Edwards Lifesciences Corporation (EW) Earnings Call Transcript & Summary

Welcome, everyone. I'm Robbie Marcus, the medtech analyst at JPMorgan. I'm very happy to host for our next session Edwards Lifesciences. We're going to start off with the presentation by Mike Mussallem, the CEO. We're going to follow up with Q&A. And Scott Ullem, the CFO, is going to join us there. For those of you who this is your first session, go to the JPMorgan healthcare conference web book, and you can find the slides available for download. And Mike will be calling out slide numbers. You can follow along. There's also an ask a question feature. So feel free to submit a question. It goes directly just to me, and I can ask it for you in the Q&A session. And then feel free to always e-mail me or Bloomberg, chat me, and I can ask your questions for you. So with that, Mike, I'm going to turn it over to you, and I will follow up with Q&A afterwards.

All right. Well, thank you, Robbie. We always enjoy the JPMorgan healthcare conference, and this year is no exception. Before we dive in, I'd just like to point out that we'll be making some forward-looking statements that have risks associated with them and are based on estimates and projections. We also use non-GAAP financial measures to help provide clarity. There's additional disclosures and reconciliations that can be found in the presentation that I'll walk through today, and it's also available on our Investor Relations website. So with that, let me start with our credo. Edwards Lifesciences was established 20 years ago. And at that time, we committed to living the values outlined in our credo. I'm extremely proud to say that our employees continue to do that every day. It's our rock, and we keep it in mind with everything that we do. Our credo closes with the statement: helping patients is our life's work, and life is now. And what that signifies is the focus and urgency of our work. And even with our successes, we know that there are still many underserved patients. They need help, and they can't wait. It's what motivates us every day, and this focus remains central to our long-term success. Now for those of you who are newer to Edwards, I want to provide a brief overview of who we are, which you can see summarized on Slide 5. Our employees are at the center of our company. They are the key to our success. We have an extraordinarily diverse and talented team who share the same focus on helping patients. As the global market leader in our field, we're a critical member of the health care infrastructure. And even during this pandemic, we have never stopped. This is especially noteworthy for those in our supply chain and those who support patient treatment in hospitals. Our patient-focused innovation strategy is unwavering. It's a differentiated strategy and one that guides us regardless of the environment or geography that we're operating in. One of the unique aspects of our strategy is the focus. At a time when medtech companies are diversifying, Edwards has remained laser-focused on innovations for structural heart disease and critical care monitoring. There's an incredible amount of growth possible within this space as these patients are vastly underserved. By staying focused, we're able to bring our decades of experience and clinical knowledge to better understand the patient's journey and advance potential solutions. The other key element of our strategy is bold innovation, and we're pursuing a rich pipeline. We are focused on innovations that change the practice of medicine, supported by rigorous clinical trials and achieving best-in-class outcomes. We know this change does not come easily and must be backed up with big evidence. And finally, leadership is the third key component of our strategy. We think that when you go first, you have the opportunity to learn faster and get a seat at the table with thought leaders. Simply put, you're a key contributor to shaping the way that value gets created. This strategy has delivered results for many years. In an unpredictable year like 2020, we're pleased that as we indicated at our investor conference, the fourth quarter was trending higher than the third quarter and approximately at the same level as 2019 when we had impressive sales results. We're not updating our guidance and plan to announce our fourth quarter results on January 27. Looking ahead to 2021, we anticipate return to strong mid-teens revenue growth. Furthermore, we believe that we're on track to achieve our long-term $10 billion-plus global market opportunity for TAVR and TMTT. This consistency of growth demonstrates how much patient demand exists for the work that we do and the power of the triple win: those innovations that extend life, improve the quality of life and are more efficient for the health care system. This is an inspirational goal and the ultimate payoff for our long-term investments. Now I'll spend a minute on each of our 4 businesses. The largest business at Edwards is transcatheter aortic valve replacement, or TAVR. This therapy has continued to grow rapidly in the years since it was first introduced and has truly distinguished itself from other medical innovations. Looking back at 2020, we celebrated some exciting TAVR milestones that directly benefited patients. More than 100,000 around the world were treated with SAPIEN valves. We received approval for TAVR-in-TAVR and updated bicuspid labeling. And we also introduced SAPIEN 3 in China, distinguishing Edwards as the first global company to offer TAVR in that country. We're proud of this leading platform, and we anticipate the double-digit compounded annual growth rate will continue in TAVR for the foreseeable future. As a matter of fact, we think that this will be more than a $7 billion opportunity by 2024 with more growth beyond that. Now to achieve that growth, we're focused on executing our threefold strategy: expanding indications with groundbreaking trials; increasing awareness and treatment rates; and finally, continuing to innovate with breakthrough technology. Slide 11 highlights 2 important examples of our strategy to expand TAVR indications with groundbreaking trials: early TAVR, which we are currently enrolling; as well as a trial for moderate aortic stenosis. We talked at our recent investor conference about our early TAVR trial, which focuses on asymptomatic patients. We're optimistic that we can complete trial enrollment of this trial in 2021 and potentially change how patients with aortic stenosis are treated by treating them when the disease is diagnosed as opposed to waiting for symptoms. Beyond that, we're looking to start a trial for moderate aortic stenosis. Rather than wait until patients are severe, we think that treating them earlier when they have moderate disease might be more effective. Studies have shown that patients with moderate AS have a high frequency of cardiac damage associated with their valvular heart disease. Waiting too long to treat these patients could result in cardiac damage that's unable to be reversed. We're very excited about starting a moderate AS trial, and we anticipate being able to get an FDA agreement to begin that trial in 2021. Now turning to our TAVR technology on Slide 12. One of the challenges of developing our next-generation platforms is how well our current platforms are working today. We enjoyed 99% freedom from death and disabling stroke at a year in our low-risk trial. Next-day discharge is very routine, and we have a low pacemaker rates with preserved coronary access. We believe that all of these features are very important, and any platform we develop in the future has to maintain those attributes. So where do we look for opportunities? Well, one is paravalvular leak. Although we have eliminated moderate and severe to a large degree, patients still have mild PVL occasionally, and we need to be able to address that. We think there's an opportunity for us to virtually eliminate mild PVL. We also believe there are opportunities to simplify the procedure to make it more forgiving and actually make it easier for patients to go through the screening process. Today, our TAVR portfolio consists of SAPIEN 3, SAPIEN 3 pulmonic and SAPIEN 3 Ultra. We're also very excited about our next-generation TAVR valve, SAPIEN X4. And beyond X4, we have a revolutionary new TAVR platform that's currently under development. Now turning to transcatheter mitral and tricuspid therapies, or TMTT. We continue to view this opportunity as one with substantial unmet patient needs and the potential to drive significant growth. Our focus is on the advancement of 3 key value drivers, which we believe are the leading indicators of our success: a portfolio of differentiated technologies, positive results from rigorous pivotal trials and favorable real-world clinical outcomes. We are guided by our vision to lead and transform the treatment for patients with mitral and tricuspid valve disease with the goal of changing the practice of medicine. This means more patients diagnosed and treated with earlier referral by a general cardiologist who has access to a full toolbox of treatment options. It also means patients treated in less than an hour who can return home the next day with no complications. We believe with a portfolio of products, we can make a big difference. And we think this opportunity, which is still small today, will be a $3 billion opportunity by 2025. And we think that's just the beginning. Slide 14 provides an overview of exactly who we hope to treat with our TMTT therapies. And as you can see, this is a diverse and complex group of patients in need of better treatment options. Leaking mitral and tricuspid valves are often associated with heart failure for multiple reasons. The prevalence is larger than aortic stenosis. So there are a lot of patients. In fact, more than 10% of the people in the U.S. over age 65 suffer from moderate or severe MR or TR. The quality of life for those patients is also heavily compromised. And after 1 year, the mortality rate is almost 20%. That's why we believe that we have a very exciting vision to transform patient care and why we believe we need the portfolio to do that. Using a catheter-based solution, we're focused on providing effective, simple, safe and repeatable procedures. We have a very large team that's completely focused on realizing this mitral and tricuspid opportunity. Now turning to Slide 15 and our portfolio of differentiated TMTT therapies. We're building a comprehensive offering of mitral innovations, including leaflet repair with PASCAL, annular reduction with Cardioband and 2 transfemoral valve replacement therapies with SAPIEN M3 and EVOQUE. Late last year, we added PASCAL ACE. This new implant has a narrower profile in spacer, providing physicians the ability to achieve optimal outcomes for more of their patients. In 2021, we expect to introduce a new innovation, our next-generation delivery system, followed by a regular cadence of regular advancements or additional advancement for the years to come. Tricuspid disease is even less understood than mitral, and we know it is very prevalent. Treatment is limited mostly to medical management with patients experiencing high mortality and a very poor quality of life. With our 3 tricuspid platforms, PASCAL, Cardioband and EVOQUE, we are very well positioned to learn rapidly and transform how patients will be treated in the years to come. Our early experience with transcatheter tricuspid therapies is very promising, and we see a large emerging tricuspid opportunity. Now we know that if we're going to change the way that medicines practice, we need to do it with big clinical evidence. And that's why we are currently enrolling 5 comprehensive pivotal studies, including 3 for PASCAL, as you can see on Slide 16. And we anticipate the enrollment of the PASCAL CLASP studies that are going to continue to ramp up, and we're still targeting U.S. approval of PASCAL DMR in late 2022. In addition to PASCAL, we're also very focused on evidence generation for our portfolio of replacement valves, SAPIEN M3 and EVOQUE. Our extensive experience with a SAPIEN in the mitral position gives us confidence as we continue enrolling SAPIEN M3, the ENCIRCLE pivotal trial. We also are building positive early evidence with EVOQUE tricuspid to initiate the TRISCEND II randomized pivotal study based on the FDA's breakthrough pathway designation. We know that it's evidence that makes the difference. And to us, getting great evidence is even more important and a value creator than early sales. Now switching gears. Edwards was established over 60 years ago as a pioneer in open heart surgery. For many patients, surgery is going to be the best option, and we have many innovations available for these patients, which can truly be life-saving. We believe the current $1.8 billion surgical -- structural heart market will grow mid-single digits through 2026 driven by increasing cardiac procedures as the global population ages. Furthermore, surgical mitral market continues to grow, bolstered by increased diagnosis, awareness and referrals of this undertreated disease. We extended our surgical leadership with 3 new product launches in 2020. And we have more launches planned for 2021, including our new surgical mitral valve. We're committed to bringing life-saving innovation to patients best treated surgically. One of the products that's contributing the most to our surgical structural heart portfolio is our flagship surgical aortic valve INSPIRIS. You'll see that on Slide 18. I'm pleased to say that INSPIRIS is now the leading surgical aortic valve in the world, featuring our proven valve design, RESILIA tissue for enhanced durability and our unique VFit technology, which enables the valve diameter to expand for future potential transcatheter valve-in-valve cases. These features make INSPIRIS the valve of choice for younger, more active patients who want to continue to live life to the fullest without the burden of anti-coagulation. We're encouraged by the growth in adoption of INSPIRIS in the U.S., Japan and Europe and are eager to launch in China in 2021 to extend our patient impact. Our second RESILIA offering is KONECT, the first preassembled ready-to-implant aortic tissue valve conduit. Launched in the U.S. earlier this year, just this past year, KONECT is built on our trusted valve design with RESILIA tissue. We have roughly 7,500 patients in the U.S. undergoing this procedure each year, and KONECT addresses a key unmet patient need and should contribute to 2021 growth in the U.S. Our third offering in the RESILIA family is our new mitral valve MITRIS. MITRIS features our trusted valve design as well as several ease-of-use advancements and compatibility with minimally invasive approaches. We'll be launching MITRIS in the U.S. and Japan in 2021, and we'll continue to extend our leadership. Beyond MITRIS, we aspire to transform how surgical mitral repairs perform with HARPOON. We estimate there are approximately 20,000 patients across U.S., Europe and Japan who received this surgical treatment that are eligible for this differentiated mitral valve repair system. And finally to Critical Care, where we are pursuing innovative sensors along with artificial intelligence that can truly improve decision-making when it matters the most. We have a long history of being the leader in hemodynamic monitoring. And our current offering, Smart Recovery, is about providing advanced hemodynamic monitoring information to help clinicians make better decisions for their patients. In turn, this reduces complications and help patients get home to their families faster. Our Smart Recovery sensors are less invasive. And our latest Acumen IQ sensor enables our artificial intelligence algorithms. There are approximately 14 million patients today that could benefit from Smart Recovery, but the majority of these patients are currently only receiving core monitoring through arterial lines. As the leader, we believe we'll be able to increase the adoption of Smart Recovery from approximately 5% today to 15% by 2026. We see a significant opportunity here. Now as you can see on Slide 21, we're taking a multistep approach to increase the number of patients who could benefit from Smart Recovery products. These building blocks focus on having the right technologies deployed, generating clinical evidence and creating awareness that leads to adoption. The first step is the right technology, which includes our HemoSphere platform; our leading sensor technologies that I mentioned earlier; and finally, the software that incorporates algorithms with artificial intelligence. The second focus area in our Critical Care business is expanding the body of clinical evidence. Earlier this year, JAMA published the HYPE randomized trial, which showed a statistically significant reduction in the duration of hypotension when clinicians use HPI software. And finally, we believe the increased evidence around hypotension will drive greater awareness among both patients and physicians. Now I'll briefly transition to our financial outlook. We know that Edwards is valued on the outlook for a bright future. And while we expect the pandemic to have a lingering impact on the global health care system, we remain very optimistic about the year ahead. In 2021, as we indicated at our investor conference, we expect sales between $4.9 billion and $5.3 billion, representing mid-teens underlying sales growth on a year-over-year basis. Our 2021 guidance assumed COVID would continue to stress the global health care system at least through the winter with a strong year-over-year recovery later in the year. This expectation included several considerations. First, the COVID impact lessens as we come out of the winter, consistent with the normal influence of seasonality. Second, effective vaccines become widely available by mid-2021. And finally, we believe hospitals are continuing to improve their ability to treat non-COVID patients who need care for structural heart conditions such as aortic stenosis. So over the next 12 to 18 months, we see numerous opportunities to drive shareholder value, including exceptional sales growth, highlighting the importance of treating these structural heart patients even during this pandemic; progress on expanding large underappreciated and underserved transcatheter opportunities; strong tailwinds from groundbreaking clinical trial results and clinical trial expansions; and a rich pipeline of bold innovation. Our aggressive R&D spending allows us to fuel this progress, which we will demonstrate through the achievement of significant milestones. And with that, I want to thank you again for taking the time to learn more about Edwards. Putting patients first has never been more important than it is today. As we stand together with the global community, I'm grateful for our extraordinary partners and team, and I'm optimistic about the future of delivering innovations to even more patients around the world. We hope you came away as enthusiastic as we are and confident that we are positioned extremely well for a long-term value creation built on a track record of credibility and trust. Our patient-focused culture drives everything we do and motivates our 15,000 employees around the world every day. Large populations of patients that we're focused on are underserved. Our innovative R&D targets breakthrough therapies that drive strong organic sales growth and exceptional shareholder returns. So Robbie, I'll turn it back over to you, and I think we have some time for questions. I'd also note that Scott Ullem, our CFO, is in the studio with me and available to answer questions that you may have as well.

Yes. Great. Maybe we could start off with a little bit of everyone's favorite topic, which is COVID-19. And it's amazing to me that a procedure that has such clear benefits for patients, life-saving benefits in a highly deadly disease would see such an impact throughout 2020. And I realize there's a lot of logistics and testing that go into getting a TAVR patient into the hospital screened, identified and ultimately implanted. But what's really the biggest headwind here that's going on right now? And maybe a follow-up question to that is at the Analyst Day earlier in December, you tapped down your expectations for fourth quarter a little bit from -- to flattish from up a little bit. Do you still stand by that now coming with the full quarter behind you?

Yes. Thanks, Robbie. You said it well, and I'll ask Scott also to help jump in on this one. But if we reflect on what's happened during this pandemic, when this all hit in March and April, the reaction of the health care system was extreme. They pretty much emptied their hospitals, emptied their ICUs and prepared for the surge. And they were relatively indiscriminate in terms of the procedures that they stop. They basically stopped all procedures. I think in hindsight, and I spent a lot of time with leaders around the country and around the world on this, they say, "You know what? We need to do better than that. We can do better than that. We need to find a way to treat COVID patients and those that really need life-saving procedures like our aortic stenosis patients." And so since that time, it's been getting gradually better. So Q3 better than Q2. We predict Q4 is going to be better than Q3. So having said that, things have gotten better. But it still is a really hard time on these patients because not only do we worry about them coming in for a procedure, but it takes some time to get ready for that procedure, getting diagnosed, getting worked up takes multiple visits to the system. And patients get cautious about that during this pandemic. And so as the pandemic subsides, even though logic says, boy, you should treat these patients and they are being treated more than they used to, it's still a headwind for us as we move ahead. Things are not pretty out there. We're not changing our guidance, so we're standing by what we said. It's going to be a tough winter. We're in some of the darkest times right now, I think, as a health care environment. But that's -- that was somewhat expected. We really expect the page to turn on that. At some point here, we really think come spring, come summer, there are going to be a substantial turnaround. And so we're optimistic about 2021.

Just in terms of numbers, Robbie, you pointed out correctly that back in October, in our third quarter earnings call, we said that we expected fourth quarter sales to approximate third quarter sales growth, which is about 3.7%. And then at the investor conference, we said it doesn't look like it's going to come out that way, and we expect more flattish. Certainly, nothing has improved since our investor conference. As Mike said, we're not updating guidance. We'll share what the ultimate results were for the fourth quarter on January 27.

And built into that, is there a discrepancy between geographies? Are you seeing the U.S. -- as we talk to other companies, it seems like U.S. is not doing fantastic but still a little better than Europe. Is that the way to think about what's going on in your business as well?

Yes. I think that's fair, Robbie. We have seen the U.S. system seems to be a harder hit than many of the places outside the U.S.

Got it. And so maybe walk us through, let's say, vaccines hit 50% of the patient population in June, which is what our biotech analyst is forecasting. I imagine that's a much higher percentage of elderly patients who would be more likely to get a TAVR than not. How should investors think about the barriers to getting back to full implantation? What are some of the time lines to keep in mind so that we don't just flip a switch and -- but huge third quarter numbers. That could happen, but what are the considerations to keep in mind as we do our models in '21?

Yes. Thanks, Robbie. It is an uncertain time, but we have some belief systems. And as you indicated, the patients that are most likely to get the vaccines first are those exact patients that probably Edwards serves most, the elderly. And so one of the big barriers, which is patients' confidence to enter the system, has every opportunity to dramatically improve. And so I really think that that's going to make a difference. Then the other part of this is just the stress on the health care system and whether they have ICU capacity available and ORs available, et cetera. And again, with the health care infrastructure employees being treated first, that should dramatically bolster the health care system and its ability to function. And they are smart enough to know that they should be treating these patients, and there's a real drive to do that. So I think this combination of effects says that it's going to pick up, and it's why we've indicated we think we're going to have mid-teens growth in 2021.

Got it. I'm going to jump to Scott here for a second. You gave us guidance for 2021 at the Analyst Day of $4.9 billion to $5.3 billion, which is growth in the mid-teens on an underlying basis. Clearly, there's a lot of variability, and that's your best guess as we sit here today. But help us work through the cadence of next year. Do you think The Street and its forecast appropriately captures what you were trying to imply at the Analyst Day in December?

Sure. Thanks for the question. So at the time, we also gave underlying growth rate guidance and the dollar guidance. And those 2 joined together. So a lot of this is just going to depend upon how we come out of this COVID experience. And if we come out faster, obviously, our growth rates are going to look better in the early part of the year than we had originally anticipated, and the opposite can be true as well. But the growth rates will vary significantly by quarter. So we expect the first quarter of 2021, obviously, be a lower growth rate. Second quarter, if we -- if things play out the way we think they will, should be a lot higher growth rate just given how depressed the second quarter was in 2020. And the second half of the year, we expect a gradual recovery in sales and in underlying growth rate.

Got it. And I know I gave you a lot of grief at the beginning of 2020, but it actually ended up being your most accurate guidance forecast, I think, ever in the company's history. So congratulations on that. Maybe as we take it from the top line down to the bottom line, The Street's forecasting very modest incremental EPS growth through the year, though TAVR has such a high incremental margin. So do you think that's the right way to think about cadence through the year? And just remind everyone what the incrementals are on TAVR if we want to dream positively about what you could do post-COVID?

So why don't I start by speaking about it philosophically, and then Scott can take you a little deeper on what the implications are to the results. We have purposely decided that we do not want to take our foot off the gas during this COVID crisis, that we want -- we're going to protect our employees. We have a fantastic group of people that do their work every day. And we're going to keep doing our best to advance the innovations because we believe that COVID is going to pass and there's a huge opportunity in front of us, and we just feel like it's the right thing to do. What that means is while we still have somewhat depressed sales in 2021 compared to what they might have been if we hadn't been in a pandemic, it has impact on our earnings. And we think that's a good trade-off for long-term value accretion for shareholders.

Yes. That's good. Yes. Well said. [ Are you looking ] into more details on the P&L or where were you going with that, Robbie?

Yes. And I think my next line was going to be just to close out here on the financials is down the P&L, you gave us some metrics at the Analyst Day. But there is still a lot of puts and takes. People's models are bouncing around as we try and adjust for all the variability in 2020 and some of the nuances of '21. If you could just help us understand some of the puts and takes down the P&L that we should keep in mind in the models.

Sure. Let me just go through it and then let me know if I'm getting to your question. So let's just start top line sales. I think the biggest influence outside operations, of course, FX, where we're expecting something like a 1% headwind as the U.S. dollar is expected at current rates weakening to benefit our top line. In terms of gross margin, there are a couple of special things running through in 2021. One is European MDR compliance, where we're continuing to make investments. And the second is just extraordinary COVID expenses like PPE and other things that we're doing in response to COVID and the impact it's having on our production environment. It's offset largely, we think, by improvements we're making and efficiency programs we have in place right now that are benefiting gross margin, which is one of the reasons why we have our gross margin guidance going up to 76% to 77% for 2021. When you get below the gross margin line, in R&D, R&D puts and takes is going to be probably largely tied to the impact that we see on sales in terms of COVID. So in other words, if COVID -- as COVID abates and lessens, we also think R&D increase should go up because we'll be able to enroll clinical trials that much faster. We've got 8 different pivotal trials enrolling right now, 5 in TMTT, 2 in TAVR and then 1 in surgical as well with HARPOON. When you get down to the operating expense line, there are a couple of things going on. One is for SG&A, we're expecting to see SG&A expenses move around a little bit as it relates to travel in particular. So travel is a little bit more than 5% of our total SG&A, 5% of our total operating profit, and that was significantly influenced in 2020 when travel came way down. It's one of the reasons why our operating margin overall on a percentage basis was pretty similar to what we thought it would be at the beginning of 2020. And then, of course, tax rate is the other one where there's some variability just based upon this accounting for stock-based options where the excess tax benefit has a pretty big impact on our tax rate. But we're right now modeling 11% to 15% for 2021.

Got it. Okay. Mike, it didn't get a ton of attention at the Analyst Day, there were a lot of different trials and products to talk about. But I wanted to try and pick your brain on the SAPIEN X4 device. What is the next frontier in TAVR? Stroke rates, at least in the lower-risk patient population, are already not perfect but pretty good. The devices are smaller and smaller, easier to implant. So what is it that we should really be looking forward to X4 that it changes the current paradigm?

Yes. So a couple of things, and I sort of alluded to it, although I wasn't very direct. We look at continued progress on improving paravalvular leak. Even though paravalvular leak is pretty good and we've gotten rid of the moderate and worse, there still is some mild leak. And so if you're -- if a surgeon did a spectacular replacement, he would basically have no leak when it was all done. And we are still striving to achieve that, and we think that's doable with some of the new technology platform. And then the further ones have to do with let's call it how forgiving the procedure is and how adaptable the procedure is in such a way that you don't have to be quite as exacting when you're working up a patient. So if you actually have more latitude when you're working up the patient and lower that burden because the system was engineered in such a way that it could accommodate more variability, you can see what a plus that would be for TAVR patients and to really take the burden down for one of the toughest parts of the procedure, which is getting in line and going through all those tests just to have your procedure.

Got it. So we're running out of time. Mike, I want to ask you one last question here that should fill up the rest of the session. And you have a number of shots on goal, whether it's in transcatheter, mitral, tricuspid even some interesting ideas in the surgical side. What's the one product that you think The Street isn't as focused on that they should be?

Yes. It's a good question. I mean I think The Street does a good job of understanding Edwards when they track us. Everything sort of begins and ends right now with [Audio Gap] Our teams in Critical Care and Surgical are continuing to innovate, and they'll have nice growth. But what's going on in TMTT is real breakthroughs. I mean these are opportunities that change the way that medicine is practiced for these mitral and tricuspid patients. And I think right now, people kind of define that opportunity based on what they see by the one product that's out there, a transcatheter mitral product. And that product is good, but those therapies could be so much better. And there's so much prevalence there that, that's the really big opportunity. I'm not sure The Street really has an appreciation for the potential of tricuspid, tricuspid's the last questions and risks associated with it. But boy, if you could help those patients they have like no answers today. So that's the way that I look at it. Again, I think The Street is pretty close on this, but we're probably more forward leaning on some of those new advancements than Wall Street is.

Got it. Well, there's certainly a lot of different shots on goal. So I'm hopeful at least some hit for the benefit of society and you and your shareholders. So with that, I want to thank you so much for joining today and really appreciate you spending time with us. Thanks a lot.

Well, thank you, Robbie. We really appreciate it, too. And thanks for all the interest in our company. We're excited about the future.

Right. Thanks, everyone.