Welcome everyone. I'm Robbie Marcus, the med tech analyst at JPMorgan. I'm very happy to introduce our next session, Edwards Lifesciences. A little bittersweet session here. Chairman and CEO Mike Mussallem's last JPMorgan conference as CEO. I think it's over 20 that you've been at, so, I'll turn it over to you, Mike, and then we'll do some Q&A.
Thanks, Robbie, and welcome all. It's a pleasure to be here. Yeah, we've done this a few times, and it's been a pleasure. I always love to talk about our company. Before we get into it, you know, we're gonna be making some forward-looking statements which involve risks. We've got all those lists on our website and filed with the SEC, so feel free to take a look. We also use non-GAAP financial measures to make our P&L more understandable for all of you, and those are all also available in our filings and on our website. The credo is not something we just use for these kind of presentations. We talk about it inside the company all the time. It's been with us since the Edwards birth, when we rang the bell April 3rd of 2000.
You can see it's a multi-stakeholder model, which is sort of vogue right now, but we were sort of born that way, and it's very comfortable for us. We ask all of our leadership to really live our credo. Matter of fact, we give credo awards to our senior leaders for doing things like creating community and being a trusted partner and being bold and decisive. We close it with, "Helping patients is our life's work, and life is now." I'm so proud that we've really built a culture at Edwards where we say routinely to our folks, clearly the number one priority is patients. Patients first, all the time, every day.
In a recent survey, I was pleased to find that 93% of our employees said they think about what's important to patients when they're making decisions every day. I think that's the kind of thing that builds a robust culture and long-term success. Lots of ways to describe our company. One of the things I'm proud of is our transcatheter technologies are getting close to being able to be applied on or having been applied on nearly one million patients, and that's very exciting. We're fortunate to be a leader in what we do. In fact, over 95% of what we sell are in number one global positions. We have a terrific supply chain that's proven to be resilient, and it certainly got tested during COVID.
Our folks showed up every day, and we had made the sufficient investments that was truly resilient through these very difficult times. Our employee base is interesting. It's grown tremendously over the years, but we have a pretty large group of people that have been with the company for a long time, but we also have a lot of people that have joined the company more recently. A matter of fact, 60% of our employees are Millennial and Gen Z. It makes kind of a cool mix, right, of a culture of people that have deep expertise and a culture of new people with new ideas and new minds that are constantly challenging the status quo.
We got a lot of smart people, including, we do a lot of research and development at Edwards. Spend 17%-18% of our sales on research and development, which is high for a company of our size, and a couple thousand engineers in our company that are dedicated and motivated to really change the world. That all feels good. We also ask our folks to be charitable. We have this aspiration people will just do something charitable that they care about each year, and over 86% of our employees do that. A lot to feel good about that. The strategy at Edwards is different than many other medical technology companies. Many other companies, like to diversify, like to grow through acquisition, et cetera. We really have a different formula.
It's based first on innovation. We don't say that lightly. We're very serious about it. We're not talking about small, incremental innovations. We're talking about big, bold, change the practice of medicine kind of innovations. Those are very hard to do. They're extraordinarily rewarding when you get it right. One of the things you know about those is that the practice of medicine doesn't change unless you put big evidence on the board. We know when we're signing up for these kind of innovations that we're signing up for decade-long sort of journeys. We're up for that because that's also what creates the durable growth. The second element of the strategy beyond innovation. By the way, innovation has risks associated with it.
There's plenty of things that go wrong along the way, and we learn how to deal with those risks and deal with the failures along the way because it's worth it, and have a lot of shots on goal at any point in time. The second element is leadership. We like to go first. It's actually lower risk to go second or third and learn from others, but you learn faster when you go first. And it also puts you in the room, when you're shaping how a new therapy or a new practice might happen, when you're with the thought leaders, when you're with the regulators, when you're with the payers. We like that position, and we enjoy going first in many regards, but again, encounters risk.
The way that we handle the risk associated with being a big-time innovator and going first is by staying focused. We say we are not gonna diversify. We think there is a tremendous number of underserved patients that have structural heart failures or critically ill, and that we don't need to diversify to do this. What's magical about that is we can really learn a lot about these patients and become experts on what the issue is and how we can make a difference. This is our strategy. A focused leadership innovation strategy. The strategy has served us well. We've been able to clock along at double-digit growth for some time. The benefit is, number one, the patient demand is tremendous.
We haven't come close to fulfilling the demand necessary that's out there, and so it's one of the things that makes us feel great about our strategy. We always strive for this triple win. There's nothing that's more rewarding than you have a therapy that extends life, extends the quality of life, and saves the system money. When we do that, then we really ring the bell. That's always our goal when we're innovating. Finally, as I mentioned earlier, very long-term kind of investments. The kind of things that Edwards does, we're gonna be committed to for a while. The success that Edwards is realizing right now are based on seeds that were planted years ago.
We know that our success in the future is gonna be based on the seeds that we're planting today, and we're planting quite a few. It gives you a sense of our strategy. Let me just walk through our businesses. We're proud of our strong leadership position. Our largest business by far is transcatheter aortic valve replacement. We have a very simple formula there. We continue to focus on adoption of this therapy. There are still many patients that are underserved. We have a portfolio of innovations, so we're consistent innovators, and we constantly look to expand the indication associated with this as well. We have big opportunities that are associated with it, and we've been involved in groundbreaking trials for some time, and we have more cooking.
It's the kind of thing that we think has a chance to continually redefine. We're so proud of this procedure. Today, this procedure is done all over the world, and it's done very effectively and very safely. Done in under an hour. Often the patients are not even anesthetized. They're going home in a day or so and actually having their heart valve replaced, which was just unthinkable for somebody like me that stared into a lot of open chests over the years, which could only be done in the past with open heart surgery. Just remarkable therapy advancement. We're not nearly finished. There's a lot of things going on right now. In the pulmonic position, there are a number of patients in need.
It's a smaller population than might be some of the other valvular positions, but it's a serious one. We've developed this Alterra stent platform that you're able to put a SAPIEN inside of. That's turned out to be potentially very important for these pulmonic patients. We just had an introduction this last year of SAPIEN 3 Ultra RESILIA. We have our latest tissue technology that's now in the marketplace in the U.S. and Japan, and soon to be more. We are advancing our next generation platform called SAPIEN X4, which has more features that are very attractive to both patients and clinicians.
We have two market expansion trials, one called EARLY TAVR, which for those of you that aren't very close to this, the way that the indication today reads, for treatment is if your aortic valve is closed down to a certain size that you would measure using a sonograph or an echo, and the patient has symptoms, then you should treat. We think this idea of waiting till the patient has symptoms is bizarre and wrong, and probably made sense when the only option was surgery. Our EARLY TAVR trial is out to prove that this is not the case. Could you imagine patients randomized, that some patients get the watchful waiting that they get today, other patients are getting TAVR, follow all the patients for two years, and let's see who's doing better. We think that's gonna be a really interesting trial.
We have another trial called PROGRESS, in which we're actually measuring patients with moderate aortic stenosis. Don't wait until it's severe, but treat patients while it's moderate. There's early data that suggests it could make a big difference for patients, and this disease is just progressive. Why would you wait? We hope to prove that. A similarly randomized trial here comparing waiting to getting a transcatheter aortic valve replacement. We're excited about those trials and what they'll mean for the future. We have one important job in front of us, which is there's many patients that don't get properly diagnosed or don't properly move through the system to treatment. We're committed to change the way that that happens.
It means a multifaceted approach in which we're working closely with hospital systems where there are actually patients already in the system that don't move smoothly through the system. We're working directly with patients to educate them. Often, you know, our patients are an elderly population, and they would attribute their symptoms to, "Oh, I'm just getting old. I can't do what I used to do before," when in fact their aortic valve is closing down and they're not getting the blood flow that they used to get. Actually educating the healthcare providers, the clinicians themselves, the frontline clinicians.
Many of them, when they went through their training, there was no TAVR option. We still have a job in front of us to make sure that they understand the options that are available to them and encourage them more about the results and reminding them also about just how deadly this disease is. It is really severe. Matter of fact, once it's severe aortic stenosis, you could argue that the risk factor is something in the order of 1% mortality per week that you delay. Serious stuff. Our emerging opportunity, which is still small today, but which we expect to be large in the future, is what we call TMTT, transcatheter mitral and tricuspid therapies .
In the past, the only way that you could treat these patients, usually they were treated with pharmaceuticals the best they could or just watch them. A few people treated with surgery. We believe that the time is now to treat these patients with a catheter-based approach, and there have been sufficient advancements to do that. Our strategy is to develop a whole range, a portfolio of differentiated therapies, because we don't think that there's gonna be one tool for the job, kind of like in aortics. We also are gonna focus on having these groundbreaking clinical trials that prove that this therapy is better than what the existing therapy is. Finally, get real-world outcomes that match anything that happens in clinicals. We prepare to provide all the support necessary to make sure that that happens. A big opportunity.
We're very excited about this one. We think this opportunity is in the $5 billion range by 2028. Right now, there's a lot of these patients, Today they're just not treated with therapies. Whether you look at the tricuspid patients, where we estimate maybe 2% of those get surgery. You know, Edwards is the one that offers these products. So when a surgeon is in there doing, for example, a mitral repair or replacement, often they'll repair the tricuspid valve at the same time. That's pretty much the extent of the surgeries today. We think, boy, if we could have a great transcatheter option, what could we do for these patients? On the mitral side, still dismally low, only 4% of these patients treated. A big opportunity.
Again, a complex disease with complex etiologies, not likely that there's 1 size that fits all. We really believe it's gonna take a toolbox, that's what Edwards is bringing to the party. We have five big pivotal trials going on. It wasn't long ago, Edwards had one pivotal trial going on. That was our PARTNER trials. It tells you about what's going on just in this space alone. We look forward to reporting on these that each have an opportunity to be game changers, because these are highly scientific, centrally adjudicated, the kind of trials that are designed to really change the way people think and to really change guidelines and to advance adoption. We're excited about these trials.
These trials include not only our PASCAL Edge- to- Edge system that's used in mitral or tricuspid therapy, but also valve replacements in both the mitral and the tricuspid side. People sometimes think that surgery has stopped growing, and actually it has continued to grow. A matter of fact, Edwards is probably the single company that's decided to continue to invest and innovate in the world of surgery because we believe that there are many patients whose only option is surgery. This is still a big marketplace, and it's one that we happen to be performing well in. We particularly are advancing our latest tissue technology called RESILIA.
This was developed over 10 years ago, and we've got a lot of data, and new data will continue to be reported, which we believe will show that there's extraordinary durability compared to the tissue treatments that were available in the past. If you go to just the reason that surgery's gonna grow, some of it is that transcatheter therapies increases awareness, and it's just gonna attract more patients into the system and increase the diagnosis rate. Also, there are just gonna be more referrals that are associated with it. There are some patients that are just gonna be best for surgery, where transcatheter is not gonna be an option. We think that this is still gonna grow, and on top of that, we expect to become a even larger and larger part of this global footprint.
Actually, growth internationally is probably gonna be significant in this space compared to U.S. growth. Critical care is a business that, probably a little bit below the radar screen for some of our investors, but it's a clear global leader. We have a history of being a leader in what's called hemodynamic monitoring, or think of it as the performance of the heart, how well the heart pumps. It becomes a critical parameter for somebody that's going through a major surgery or somebody that's in an ICU. Edwards has always had the benchmark technologies and been the market leader in how is the heart performing. What's new here, and this was really led by our leader, Katie Szyman, is to make these technologies smarter than they ever were in the past.
Instead of them only being backward-looking, is can we create algorithms that look at the history here and be predictive of what you might see in the future. Give clues to the anesthesiologist or the intensivist that, "Hey, you might be headed for a low blood pressure situation," which is dangerous, and to give them 10, 15 minutes notice that they can act on it before it happens. We think this is a game changer for these clinicians and one of the ways that we add value. We have new monitors, we have new disposables, and new algorithms that support that. This is an aggressive practice that we're moving forward. Let's get into the numbers a little bit.
2022 had its share of challenges from an environmental perspective, but we look back at it and say, "Hey, it was a pretty good year." We had growth prospects that were double-digit, and, you know, we fell a little bit short of that, but we still were a pretty healthy growth company in 2022. We're pleased that we made progress on a lot of our longer term important regulatory approvals and milestones. This was something that really wasn't seen by others, but we got RESILIA approved to apply on our transcatheter aortic valve, and that we think is gonna be a very important innovation when those customers and those patients are demanding more durability than ever before.
We've got our PASCAL system that got a CE mark and U.S. approval and our mitral RESILIA valve in the surgical products also approved. Some real nice approvals and at the same time achieve important clinical milestones. We just stayed aggressive investors. We didn't pull back because of the pandemic. We didn't pull back because sales fell a little short. We stayed aggressive in terms of investing in the future. It's not our intention to update our guidance at all associated with this. We were just in front of investors at our investor conference in early December, and we'll be reporting our results here by the end of the month. In 2023, we expect it to be a year of strong growth and continued year of investment.
We expect our sales to grow in the 9%-12% range. What's gonna drive that? Well, some of it is gonna be continued improvement in the environment. We think some of the challenges like staffing for hospitals and just the overhang from COVID will gradually improve during the course of the year. At the same time, being able to have RESILIA tissue and TAVR, we think is very meaningful. Being able to launch our Precision PASCAL product at this point is gonna be very meaningful, and we also expect to have an approval for our EVOQUE tricuspid replacement valve by the end of the year. In surgical, we continue to gain share and advance our products that are based on RESILIA. This is the INSPIRIS valve in the aortic position and the MITRIS valve in the mitral position.
In critical care, we continue to march ahead with this, what Katie would call smartifying our portfolio, to have these advanced products that are more predictive and more helpful to clinicians than ever before. When we look further ahead, and we look, say, five years from now, we believe that the market opportunity is gonna approximately double from where it is today. It'll be approximately a $20 billion opportunity versus the $10 billion that Edwards probably faces today. Why do we think that's gonna happen? We think that the TAVR opportunity will approximately double. We think the transcatheter mitral and tricuspid, which is very small today, is gonna increase to $5 billion and growth in critical care and surgical as well. We're very optimistic. This sort of translates to a low double-digit compound annual growth rate, if you will.
Of course, it won't be a straight line. It'll be bumpy for all the reasons that you know when you're an innovator. But 2028, we don't think is anything close to peak sales. As a matter of fact, many of the things that Edwards is working on today, won't really bear fruit by 2028. Things like the moderate aortic stenosis trial, it'll just be reading out by 2028. If that's a successful trial, that'll be a significant driver of growth beyond 2028. We think that transcatheter mitral and tricuspid repair will be pretty mature by 2028, and there will be some replacement by 2028, but the replacement won't be near peaking at that point, and that'll be a big opportunity.
We think there's a way to apply Edwards' know-how and skills related to transcatheter technology and interventional, if you will, to treat heart failure that we're not doing today. We don't have more to share on that one, but we think all three significant opportunities for the future. Just to summarize, I am gonna be stepping down from the CEO role, but I have a tremendous amount of confidence in our executive team, our leadership team, and the talent across Edwards. They're very driven. We have a pipeline like we've never had before and an outlook like we've never had before. This idea that we have large populations of patients that are untreated is very attractive, and no one focuses like we do.
We've got a track record of credibility in which allows us to move forward with our innovations in a very positive fashion, already having some credibility in that. We've got this incredible culture of patient centricity, where our people really do care about patients first. We may get positions as well for durable success. I'm really proud of our R&D team. We're able to attract some of the best and brightest from around the world because they wanna go after big, bold innovations, and they wanna be patient-focused, and so allows us to bring incredible talent in. Finally, when we get that right, we don't have to worry about growing the company through acquisitions and all that. We can do it organically.
We think we're gonna create enough innovation that we'll be able to have good, sustainable, solid growth for a long period of time. It gives me a lot of confidence. With that, I'll conclude. I'll invite my partners, Bernard Zovighian, who is just recently named the President of Edwards Lifesciences, who's gonna become the CEO after our shareholder meeting in May, and Scott Ullem, our CFO and more, and we're happy to take questions.
Great. Thanks, Mike. maybe I'll kick it off, Bernard. A question for you. you're a newer face to a lot of investors.
Mm-hmm.
I thought it'd be good to start off with your thoughts. You know, what do you like that Edwards was doing before you came in? Anything you wanna do differently as the new CEO?
Yeah, no. Thank you so much. Good morning, everyone. Great to be here. Look, you know, first, you know, I'm very confident about, you know, this transition. You know, I have been with the company eight years. You know, Mike and I have been working together. We know, you know, each other, you know, very well, and it is an amazing company. You know, very, it is, you know, well-run. You know, we have this very unique, you know, strategy. We care about innovation. We care about the patients. You know, very often people ask me, "Are you going to make any changes?" I'm saying, you know, for now, you know, no. You know what? You know, I like, you know, what we have. We have an amazing executive team. We know what we are doing.
At the same time, you know, I'm going to be, you know, very vigilant about, you know, the environment. If we need to make some changes, you know, down the line, you know, for sure, you know, we will do it.
Great. You know, when you look across the business, it's obviously TAVR has been the big growth engine, and TMTT is coming up and probably, if not the future, a big part of the future. You know, how are you, as the incoming CEO, how are you thinking about prioritizing investment within Edwards? Do you agree with what I just said, and anything you would add to that?
For sure, Robbie, I will start with, you know, we have, you know, four businesses. You know, critical care and surgical are, you know, big businesses, very successful businesses. We are investing, we are innovating, we will continue to do that. It is super important, you know, to the patient we serve. TAVR today is the biggest, you know, business within the company. It has a lot of potential in the years to come. TMTT, you know, we started this franchise about five years ago with the vision to change our practice of medicine. We made a lot of progress. We have a lot of confidence, and there is a lot to do, but yes, you know, TMTT is going to be, like with TAVR, a major growth driver for the company.
I agree with you that structural heart is a huge opportunity for the long run. It has run into some difficulties over the past year as staffing's been a challenge and COVID disrupted some of the top of funnel for patients coming in. I saw on the slide you're not updating guidance today. I just wanna make sure you typically don't pre-announce here, but are you guys still reaffirming the guidance? Is that one way to read it?
We're not updating guidance. We'll tell you the whole story about the fourth quarter in three weeks from today at our fourth quarter earnings report.
Maybe if I turn to 2023, you did guide to 9%-13% sales growth for the company.
9%-12%.
9% to 12%, sorry. you know, anything that you've seen since the Analyst Day that maybe gives you a little more confidence in the growth rate? Have any trends changed or any environments improving or not improving around the world?
I mean, look, obviously, there's been a lot going on, We had a holiday break and everything in between, No, we're not gonna talk about the week to week since four weeks ago when we had our investor conference in New York. We'll take everybody through what's been going on three weeks from now on our January 31st fourth quarter call.
If I turn maybe to some of the new product launches, SAPIEN 3 Ultra RESILIA a couple of months out in the market, maybe you could talk about the feedback you're getting from the clinicians. You know, is it the reception that you were hoping for? Do you think they're buying into the durability of the valve that we've seen with RESILIA on the surgical side?
I'd be happy to comment. Again, Robbie, it's tempting to give a mid-quarter update, and we're not gonna do that, but our premise.
Qualitatively.
Yeah. No, our premise going into this was, this truly was more valuable and that we were going to do a little bump on our list price. We were gonna also continue to offer our ultra valve for people that didn't wanna step up to the Ultra RESILIA. Those conversations are going on right now. We feel pretty good about our strategy, and we have from the beginning. We think people will see the value in doing that. In terms of the pace that that moves at is very hard to predict. You know, again, customers also have the option of using volume to be able to get discounts. That could be another way that they handle with the change to RESILIA. Yeah.
Maybe if I look at the TAVR market longer term, you're doing the EARLY TAVR trial. You're also looking at more moderate patients. Right now, severe aortic stenosis and then moderate aortic stenosis. What work do you think Edwards is gonna have to do, assuming the trials are positive to drive utilization in those patient populations? Do you think clinicians are already willing and able to buy into that? Do you think there'll have to be a heavy lift on your part to get guidelines changed and really drive it from the ground up?
Yeah. I'll start, and others can jump in here. I think it's a gradual process, and I think multifaceted on our approach. We're gonna need to be diligent. Some of this is almost generational, where people were trained one way maybe 30 years ago when they went through their training, and they're retiring now, and the new people coming in are very well aware of the attractiveness of the TAVR options. Some of it is the fact that we're going directly to patients with things like direct-to-consumer, awareness that we've never had in the past. Some of it are things like our partnership with American Heart Association. They've tackled issues like ours in the past, like, they call it Get With The Guidelines.
For example, the Door-to-Balloon campaign, where they said, you know, you better get from the time you hit the hospital door till you have a balloon, it needs to be under an hour. They were able to drive change across the system. It took a few years for that to happen. It's become commonplace. We're partnered with them on a program called Target: Aortic Stenosis to do something very similar in the U.S. hospitals. We're starting to generate data. It'll be multifaceted, Robbie. We're convinced that we're gonna be able to make progress.
I'll just add to that. The evidence does a lot of the heavy lifting. The reason we invest so much in these pivotal clinical trials, this year we'll invest 17%-18% of sales on R&D, is because the facts matter. Facts take the emotion out of change. There's other work to do to make sure that those get communicated. It's an important part of what we think our long-term growth strategy is gonna be built on.
We're going to see some new competitors on the TAVR front coming into the U.S., so with new products, new competitors, but you already compete against pretty much all of them outside the U.S. right now. You have been doing very well holding share, and the competitors are fairly small market share, 10%, 15% or so. Do you think that's a good proxy to think about how you'll compete against incremental investors in the U.S.?
You know, the short answer is yes. We have a little experience with this. As you know, we introduced TAVR in Europe in 2007, we've had a chance to see, is Europe a reasonable proxy and predictor of what might happen in the U.S.? I think by and large, it's true. Not, not 100% because the U.S. is more selective in terms of their approval. You don't see so many small companies able to get U.S. approvals. We have a full complement of competitors, for example, in Europe. Besides us and our other major competitor, the rest of the companies, I think, account for maybe 15% share of the total marketplace. We wouldn't be surprised if it shaped up in a similar fashion in the U.S.
If I switch gears to the TMTT platform, correct me if I'm wrong, but Edwards is the only company with a late-stage platform in both repair and replace and mitral and tricuspid. One, I just wanna make sure that's right. Two, how important is it to have this toolbox approach? I know we've been hearing about it for years, is that something that you really do believe in?
Yes. You know, we do believe it is important. You know, this patient population is very diverse, very complex, you know, with, you know, different anatomies. We believe that if we want to treat all of these patients, we need, you know, repair and a replacement for mitral and tricuspid. You know, we have, you know, we have gotten a lot of learning in the past, you know, five years. We feel very confident about, you know, the technology we are having. We are running five, you know, randomized, you know, pivotal studies right now. You know, one, you know, was presented at TCT and published, you know, around, you know, the same timing. You know, more to come here. We are, you know, deploying our high touch model in the field, and we see that.
You know, physicians are telling us, "Yes, you know, these patients are different. They are complex. They are very diverse, and we need multiple therapy to treat, you know, all of them.
Yeah. Maybe for you, Scott, or whoever wants to take it. On, you spend a lot on R&D, and you've produced some great bodies of work and clinical evidence and driven the field. How much longer do you think you're gonna have to spend at such a high level as a percentage of sales? Do you think we're coming close to maybe seeing some more leverage in R&D, or should we expect that to continue for the foreseeable future?
Yes and no. We're gonna keep investing aggressively, and one of the things that's really core to our strategy is relentless innovation. Innovation both in research and development and in clinical trials. It's just an important part of what's been driving our success and will continue to drive our success in the years ahead. At some point, the numbers get big enough that the ratio of R&D to sales may come down, but it doesn't change the strategy of being aggressive investors in a way that other companies in this space are not.
How big a competitive advantage is that? I look at all your peers out there, and I don't think anyone possibly could be spending anywhere close to you in structural heart.
Well, I think it's an advantage. It's what's helped us carve out the position we're in right now, where we've got an excellent product portfolio with a long pipeline of next-generation products and a lot of evidence to back up those technologies. It's important. We're also commercial investors. We need a return on those investments, and we think carefully about where we are making investments, and where we're gonna be able to really treat patients, help a lot of patients, and benefit all the other constituencies along the way.
We've seen with capital allocation in the past few years, more of a bias towards share repurchase rather than M&A. You know, we hear most large cap med tech companies talking M&A, M&A, M&A. Edwards we hear less from. Do you think there are areas out there that are worthwhile for M&A that would be complementary to your business?
Oh, for sure. We're actually very active on the business development front. In fact, our partner, Don Bobo, who runs corporate development of business strategy for Edwards is here. We do a lot of investing early stage. We partner with clinicians, we invest in early-stage startups. Most of these investments are companies that are pre-product approval, sometimes pre-product. We're gonna continue to be active. We have a good position of having more cash than we can probably use to satisfy those investment opportunities because we're gonna stay focused, and we think the opportunities in structural heart are so significant.
Just wanna poll the room. Any questions? No. All right. Maybe, one last one here as we're moving out. As we look across the world with surgical trends and maybe a potentially difficult economic environment, do you see any changes to, and I'm thinking more outside the U.S., government's willingness to pay for structural heart given, it is a pricier device?
Yeah. Actually, we think there's a greater correlation to. We see consistently when the economies improve and GDP per capita grows, the spending on healthcare grows along with it. As the world gets bigger and stronger, which it's consistently done, there become even bigger investors in healthcare. We have a pretty strong team that generates global economic data. When you look at the bang for the buck for what we do in structural heart disease, we're happy to compare that to almost anything else that they spend money on in their system. We like the way that the future shapes up in that regard.
All right. Great. Maybe we're about out of time. Maybe we can end it there. Thanks a lot and thanks everybody.
Thanks all for your interest and your time.