Mike Mussallem
Chairman & Chief Executive Officer at Edwards Lifesciences
Thank you, Mark. Let me begin by saying, I remain very proud of our team's steadfast dedication to our patient-focused strategy. Throughout the first quarter, our supply chain delivered and our field team continued to support the skilled clinicians and patients who count on Edwards. We continue to believe that 2022 will be an important year for Edwards Lifesciences as we expect low double-digit sales growth and meaningful progress on our pursuit of significant opportunities to improve patient care.
Looking beyond 2022, we remain confident in our long-term strategy and our pipeline of innovative therapies. Our patient-focused culture drives us and motivates our employees around the world and our R&D targets breakthrough therapies that can create significant value for patients and health systems, enabling strong organic sales growth.
As we are hopeful the worst of the pandemic is behind us, we're constantly reminded of the importance of our work as we pursue solutions for cardiovascular disease, which continues to be the number one killer in the US and the world, well ahead of cancer and other deadly conditions.
Turning now to our first quarter financial results. Sales of $1.3 billion increased 13% on a constant currency basis versus the year-ago period. Despite the impact that Omicron had on hospital capacity, resources and procedure volumes in January, especially in the US, Q1 global sales were moderately better than our expectations. Sales were lifted by performance outside the US, where we experienced a less pronounced impact from the pandemic.
Underlying sales growth was double digit across all regions and benefited from improving trends as we progressed through the first quarter. In TAVR, first quarter global sales were $881 million, an increase of 14% on an underlying basis, with continued strong growth outside the US. We estimate the global TAVR procedure growth was comparable with our own growth and average selling prices were stable globally.
In the US, our first quarter TAVR sales grew approximately 10% versus the prior year and we estimate total procedure growth was comparable. TAVR adoption was broad-based across hospitals and our SAPIEN valves continue to demonstrate distinguished clinical performance. Outside the US, in the first quarter, our underlying TAVR sales grew approximately 20% on a year-over-year basis and we estimate total procedure growth was comparable. We continue to see excellent opportunities for OUS growth as international adoption of TAVR therapy remains low.
In Europe, Edwards sales growth was driven by the continued strong adoption of our SAPIEN platform and was broad-based across all countries. Our treatment rates recovered nicely throughout the quarter although they differed by country, reflecting variable COVID impacts. We estimate that our competitive position was stable.
In Japan, we also experienced strong TAVR adoption and the number of TAVR procedures performed exceeded surgical aortic valve replacement. Following reimbursement approval last year for the treatment of patients at low surgical risk, we remain focused on expanding the availability of TAVR therapy throughout the country. And broadly across the globe, we continue to see encouraging TAVR adoption in many underpenetrated countries.
In addition to geographic expansion, we remain focused on helping more patients gain access to TAVR therapy. In Q1, we continued to advance two pivotal trials aimed at expanding indication. First, our early TAVR trial for the large group of patients with severe AS and no diagnosed symptoms. And second, our PROGRESS trial that is evaluating patients with moderate AS, which represents a group that is much larger than those with severe AS. We also remain on-track to begin treating patients this quarter in our ALLIANCE pivotal trial for our next-generation TAVR technology, SAPIEN X4.
In summary, assuming no new COVID headwinds and a gradual improvement in U.S. hospital staffing shortages throughout the year, we continue to plan for underlying TAVR sales growth to be in the range of 12% to 15%. We remain confident that this large global opportunity will double to $10 billion by 2028, which implies a compounded annual growth rate in the low double-digit range.
Now turning to TMTT. To transform patient care and unlock the significant long-term growth opportunity, we continue to make steady progress on three key value drivers: a portfolio of differentiated therapies, positive pivotal trial results to support approvals and adoption and favorable real-world clinical outcomes. We're pleased with our high procedural success rates and we continued our strong momentum with more patients than ever treated with our TMTT technologies this quarter.
In Mitral Repair, we continue to achieve excellent clinical outcomes with PASCAL as we expand commercially and treat more patients in Europe. We remain on-track for US approval of PASCAL Precision for patients with degenerative mitral regurgitation late this year, supported by our CLASP IID pivotal trial. We continue to advance the enrollment of CLASP IIF pivotal study for patients with functional mitral regurgitation. And later this year, we expect European approval of our new PASCAL Precision system, which is engineered for enhanced navigation and an intuitive user experience, extending our differentiated platform.
In mitral replacement, we continue to broaden our experience with both of our transcatheter mitral replacement technologies through the ENCIRCLE pivotal trial for SAPIEN M3 and the MISCEND study for EVOQUE Eos. This early experience with the Sub 30-French transfemoral therapies gives us confidence that these platforms have the potential to transform treatment for the many patients in need.
Turning to transcatheter tricuspid therapies. As we continue to build a body of clinical evidence for PASCAL in the tricuspid position, we are pleased with the recently presented late-breaking data at the ACC meeting last month. We are encouraged by the sustained significant in tricuspid regurgitation and improvements in quality-of-life measures experienced by patients and look forward to bringing additional clinical evidence through our CLASP II TR pivotal trial, which is currently enrolling.
In addition, we continue to make progress in enrolling our TRISCEND 2 pivotal trial of the EVOQUE system. We expect a late 2022 approval for EVOQUE tricuspid replacement in Europe and remain committed to providing solutions for these patients who have a very poor prognosis and few treatment options today.
Turning to our results. First quarter global TMTT sales were $27 million, driven by the continued adoption of the PASCAL platform in Europe. Although there was an impact from COVID early in the quarter, we exited March with positive momentum. As we expand in Europe, physicians continue to achieve high procedural success rates and excellent clinical outcomes.
Assuming a diminishing COVID-related impact, we are planning a gradual ramp in Q2 and a significant acceleration in the second half of the year to reach our 2022 sales guidance of $140 million to $170 million. We look forward to continuing our progress toward advancing our vision to transform the lives of patients with mitral and tricuspid valve disease.
In Surgical Structural Heart, first quarter 2022 global sales of $221 million increased 6% on an underlying basis over the prior year. Despite a soft start to the year associated with COVID, we are encouraged by the steady improvement across most regions over the course of the quarter, driven by increased penetration of premium technologies and procedure growth. Although hospital staffing shortages remain a concern, we believe that life-saving surgical therapies continue to be prioritized.
At the end of March, we announced the US FDA approval and commercial launch of our MITRIS RESILIA valve, which adds to the portfolio of durable RESILIA tissue products with a valve designed for the heart's mitral position. Built upon previous generations of proven mitral valve technology, MITRIS offers greater ease of use and is designed to facilitate potential future transcatheter interventions.
Today, nearly 60% of the world's surgical mitral valves are mechanical. RESILIA tissue should allow patients to thrive without the quality-of-life compromises that may come from having a mechanical valve. Initial feedback from US surgeons has been very positive.
In summary, we remain confident that our full year 2022 underlying sales growth will be in the mid-single-digit range for a Surgical Structural Heart driven by market adoption of our newest premium technologies. In Critical Care, first quarter sales of $212 million increased 11% on an underlying basis driven by balanced contributions from all product lines. Demand for our state-of-the-art HemoSphere monitoring platform remains strong and lifted our sales.
Our broad portfolio of Smart Recovery sensors and our TruWave disposable pressure monitoring devices supported the increased number of patients in the ICU in the first quarter. Additionally, we continued enrollment in the HPI Smart-BP trial, focused on generating additional clinical evidence to support the adoption of our Hypotension Predictive Index software.
In summary, we continue to expect mid-single-digit underlying sales growth for 2022, which are moderated by the strong prior year comparisons over the remainder of the year. We remain excited about our pipeline of critical care innovations as we continue to shift our focus to Smart Recovery technologies designed to help clinicians make better decisions for their patients.
And now I'll turn the call over to Scott.