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Edwards Lifesciences Corporation (EW)

Q3 2017 Earnings Call· Tue, Oct 24, 2017

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Transcript

Operator

Operator

Greetings, and welcome to the Edwards Lifesciences Third Quarter 2017 Earnings Call. At this time, all, participants are in a listen-only mode. A brief question-and-answer session will follow the formal presentation. [Operator Instructions] As a reminder, this conference is being recorded. I would now like to turn the conference over to your host, David Erickson, Vice President, Investor Relations. Thank you, sir. Please begin.

David Erickson

Analyst

Welcome, and thank you for joining us today. Just after the close of regular trading, we released our third quarter 2017 financial results. During today's call, we'll discuss the results included in the press release and the accompanying financial schedules and then use the remaining time for Q&A. Our presenters on today's call are Mike Mussallem, Chairman and CEO; and Scott Ullem, CFO. Before we begin, I'd like to remind you that during today's call, we will be making forward-looking statements that are based on estimates, assumptions and projections. These statements include, but aren't limited to, financial guidance and current expectations for new product approvals, benefits and launches, clinical and regulatory timelines, competitive matters, trends in therapy adoption and foreign currency fluctuations. These statements speak only as of the date on which they are made, and we do not undertake any obligation to update them after today. Additionally, the statements involve risks and uncertainties that could cause actual results to differ materially. Information concerning factors that could cause these differences and important product safety information may be found in our press release, our 2016 annual report on Form 10-K and our other SEC filings, all of which are available on our website at edwards.com. Also, a quick reminder that when we use the terms underlying and adjusted, we are referring to non-GAAP financial measures. Otherwise, we are referring to our GAAP results. Additional information about our use of non-GAAP measures is included in today's press release and on our website. Now I'll turn the call over to Mike Mussallem. Mike?

Mike Mussallem

Analyst · JPMorgan. Please proceed

Thank you, David. We're pleased to report strong third quarter performance that continue to deliver double-digit overall organic growth, driven by robust sales our innovative therapies. Total sales grew 13% on an underlying basis, which was in line with our expectations. Sales were lifted by strong global growth in TAVR and are consistent with our projection of a plus $5 billion market opportunity by 2021. We continue to aggressively pursue breakthrough structural heart therapies with the potential to drive significant future growth and help an even broader group of patients. Before we get into the product line results, I'd like to say a few words about the impact from recent natural disasters in the Caribbean and the U.S. Edwards has significant operations in Puerto Rico and the Dominican Republic, which are the principal manufacturing locations for our Critical Care products. Our Puerto Rico facilities sustained some flooding, which temporarily affected manufacturing operations there, until we resumed full production a couple of weeks ago. None of our heart valve manufacturing is conducted in those areas. Most importantly, all of our employees have been accounted for and are safe. And although a number have reported significant damage to their homes and loss of personal belongings, Edwards and our employees across the globe are generously making contributions in support of our people there. I was able to personally visit the area recently and was very inspired by our employees' resolve and eagerness to return to work so they can continue to help patients. While a number of the procedures in Houston and Florida were postponed during the hurricanes, fortunately, we believe a substantial number of these patients have since been treated. The majority of these affected hospitals have resumed normal operations, and we estimate the total impact on our third quarter sales was…

Scott Ullem

Analyst · JPMorgan. Please proceed

Thank you, Mike. I am pleased to report another quarter of double-digit underlying sales growth, which generated strong earnings per share growth. Adjusted sales were $838 million, up 13% over 2016. These results were consistent with our expectations and the typical seasonal slowdown. In addition, adjusted sales include $17 million of Germany de-stocking sales. We continue to expect 2017 to be an excellent year with underlying sales growth above our original expectation of 10% to 14%. Our operating margin expanded over 2016 and is on track to achieve attractive levels this year. Adjusted earnings per share growth was 24%. Adjusted EPS was $0.84, and GAAP EPS was $0.79, which includes the $10 million charge related to closing our small manufacturing plant in Switzerland that Mike discussed, as well as other customary adjustments consistent with prior quarters. As we previously discussed, forecasting earnings per share is less because of the new accounting for stock-based compensation. Adjusted earnings per share would have been $0.88 this quarter, based on the excess tax benefit we estimated in our guidance last quarter. For the quarter, our gross profit margin was 74% compared to 72.8% in the same period last year. This improvement primarily reflects the benefit of a more profitable business mix, led by growing sales of TAVR, as well as a favorable comparison of supply chain expenses. Partially offsetting these benefits were expenses associated with flooding from Hurricane Maria in Puerto Rico and the planned closure of our manufacturing plant in Switzerland. We continue to expand our full year 2017 gross profit margin, excluding special items, to be at the midpoint of 74% and 76%. Going forward, this is a good near-term modeling assumption, anticipating mix improvements, offset by planned capacity improvements. We'll discuss those expectations at our investor conference in December. Turning to…

Mike Mussallem

Analyst · JPMorgan. Please proceed

Thank you, Scott. We're very pleased with performance achieved across all our product lines and believe our future remains bright. Our innovative TAVR therapies continue to deliver value to patients, and our transcatheter mitral and tricuspid valve technologies continue to represent exciting opportunities for breakthrough therapies. Overall, we're confident that our important innovations will result in a continued strong outlook as we deliver valuable solutions for the patients we serve. And with that, I'll turn the call back over to David.

David Erickson

Analyst

Thank you, Mike. Before we open it up for questions, I'd like to remind you about two upcoming events. First, there is an informal Q&A with Dr. David Cohen at TCT in Denver next Tuesday. If you haven't RSVP-ed, please do so this week. Second is our 2017 Investor Conference on Thursday, December 7, in New York, which will include updates on our latest technologies, as well as our outlook for 2018. More information about this event will be available in the coming weeks. We're ready to take questions now. In order to allow broad participation, we ask that you please limit the number of questions. If you have additional questions, please re-enter the queue and we’ll answer as many as we can during the remainder of the call. Operator, please go ahead.

Operator

Operator

Thank you. We will now be conducting a question-and-answer session. [Operator Instructions] And thank you, our first question comes from the line of Mike Weinstein from JPMorgan. Please proceed.

Mike Weinstein

Analyst · JPMorgan. Please proceed

Thank you very much. I appreciate you taking the question. So, let me just touch first on the TAVR business. So, the TAVR business grew on underlying basis, 20%, 21% this quarter, 25% in the first nine months of the year and the midpoint guidance for the 20%, 25% range for the year would seem to imply about 16% growth in the fourth quarter. So, I guess one is that, is that, right? Is that what you meant to imply? Two, can you just talk about your view of the TAVR market this quarter? Obviously, the U.S. market -- U.S. business was down sequentially, which was a little bit below The Street's expectations, but the OUS business was stronger. And just how should we think about TAVR market growth clearly over the next, let's call it, 1.5 years before we potentially get to a readout on PARTNER III and how you think about the market growth for the next big catalyst? Thanks.

Mike Mussallem

Analyst · JPMorgan. Please proceed

Yeah, thanks, Mike, appreciate the question. Yeah, the math that you did around the remainder of the year sounds like it's pretty close. That was the signal that we're trying to send. And yeah, it is a correct observation that the sales growth during the course of the year is lower in the second half than it was in the first half. We're really pleased -- we were surprised a high level of sales growth in the first half, it was extraordinary from our perspective. Remember, we went into the year thinking far less. And the second half of the year has kind of turned out the way that we expected. Remember, this is a long-term growth platform. We're very pleased that this many years after the introduction, we're still growing strong. We think it's particularly remarkable outside the U.S. where we started introducing in Europe 10 years ago to be growing at 20% OUS is something that we think is pretty impressive. But broadly, we have a long-term view. We projected that we think that this market opportunity will be more than $5 billion by 2021, and we think that the results that we're putting up this year, including the way we expect was in line with that. So yeah, I don't expect that we're going to have the heavy 60% growth rates that we had just a year ago and that we're going to settle into something that's more moderate. We'll give specific guidance at our investor conference in December, but I think the way that you characterized it is accurate.

Mike Weinstein

Analyst · JPMorgan. Please proceed

Okay. And then Scott, it's probably been several quarters since you guys haven't reported a quarter and then raised guidance for the full year. Could you just maybe try and tease out some of the different moving parts that you're running through in your prepared commentary? Obviously, the hurricanes had some impact on the business, but can you just kind of run through some other items you think may be holding back earnings in the third and fourth quarter? Thanks.

Scott Ullem

Analyst · JPMorgan. Please proceed

Yes. So, we feel really good about where we are year-to-date. And we're glad that we had a third quarter that met our expectations. It's pretty lofty expectations, as Mike said, a lot higher than we originally expected to be end of the year. So, I don't think anything is really holding back our continued growth. I think that there will be some changes in the fourth quarter around gross margin. We'll get a little bit less help from FX, which will impact earnings per share. But that's in our guidance. I'm not sure it's really noteworthy. Beyond that, fourth quarter is looking pretty much the way we thought it would earlier this year, and we think we're off to -- we think we're on the right path.

Mike Weinstein

Analyst · JPMorgan. Please proceed

Okay. I’ll let some other jump in. Thank you, guys.

Operator

Operator

Thank you. Our next question comes from the line of David Lewis with Morgan Stanley. Please proceed.

David Lewis

Analyst · David Lewis with Morgan Stanley. Please proceed

Thanks, and good afternoon. Mike, I just want to start with a couple of product questions and maybe a quick follow-up. On CardiAQ, I appreciate the update. Can you just give us a general sense of this sort of reformulation of the product? What rough sense would have in terms of the delay and then the CE mark trial or assuming we stopped and you restart it. Should we be thinking more of a six-month delay to restarting that trial or 12-month? And for the December Analyst Day, is there a chance we get an update on the next-generation SAPIEN platform? And then I have a quick follow-up.

Mike Mussallem

Analyst · David Lewis with Morgan Stanley. Please proceed

Yeah. Thanks, David. We're not prepared to lay out specific CE mark timing. We should be prepared to do that when we get to the investor conference, David. The bigger point that we wanted to do today was to share with you the change of strategy in which we felt it was appropriate to implement these significant enhancements that we think are going to be really meaningful that it's important for us to jump back. Overall, I think it actually is going to collapse our time to success, the time to long-term success, although it might delay for sales, but we think that's going to be -- this is going to be a good trade-off in the eyes of investors. In terms of next-generation SAPIEN valve, I don't that we're going to get into details on that for competitive reasons. We're really pleased that we're going to be launching both the Ultra System and CENTERA here before year-end, and we think there will be a lot of customer excitement around that. And as you correctly identified, we are working on next-generation systems that could be even more exciting, but we're probably not ready to share that yet.

David Lewis

Analyst · David Lewis with Morgan Stanley. Please proceed

And then Mike, just want to come back to the U. S. market dynamics again. Obviously, you try to quantify what the hurricane impact was and it seems sort of minimal, but given the fact that other companies that have reported so far, their earnings have actually shown some rather weak U.S. utilization numbers and each quarter for Edwards in the U.S. market has not been particularly predictive of, let's say, the next quarter from a sequential growth perspective. Is there anything from a share perspective or utilization in certain accounts or the rate in which accounts came on board here in the third quarter that surprise you in any way? Thanks so much.

Mike Mussallem

Analyst · David Lewis with Morgan Stanley. Please proceed

Yeah. Thanks, David. I think that, that share positions have continued to be pretty consistent, pretty stable, both inside and outside the U.S. compared to a quarter ago. So probably not a lot of news from that perspective. The competitive dynamics probably haven't changed quite as much as we thought they might that could still be in our future. In particular, that -- we noted that the exit of Lotus from the marketplace probably didn't help us very much. It may have helped our competitors, but I don't know that there's a lot of other dynamics that are going on. We feel like the market is still growing nicely and that we're pretty much growing in line with market growth.

David Lewis

Analyst · David Lewis with Morgan Stanley. Please proceed

Great. Thank you very much.

Operator

Operator

Thank you. Our next question comes from the line of Larry Biegelsen with Wells Fargo. Please proceed.

Larry Biegelsen

Analyst · Larry Biegelsen with Wells Fargo. Please proceed

Good afternoon. Thanks for taking the question. Let me ask the ubiquitous 2018 question maybe a different way it sounds like Mike based on your recent comments in September, public comment you expect the TAVR and the critical-care business to grow at a similar rate next year as 2017. I guess, the question is, are you willing to talk a little bit about the contribution from mitral and tricuspid next year and big picture should we think about 2018 as a transition year before we see the low-risk data at ACC presumably in early 2019? And on the P&L it sounds like you plan to invest in a dedicated mitral and tricuspid sales force next year in Europe, which will I don't have set any leverage in the P&L is that fair? Thanks for taking the question.

Mike Mussallem

Analyst · Larry Biegelsen with Wells Fargo. Please proceed

Yeah, thanks, Larry. So, a few things. First of all, as you've correctly pointed out we're not ready to share specific guidance for 2018. You all know quite a bit about our critical-care business and our heart valve business and our transcatheter aortic business, and all those businesses have some pretty clear trajectories and I think we've been clear in terms of what we think is possible. We think they're both -- they're all going to be really nice growers and maintain their leadership. So that's that. In terms of transcatheter, mitral, and tricuspid, I don't expect 2018 to be much of a sales year. I think it's going to be a really important year in terms of us making progress toward key milestones, creating value, sort of crack the code on what's most important and laying evidence in place, so it'll be an important year, but not one that probably is going to drive sales growth. We're more focused on what kind of growth will those platforms will provide some time out, more in the mid to long term. So, you should think about it from that perspective. In terms of investments, we're always thoughtful about that. Of course, some investments are going to need to be made in advance, and, you know, we were spending pretty aggressively in R&D field resources we'll try and be thoughtful on that and try not to get too far ahead of ourselves although some of that will be advanced investment. So, I don't think you should see an overall dominant affect from that in the 2018 plan.

Larry Biegelsen

Analyst · Larry Biegelsen with Wells Fargo. Please proceed

Thanks for taking the questions, guys.

Operator

Operator

Thank you. Our next question comes from the line of Bob Hopkins with Bank of America. Please proceed.

Bob Hopkins

Analyst · Bob Hopkins with Bank of America. Please proceed

Hi, thanks and good afternoon. So just first of all just a clarifying question on the TAVR business and THV sales in the quarter because of the what happened in Germany I think there's maybe a little bit of confusion so just to be clear in the third quarter your worldwide THV sales adjusted for Germany were $498 million and that compares to on an apples-to-apples basis $510 million in the second quarter. Is that right?

Scott Ullem

Analyst · Bob Hopkins with Bank of America. Please proceed

So, Bob, its Scott. Yeah, the $498 million is adjusted for $17 million of Germany stocking, and relative to the second quarter 510 – hold on one second let me just make sure we're giving you the apples-to-apples number. Yeah, so it's $510 million also adding back the consumption of sales, stocking sales in Germany.

Bob Hopkins

Analyst · Bob Hopkins with Bank of America. Please proceed

Okay. And then just, Mike, to clarify your comments on the U.S. market, because obviously that one change this quarter was your competitor did get approval for intermediate risk, so you think that you basically held share despite that approval and that the market growth rate will be around this 20% level?

Mike Mussallem

Analyst · Bob Hopkins with Bank of America. Please proceed

Yeah, thanks, Bob. Yeah, we think that this has been pretty consistent that there wasn't a big change in share. It's hard -- it's always tough to estimate because, you know, we report out of cycle with each other. But our best estimate is that we're probably growing in line with the market and we basically factored those approvals into our guidance.

Bob Hopkins

Analyst · Bob Hopkins with Bank of America. Please proceed

Okay. And then maybe one quick comment on Japan, that's a clear bright spot in the quarter, how sustainable is that growth in your view. Just give us a sense of market dynamics in Japan currently?

Mike Mussallem

Analyst · Bob Hopkins with Bank of America. Please proceed

Yeah, the adoption in that country is still early they're continue to go add centers as we had expected and we continue to believe that right now they're primarily just treating high-risk patients, so the opportunity for expansion is still significant there. Hard for us to quantify, but we could talk about that one more in December as well.

Bob Hopkins

Analyst · Bob Hopkins with Bank of America. Please proceed

Great. Thank you very much.

Mike Mussallem

Analyst · Bob Hopkins with Bank of America. Please proceed

Sure.

Operator

Operator

Thank you. Our next question comes from the line of Chris Pasquale with Guggenheim. Please proceed.

Chris Pasquale

Analyst · Chris Pasquale with Guggenheim. Please proceed

Thanks. Mike, just a couple for you to start on the mitral program and it's been hard to tell, obviously, this year from the revenue piece of what's going on with Cardioband but you guys along the way have been making some investments to lay the foundation there. Can you just give us an update at this point of what's your European transcatheter mitral sales organization looks like how many people have you actually added this year?

Mike Mussallem

Analyst · Chris Pasquale with Guggenheim. Please proceed

Yeah, I'm not sure the exact numbers, Chris, but yeah, we have been adding people to the Cardioband organization in Europe. Maybe one of the things that's not apparent here is we believe that Cardioband not only applicable in the mitral position but also in the tricuspid position. So, in addition to our field resources and, well, all of our resources for that matter supporting Cardioband mitral cases they're also supporting Cardioband tricuspid cases and we think Cardiobond could be an important contributor there. We don't get any sales credit, no commercial cases for the tricuspid cases those are still commercial at this time. So, we've ramped up. There's probably maybe a few more resources, but basically where we want to be right now that sort of leveling out here in the fourth quarter.

Chris Pasquale

Analyst · Chris Pasquale with Guggenheim. Please proceed

Okay. And then one for Scott just following up on Larry's question about the potential to drive operating leverage next year and I know we'll get into this in a lot more detail in December. But it seems like you guys have been in investment mode of one form every year for the last several years. Are you trying to signal that you're thinking about 2018 differently from what we've seen the last couple in terms of the level of investment that's required and therefore the potential for operating leverage, or is it just shifting to new priorities as they come along?

Mike Mussallem

Analyst · Chris Pasquale with Guggenheim. Please proceed

No, we are going to continue to invest aggressively in the business especially around research and development. We've made a lot of progress over the last two years just in leveraging SG&A as we've gotten more global. We’ve continue to drive that SG&A is a percentage of sales ratio down. We're looking for opportunities to continue to get more efficient. That said, we're going to invest as Mike said in field resources to support our transcatheter mitral and tricuspid therapies, but I think overall our operating margin continues to look very favorable. It's improved over the last couple of years and it's an area of focus, but, again, primary focus at Edwards is driving top-line organic growth.

Chris Pasquale

Analyst · Chris Pasquale with Guggenheim. Please proceed

Thanks.

Operator

Operator

Thank you. Our next question comes from the line of Matt Miksic with UBS. Please proceed. Matt Miksic, your line is now live. Please proceed.

Matt Miksic

Analyst · Matt Miksic with UBS. Please proceed. Matt Miksic, your line is now live. Please proceed

Thanks so much. Yeah, I’m sorry to again mute there. Thank you for taking my question. So, I had one, Mike, and many questions here on the U.S. growth and one thing that you did mention, I don't think was -- some of the comments you made in the first half of the year was kind of surprised in terms of performance of the smaller, newer centers entering the market and expanding geographically in the U.S. I just want to get a sense if you had any comment or color on what that look like in Q3?

Mike Mussallem

Analyst · Matt Miksic with UBS. Please proceed. Matt Miksic, your line is now live. Please proceed

Yeah. We continue to have new centers joined. We probably have, I don't know, maybe a dozen new centers joined in the quarter. So, we were probably in excess now of 550 centers and we do get contribution from those. And so, we're actually seeing a contribution across the board from large centers to small. It seems as though when new centers come in, that they unlocked a group of patients that maybe weren't being seen by the centers that were already present. Maybe because people were their own networks or they just did weren't insider referral pattern that found them into a TAVR Center. So, we are getting a contribution from that. But as you can imagine, the numbers are getting large. And so, this is validates for us the under treatment that's going on in TAVR and gives us confidence that this is going to have -- quite a bit of a runway in front of us.

Matt Miksic

Analyst · Matt Miksic with UBS. Please proceed. Matt Miksic, your line is now live. Please proceed

And just to follow-on to that is from a follow-up on the market I think, there's a perception that we have an immediate risk of this last indication and now it's going to be too early 2019 before we get another catalyst in terms of data. But entering the intermediate-risk market, didn't substantially expand the number of patients it can be treated in the U.S. I'd love to get your sense as to, may not be another clinical catalyst for TAVR until early 2019, but where are you in terms of -- do you feel like penetration or is this something we would expect to quickly get through this number of patients or is this a group of patients that you expect to be kind of growing into over the next two to three years?

Mike Mussallem

Analyst · Matt Miksic with UBS. Please proceed. Matt Miksic, your line is now live. Please proceed

Yeah. Thanks, Matt. Yeah, we've tried to talk about this before. We really believe that there's a dramatic under-penetration of patients. So, when we looked at severe aortic stenosis patients in 2016 with symptoms, we felt that less than 20% were being treated. And so, we have a big opportunity. And even, though we have the intermediate risk approval it takes time for clinical practice to change it takes time for the guidelines to change it takes time for referral patterns to change and that's been happening. And overall, we're pleased we've seen some nice growth. But we're not coming close to the full potential that was unlocked with that indication let alone what's still in front of us. So, we continue to have work on that. So TAVR's still underutilized. The new data on – that we continually present. I think is very helpful in terms of making the argument and we've got some data actually coming up at the upcoming TCT where they're going to highlight the economics which will be interesting to see how contemporary economics compare to the economics that were last measured within the PARTNER trial.

Matt Miksic

Analyst · Matt Miksic with UBS. Please proceed. Matt Miksic, your line is now live. Please proceed

Thanks for the color.

Operator

Operator

Thank you. Our next question comes from the line of Jason Mills with Canaccord Genuity. Please proceed.

Jason Mills

Analyst · Jason Mills with Canaccord Genuity. Please proceed

Hi. Thanks for taking the question. Mike, can you hear about okay? I am on a cell phone.

Mike Mussallem

Analyst · Jason Mills with Canaccord Genuity. Please proceed

Yeah, Jason. Hear you fine.

Jason Mills

Analyst · Jason Mills with Canaccord Genuity. Please proceed

Super. So, start with mitral. I'm sure you've had a chance to take a look at least of course you look at intrepid Medtronic announced first patient enrollment. Perhaps, interest in your comments, just supposing the inclusion, exclusion criteria and as far as you've have a chance to really evaluate one versus the other to Cardioband and your broader thoughts on moving towards commercialization of products in the United States for a functional mitral regurgitation? And sort of how those algorithms will play out? I know it's probably hard to discern at this point, but just interested in what you learned or what observations are coming out of the commencement of both of those trials?

Mike Mussallem

Analyst · Jason Mills with Canaccord Genuity. Please proceed

Yeah. Thanks, Jason. Yeah, I'm not sure going deep into the inclusion or exclusion criteria or deep into trial design is all that insightful. But I think the portfolios themselves and the strategies are more interesting. We're going to drill deep on that when we get to our investor conference. But broadly, you can see that our competitors feel comfortable moving forward with a transapical system and we have chosen a different tack here. We really believe that transapical is going to be necessary to unlock this. And so that's going to be important. We also think that repair is going to play an important role in mitral therapies and we're pursuing a couple of technologies very aggressively there. We'll talk about exactly how that might all come together. But in the near-term, mitral is primarily a repair marketplace, and we have – there has to be some pretty impressive data presented to make the case that replacement technologies are ready to unseat them. And so, what we stay focused on is the really the long-term in terms of being able to treat the most patients with therapies and really cause the practice of medicine to change. Right now, these mitral patients just do not get treated. Surgery is not considered an interesting alternative. And until we have catheter-based technologies, which are safe and effective, it's not going to change. And we do think it's going to be a toolbox, which is why we have a full portfolio. And we are feeling very good about what we're able to see. We're on steep learning curves, so we're gathering a lot of experience with all of our systems, and that's informing our strategy. So, we'll try and paint ad more comprehensive picture when we're together in December, but maybe that's a good starter.

Jason Mills

Analyst · Jason Mills with Canaccord Genuity. Please proceed

It is. Thanks Mike. I’ll look forward to that. And then as a follow-up, on the TAVR side, going back to Mike's question initially start the call, it looks like fourth quarter sort of in that mid to high teens range, 16%, 17% but what was interesting in this quarter as you pointed out U.S. business grew a little bit slower perhaps than you may be expected in the OUS business outperformed. Do you expect that trend to hold in the fourth quarter? Do you think that U.S. will reaccelerate and perhaps grow a little bit faster than international markets? And then Scott just as a squeak-in for you gross margins your guidance seems to be prior we’re going to see a step up in the fourth quarter and I want to make sure I got that right. Thanks, guys.

Mike Mussallem

Analyst · Jason Mills with Canaccord Genuity. Please proceed

Yeah, thanks Jason. I may have sent an inappropriate signal, if I suggest that that the U.S. was below our expectations. It was right in line with our expectations. Remember when our surprise was early in the year, when we projected what we thought would happen across the TAVR world in 2017, we originally had a projection of 15% to 20% growth and that was based on growth both inside and outside the U.S. Do I think the U.S. will get slower? Well, I think there's a lot of large numbers where some of that is probably going to be likely. One of the things that is impressive is that the OUS where penetration is low is continuing to be strong, but I don't expect any certainly big dramatic changes, Jason, if that's what you're asking.

Scott Ullem

Analyst · Jason Mills with Canaccord Genuity. Please proceed

And, Jason, it's Scott. Regarding fourth quarter and gross margins actually we think that the gross margins may be under pressure in Q4 versus Q3 if foreign currencies stay at their current levels. We had a little bit of benefit from FX in the third quarter and at current rates we would probably not see that same benefit.

Jason Mills

Analyst · Jason Mills with Canaccord Genuity. Please proceed

Okay. I'll get back in queue. Thanks, guys.

Operator

Operator

Thank you. Our next question comes from the line of Raj Denhoy with Jefferies. Please proceed.

Raj Denhoy

Analyst · Raj Denhoy with Jefferies. Please proceed

Hi. Good afternoon. Wonder if I could just ask if there's any additional color you can give us on the PASCAL trial, the CLASP trial I think you told us today, where is that in terms of enrollment and when do you expect to get that product approved in Europe?

Mike Mussallem

Analyst · Raj Denhoy with Jefferies. Please proceed

Yeah. Thanks, Raj. One of the things that I might call your attention to, I don't know if you noticed that there actually was a Lancet article that was published in August about our early feasibility results in PASCAL. This had, I think it was, about a 23-patient experience and it was really a feasibility study and it walked away with a conclusion that there was impress with the high rate of technical success and the reduction of mitral regurgitation. And so, the fact that such a new technology would gain that kind of profile we think we were pleased with and we think that's relatively noteworthy and so we're today engaged in this. We think that there -- well, you should expect that there's going to be a presentation at TCT, so I think if that same Lancet group that you're going to see six-month results at TCT and you're going to see -- we'll share more about this. The trial itself is on ClinicalTrials.gov, it's more than a 100-patient trial with I think a six-month primary end point, so maybe you can certainly refer to what's on that website to give you a little more information.

Scott Ullem

Analyst · Raj Denhoy with Jefferies. Please proceed

I guess the question is more, you know, as we think about the opportunity for that product, right I mean, as you know Mike is doing several $100 million in Europe and you think about potentially getting on the market next year, is that maybe too aggressive a timeline and if when you do get there, what are your thoughts or expectations around what you can do in that market?

Mike Mussallem

Analyst · Raj Denhoy with Jefferies. Please proceed

Well, I think the time line sounds aggressive. I mean, obviously, we're going to move as fast as we responsively can move. But I wouldn't be penciling anything in at 2018 at this point. We're very optimistic about the product line. We think it is -- it's one that users are going to like. We've gotten some nice feedback at this point. But it's still early in the evolution and I think it's one that we're a little bit more data. That will be interesting to see what's discussed at TCT next week.

Raj Denhoy

Analyst · Raj Denhoy with Jefferies. Please proceed

Okay. Fair enough. And maybe I'll ask one on surgical valves, don't get asked that very often. But in terms of the new technology add-on payment for INTUITY, any thoughts around what that can due to growth for that product adoption of that product in the United States?

Mike Mussallem

Analyst · Raj Denhoy with Jefferies. Please proceed

Yeah. We're really pleased that we got the new technology. We think it's going to have a positive impact. It went into effect October 1 of this year, and it's going to help hospitals, remember, when hospitals try to adopt these new technologies, often, it's really burden on their cost system. So, for Medicare patients, this helps defray some of that. And so, what it allows people to do is to get involved with an innovation like INTUITY and we think that it's going to provide, hopefully, some longer-term impact because they're going to have a chance to experience the product and have we think some very positive results associated with it and want to continue.

Raj Denhoy

Analyst · Raj Denhoy with Jefferies. Please proceed

That's helpful. Thank you.

Operator

Operator

Our next question comes from the line of Isaac Ro with Goldman Sachs. Please proceed.

Isaac Ro

Analyst · Isaac Ro with Goldman Sachs. Please proceed

Good morning, guys. Thanks. First question was on the U.S. TAVR market, specifically with regards to OR capacity. Just curious if you could share with us you said you have visibility what percentage over portion of ORs you guys have out there active today or your approach theatrical limit in terms of the procedures they handle for TAVR? And I'm wondering if you think to the extent this that's an issue you'll see any alleviation of those capacity constraints on a timely fashion? Just trying to figure out if demand side here is starting to hit limiting items? Thank you.

Mike Mussallem

Analyst · Isaac Ro with Goldman Sachs. Please proceed

Thanks, Isaac. I appreciate the question. And we’ve been asked that before. We continue to feel the same way. We just don't see this capacity as an issue as it relates to the TAVR. We see places where within an existing system, they're able to do six or even seven TAVRs in a day, so it's remarkable the way we are able to expand the capacity. And the bigger question is their ability to add teams, and hospitals can be pretty resourceful. I think they find – most hospitals find that they're able to be profitable and they will make the addition teams. So far, capacity is not really been an issue for us.

Isaac Ro

Analyst · Isaac Ro with Goldman Sachs. Please proceed

Okay. Thanks. And then maybe just a follow-up on the competitive landscape as we look into 2018 and beyond, what's your best guess when you think about how lot of your U.S. customers behave in terms of how they're going to think about maintaining the training required for multiple platforms? Is there sort of rule of thumb here you can share with us regards to whether or not two or three or more platforms start to become problematic from a training perspective and just kind of curious what that means, if whether or not that would change in the event that pricing were to become more aggressive from some of the new entrants?

Mike Mussallem

Analyst · Isaac Ro with Goldman Sachs. Please proceed

Yeah. We think, typically, most hospitals like to have more than one system on the shelf. Either because of a anatomical reasons or just competitive reasons, they like to have more than one. But we find that typically, they will have -- we call it a workhorse product or one valve that they're going to go most of the time, they get very comfortable with it, they have good outcomes. We think that will continue to be the case and that will be the primary dynamics you will experience. I think it will be unusual to see three or four systems on hospital shelf for the exact reasons you've mentioned.

Isaac Ro

Analyst · Isaac Ro with Goldman Sachs. Please proceed

Understood. Thank you.

Operator

Operator

Thank you. Our next question comes from the line of Bruce Nudell with SunTrust Robinson Humphrey. Please proceed.

Bruce Nudell

Analyst · Bruce Nudell with SunTrust Robinson Humphrey. Please proceed

Hi. Good afternoon. Mike, I had a question about the fourth quarter. Are you just basically assuming that the U.S. market decelerates below 20%?

Mike Mussallem

Analyst · Bruce Nudell with SunTrust Robinson Humphrey. Please proceed

It's tough to know. It's probably that's the case. There may be a little bit of share in there, but it's probably moving in that direction over time. So we don't expect that there's going to be a big share shift necessarily in the quarter. So, I would expect the market to grow probably in line with our expectations. So, I don't know, the 15% to 20% range is probably moving in that direction.

Bruce Nudell

Analyst · Bruce Nudell with SunTrust Robinson Humphrey. Please proceed

Okay, perfect. And then just changing gears to PARTNER III. What's the average age in that trial of the patients? And also, is there an update in there to really allow for aggressive use in younger tricuspid patients?

Mike Mussallem

Analyst · Bruce Nudell with SunTrust Robinson Humphrey. Please proceed

Yeah. So unfortunately, we're not able to see the age or -- and I'm not supposed to see the age of these patients. This data set this up and opened up yet, so I don't have that. I can't really share the characteristics of it. The PARTNER III study should support indication expansion for -- with no particular age limit. So, I don't know that it is going to be important. In terms of bicuspid, I don't know if I have a really clear answer for you. We're running a registry just for that group of patients hopefully, we get some insight into that.

Bruce Nudell

Analyst · Bruce Nudell with SunTrust Robinson Humphrey. Please proceed

Thanks so much.

Operator

Operator

Thank you. Our next question comes from the line of Josh Jennings with Cowen & Company. Please proceed.

Josh Jennings

Analyst · Josh Jennings with Cowen & Company. Please proceed

Thanks. Good evening. I was hoping to ask about the SAPIEN 3 Ultra valve files and when -- what should we expect to see data. And with the added features of taller outer skirt, how low should we think about the PBL rate going from SAPIEN 3 Ultra?

Mike Mussallem

Analyst · Josh Jennings with Cowen & Company. Please proceed

Yeah. So, we're excited about getting the SAPIEN 3 Ultra out there. It's -- will have a CE Mark, and so you'll see the data ultimately following the CE Mark. So, I'd imagine may be mid-next year look at some of that in. In terms of its performance, it's got a couple of features and that's current that good really improve the performance. taller skirt we should make it -- we should get little better acute results. And then the skirt is also made of a different material, which should promote tissue in growth, and so we're hopeful that, that has some improvement on long-term results. So, we're optimistic about this valve platform. But again, I think it's one of those things that you start seeing it may be a middle of next year and then we'll certainly be following it over time.

Josh Jennings

Analyst · Josh Jennings with Cowen & Company. Please proceed

Great. And it sounds like the U.S. approval will be in front of potential low-risk approval. I wanted to ask about the low risk indication with the trial enrollment completion slated for the end of this year, are you expecting to have a Continued Access Program ongoing in 2018?

Mike Mussallem

Analyst · Josh Jennings with Cowen & Company. Please proceed

Okay. So first, -- yeah, we would expect that we would be able to get the Ultra valve into the U.S. because it should be a PMA supplement we would hope that by the end of 2018, that we'd get there. I don't know if we've made a decision on continued access. I wouldn't necessarily count on that. So, it's probably too soon. We – I'm certain will be in discussions with FDA about it. But right now, I don't have any good answer for you or clear one.

Josh Jennings

Analyst · Josh Jennings with Cowen & Company. Please proceed

Understood. Thanks for the answers.

Mike Mussallem

Analyst · Josh Jennings with Cowen & Company. Please proceed

Sure.

Operator

Operator

Our next question comes from the line of Kristen Stewart with Deutsche Bank. Please proceed.

Kristen Stewart

Analyst · Kristen Stewart with Deutsche Bank. Please proceed

Hi. Thanks for taking the question. I was wondering Scott, if you could go to the gross margin for this current quarter. And can you quantify what the impact of Puerto Rico was or just cost from the hurricanes? And maybe just compare quarter-to-quarter what some of the puts and takes are? And that have a follow-up after that.

Scott Ullem

Analyst · Kristen Stewart with Deutsche Bank. Please proceed

Sure, Kristen. So, Hurricane Maria, about 40 basis points. But let me take you through the whole gross margin profile. But it was pretty much as we expected it would turn out like, excluding special events. So, we ended at about 120 basis points higher than third quarter 2016. 220 basis points higher, driven by mix and about 140 basis points FX of about 0.5 point in supply chain and manufacturing benefits year-over-year of about 30 basis points. It was offset by Maria which you talked about before the closure of our Swiss facility and accelerating some depreciation on those assets is about 20 basis points. And then other items, about 40 basis points. So overall, it's pretty much like we expected. It turned into earnings per share of $0.88, excluding the actual excess tax benefit versus what we had expected. So, we expected a higher ETB than we thought would achieve, which is why our EPS looks like $0.84, but the way we're thinking about it modeling it, it's more like $0.88.

Kristen Stewart

Analyst · Kristen Stewart with Deutsche Bank. Please proceed

Okay. Perfect. And then Mike, just regarding CENTERA, I know that you said you're going to use the experience early on what to guide your use, but what exactly are you looking for? You guys know the transcatheter valve market very well at this stage, so what are going to be some of the milestones that you be looking at and considering in order to determine what exactly will be definitive, I guess, to inform whether or not you'll pursue I guess, and expanded launch of CENTERA in Europe or a launch in the United States?

Mike Mussallem

Analyst · Kristen Stewart with Deutsche Bank. Please proceed

Yeah. We're also – it's going to be interesting, Kristen, for us to observe the particular the behavior of physicians when they have CENTERA in their hands. CENTERA has a lot of advantages associated with it. Some of those physicians that are probably use self-expanding systems are probably spending much less at this point. So, we're going to have a chance to see just how they feel about an improved system that maybe has a higher price than the systems that they're using today and we look forward to that feedback and that's going to teach us a lot about what we need to think about for the future.

Kristen Stewart

Analyst · Kristen Stewart with Deutsche Bank. Please proceed

So, it's just mainly a cost, I guess, differential in your mind?

Mike Mussallem

Analyst · Kristen Stewart with Deutsche Bank. Please proceed

They're probably use of cost differential, but that's not really driving us what we're really interested here in is seeing whether – the value framework for CENTERA is the way that we believe it will be. We think physicians are going to be pleased with it and are going to prefer CENTERA, but would really like to see that improving clinical practice.

Kristen Stewart

Analyst · Kristen Stewart with Deutsche Bank. Please proceed

Okay. All right. Thanks for taking my questions. I appreciate it.

Operator

Operator

Thank you. Our next question comes from the line of John Gillings with JMP Securities. Please proceed.

John Gillings

Analyst · John Gillings with JMP Securities. Please proceed

Hey thanks guys. Just one from me tonight big -picture one on the mitral segment. So, given that we're in the early stages of developing treatments for mitral disease and you've got what's shaping up to be a pretty robust portfolio of mitral products. Can you help us understand the extent to which there's cross-pollination of ideas between these teams and how that's shaping Edwards' overall approach to mitral disease, product development and, you know, maybe if that portfolio view had any impact on the decision to make some of the changes to the CardiAQ valve? Thanks.

Mike Mussallem

Analyst · John Gillings with JMP Securities. Please proceed

Yeah. Thanks. Inside Edwards, we've decided to organize our transcatheter mitral and tricuspid programs into a team that works together, so even though there are dedicated teams for each of these technologies, they share a lot of learning. Certainly, there's a lot of commonality and sharing across the clinical team across the regulatory team across the operations and supply chain team that actually goes throughout the organization. The management team sit together and they talk about their progress and their set-backs. It is very much does inform our strategy. So, yeah, it's a key opportunity that we have by having this portfolio of products that we're able to learn from each other. So, we think it's going to pay off. Actually, we think it will be a key success factor for Edwards in the long run and we're using that insight to actually shape our strategy today. Again, you'll get a chance to hear more of that. We feel like it's a little tough to do on a quarterly conference call, but we'll be able to get into it a little deeper at our Investor Conference in December.

John Gillings

Analyst · John Gillings with JMP Securities. Please proceed

Perfect. Thanks, guys.

Operator

Operator

Thank you.

Mike Mussallem

Analyst · JPMorgan. Please proceed

Okay. Well, thank you for your continued interest in Edwards. Scott and David and I welcome any additional questions by telephone. And with that, back to you, David.

David Erickson

Analyst

Thank you for joining us on today's call. Reconciliations between GAAP and non-GAAP numbers mentioned during this call, which include underlying sales and growth rates and amounts adjusted for special items, are included in today's press release and can also be found in the Investor Relations section of our website at edwards.com. If you missed any portion of today's call, the telephonic replay will be available for 72 hours. To access this, please dial 877-660-6853 or 201-612-7415 and use conference number 13670702. I’ll repeat all those numbers for you, 877-660-6853 or 201-612-7415 and the conference number is 13670702. In addition, an audio replay will be available on the Investor Relations section of our website. Thank you very much.

Operator

Operator

Thank you. This concludes today's conference. You may disconnect your lines at this time and thank you for your participation.