Top-line Growth and Segment Performance
Q4 revenue of $361M, up 9.5% on a constant currency and organic basis; full-year cardiopulmonary revenue $785M, +13% YoY; cardiopulmonary Q4 revenue $207M, +10% YoY; epilepsy full-year revenue growth 6% and Q4 epilepsy +9% YoY with broad regional strength (Europe & RoW +17% Q4; U.S. epilepsy +8% Q4).
Adjusted Profitability Expansion
Adjusted operating income rose to $64M in Q4 from $56M a year ago; adjusted operating margin improved to 18% from 17%; adjusted diluted EPS $0.86 vs $0.81 in Q4 2024.
Strong Cash Position and Debt Reduction
Cash balance of $636M at year-end vs $429M prior year; total debt reduced to $377M from $628M year-end 2024 (including early repayments and convertible note repayment).
Free Cash Flow and Guidance
Full-year 2025 adjusted free cash flow $183M vs $163M prior year; 2026 guidance: revenue growth of 6%–7% (constant currency), adjusted diluted EPS $4.15–$4.25 (~8% growth at midpoint), adjusted FCF guide $160M–$180M (includes assumptions noted).
Epilepsy Reimbursement and Clinical Momentum
Medicare provider reimbursement for VNS Therapy increased ~48% for new patient implants and ~47% for end-of-service procedures effective 1/1/2026; CORE VNS (800 patients) delivered compelling, durable results reshaping clinical perception and supporting expanded access.
Regulatory and Innovation Progress
FDA approval received for cloud-based digital health platform (foundation for Connected Care); OSPREY 12-month OSA dataset imminent; modular PMA on track with expectation of clinical trial device PMA in H1 and MRI-compatible supplement to follow.
Product Adoption and Commercial Levers
Essence represented ~55% of annual HLM placements in 2025 with a target of ~80% by 2026; cardiopulmonary consumables grew mid-teens in Q4 and low-teens for the full year driven by market share gains, procedure growth and pricing.
Strategic Investments and Future Launches
Design freeze completed for next-gen oxygenator (moving to scale-up); planned launch timeline for next-gen oxygenator ~2028; limited market rollout of clinician portal in 2026 and full digital/BT-enabled epilepsy generator launch planned for 2027.