong double-digit growth product for Boston Scientific for the foreseeable future?
Yeah, we believe so. Through the third quarter, it grew roughly 25% this year. Dr. Stein can comment. I believe for the current indication of WATCHMAN, we're still, like, maybe 8%-9% penetrated in the U.S. There's plenty of room to grow globally under the current indication. The CHAMPION enrollment that just finished in 2022, as I've mentioned, is significantly faster than we thought. We think the market has the opportunity to grow, you know, to 5 billion-$6 billion markets over time if those trials prove out to be positive. Even in the current indication, we're still high single digit utilization. We have just a terrific product that doctors are very comfortable with. It's very safe. They have great results.
They're referring cardiologists or neurologists or GI doctors have had great results, so they're demanding WATCHMAN. We do have a competitor in the market, but we think with the install base we have, the safety profile, the physician confidence, and the plans that we have for steerable sheath and others will continue to make this a double-digit growth driver.
Rewind a year and a half ago, there was a lot of angst about the new competitor coming in in 2021. Fast-forward to today, we've seen your results look really strong over the past year. Are you seeing that having more feet on the street is actually helping drive awareness for LAA?
I think it's. Dr. Stein , you can comment if you want. I think there's a lot of parallel threads that make us, that makes this very successful for Boston Scientific. One is the product itself and the safety profile that doctors see and the ease of use that physicians feel with WATCHMAN FLX is very difficult to compete against. When you try another product, it doesn't feel the same. I think just the safety profile, the clinical results, the confidence they have with our team in the lab with them, what we do to help those physicians educate their referring physician base to help grow the market. They know we're investing in clinical science. They know we're investing in next-gen technology. We really tie all that together.
Yeah, we have a competitor and, you know, they're gonna gain some share, but we really like our leadership position for the future here.
Yeah, I mean, I'd say, I mean, it gets back to what we were talking about with FARAPULSE, right? What drives utilization? You know, safety, efficiency, efficacy. If you look at the results of the WATCHMAN FLX clinical trial, there's just no doubt but that this is industry-leading in terms of safety, in terms of efficiency, and in terms of efficacy. You know, one thing I'd point to, Mike mentioned it during the prepared comments, you know, in spite of all the challenges of COVID, we enrolled the CHAMPION-AF trial a full year ahead of our expectation going in. I think that just says something about the interest, enthusiasm, excitement that folks, you know, in practice have, again, about the important need that there is for an alternative to long-term oral anticoagulation.
While cardio usually gets a lot of the attention just given the number of clinical trials there, your med surge business is actually about half of Boston Scientific. Been very strong, consistent, close to high single-digit growth businesses for you. Maybe just spend a minute on what is driving such a high growth rate and what allows Boston Scientific to retain its leading position there.
Both endo and urology, I'll speak to those two first. You know, I can't lump them together, but say that they're both in markets that grow, you know, 6% to 7%, so they're nice growth markets. We consistently grow faster than the market group in those areas. The common denominator between those, starting with endo, is their breadth of their portfolio is very unique in the endoscopy business. We continue to innovate and to create new adjacencies. You've seen us do that with single-use imaging. You've seen us do that with SpyGlass. You've seen us do with that product called AXIOS. Now we expect to continue to lead in a really emerging field called endoluminal surgery, which is quite popular in Japan and gaining traction in Europe and the US.
That'll be aided by two of the acquisitions that we signed but haven't closed, as well as, augmented by our organic portfolio. It's the breadth of our portfolio, the innovation within that portfolio, the globalization that we have, and the contracting, the way we partner with our customers, given the breadth and the uniqueness of the portfolio, helps sometimes to enable, you know, strong share commitments and fair pricing economics. You really have those same exact traits in urology, although a completely different industry, with strong category leadership, the widest portfolio, to treat stone, prostate, and really a larger globalization opportunity within urology 'cause endo is very much almost a 50/50 U.S., outside the U.S., whereas our endo business is maybe 75/25.
You're seeing us invest more in the international markets in urology. The acquisitions that we've done in urology have really transformed that business with Lumenis and what was the other one we did a few years ago? Augmenix.
Yeah, Augmenix.
Yeah.
I want to maybe wrap up with M&A and the environment for M&A. It's been a very prolific acquirer of businesses, some small, some medium, not a whole lot of large. What's the current environment like and the appetite for sellers here, especially with rising interest rates and your ability to continue to find attractive targets at reasonable valuations?
I think credit to our BD team. If you look over the last two years and look at the different deals we've done, the entire world is our landscape. Sometimes people look at a very small slice of it and say, you know, "What are valuations like?" Right? Well, we bought a private company in Canada. We bought a in Baylis Medical. We bought a company from a private equity firm in China in Lumenis. We've done deals in Korea and China, again, that haven't closed yet, in investment deals. The creativity of looking at the entire world as your as your canvas, so to speak, it's a very healthy pipeline. It really is.
What's nice, again, if you look back over, you know, whether it's one year, two years, five years, it's across the whole category of the businesses that we have. It's not just, you know, in cardiology or in electrophysiology. Two endo deals, in 2022. It's a very healthy and robust pipeline, and I would look for us to continue to be active. It's our number one capital allocation priority, as Mike mentioned, and I'd look for us to continue it.
We often don't get a look into what's inside the venture portfolio. Any kind of high level thoughts you could give us on how many are potentially near-term acquisition targets or any color on the mix of the venture portfolio?
At any point in time, we have probably 35- 40 investments in the VC portfolio. You'll see some years where there's less, you know, shoots that come up from that in terms of seeds, but which was probably more of 2022. There wasn't a lot of activity. I think as you go through, there is a regular drumbeat and a regular cadence. If you have 35 or 40 companies, where each year you're gonna have some that are gonna be successful and looking to exit. I would look over the next few years and say that'll continue to provide us opportunities for thoughtful M&A.
Doesn't mean we'll do them all, but it is really nice to be a part of those acquisitions 'cause you're a thoughtful acquirer, you've been a part of the company, you likely would've had a board seat. It's just a very, a very thoughtful way to acquire a company.
You've had great success. Well, great. We're out of time. I wanna thank you for joining.
Thank you.
Thanks everyone for listening.
Thanks, Robbie. Appreciate it.