Michael A. Mussallem
Chairman and Chief Executive Officer at Edwards Lifesciences
Thanks, Mark. In the second quarter, total company sales reflected year-over-year and sequential growth across all four of our product groups on a constant currency basis despite several challenging factors. Sales were lifted by a strong performance outside the U.S. with double-digit underlying sales growth in Europe and Japan. On a constant currency basis, total company sales grew 5% compared to the extraordinary second quarter of 2021 when sales increased 44% lifted by the treatment of patients who had postponed their care.
Nevertheless, second quarter sales and EPS were at the lower end of our expectations as a result of U.S. hospitals struggling with staffing shortages as well as the stronger U.S. dollar. We now anticipate that these challenges are likely to persist throughout 2022. And as a result, we are lowering our second half outlook to more realistically reflect the current operating environment. Although the near-term environment remains uncertain, we are unwavering in our long-term pursuit of groundbreaking innovations. We're investing to achieve breakthrough therapies that create significant value for patients in the health care systems, enabling strong organic sales growth. We continue to make meaningful progress on our pipeline and expect to achieve important milestones by year-end. As the global population ages and cardiovascular disease remains the largest health burden, we continue to believe the opportunity to serve our patients will nearly double between now and 2028.
Now turning to the quarterly results by product group. In TAVR, second quarter global sales of $907 million increased 5% on an underlying basis, despite approximately 50% growth in the year ago period. Sales were below our expectations due to the ongoing U.S. hospital staffing constraints and foreign exchange headwinds, but still represented our highest quarter of TAVR sales. We estimate global TAVR procedure growth was comparable with Edwards growth in the second quarter. In general, local selling prices were stable, although the average global selling price declined slightly due to the weakening euro and yen. In Q2, we continued to advance two pivotal trials aiming to expand indications. First, our EARLY TAVR trial is studying the large group of patients with severe aortic stenosis and no diagnosed symptoms.
Second, our PROGRESS trial is evaluating patients with moderate AS, which represents a group that is much larger than those with severe AS. And last month, we also began treating patients in our ALLIANCE pivotal trial for our next-generation SAPIEN X4. In the U.S. our TAVR sales were approximately flat with the elevated prior year, but increased in the high single-digit range sequentially. We estimate that our share of procedures was stable. As previously mentioned, our second quarter U.S. TAVR sales were impacted by slower-than-expected improvement in the U.S. hospital staffing and temporary contrast agent shortages.
Also recall in Q2 of last year, our U.S. TAVR sales increased over 50% on a year-over-year basis as COVID vaccines became more widely available and patients who had waited were treated. On a three year compounded annual basis, our U.S. TAVR sales increased 10% compared to the strong second quarter in 2019. Outside the U.S. In the second quarter, our underlying TAVR sales grew in the mid-teens on a year-over-year basis, and we estimate total procedural growth was comparable. This strong growth outside the U.S. was consistent with our underlying three year compounded annual growth rate also in the mid-teens. Long-term, we see excellent opportunities for OUS growth as we believe international adoption of TAVR therapy remains quite low. In Europe, Edwards sales growth was driven by the continued strong adoption of our SAPIEN platform. We estimate that our competitive position was stable.
Localized hospital staffing disruptions impacted second quarter results, although this headwind was less pronounced than in the U.S. 15 years after commercialization, it's encouraging to see the resilience of the TAVR programs in Europe despite the challenging backdrop of today's environment. In Japan, we experienced continued strong TAVR adoption as we remain focused on expanding the availability of TAVR therapy throughout the country. Similar to last quarter, the number of TAVR procedures performed exceeded surgical aortic valve replacement following approval last year for patients at low surgical risk. In summary, we continue to be very optimistic about the long-term potential of TAVR because of its transformational impact on the many patients suffering from aortic stenosis and because many remain untreated. Recall that we had previously assumed an improvement in the U.S. hospital staffing shortages throughout the year. We're now anticipating a slower improvement. And as a result, we are adjusting our full year outlook.
We expect underlying TAVR sales growth of around 10% in full year 2022 versus the previous expectation for 12% to 15%. Longer-term, we remain confident in this large global opportunity and that it 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 treatment and unlock the significant long-term growth opportunity for mitral and tricuspid patients, we remain focused on three key value drivers: a portfolio of differentiated therapies, positive clinical trial results to support approvals and adoption and favorable real-world clinical outcomes. At the TCT Conference in September, we expect the first results of the Class IID pivotal trial evaluating patients suffering from degenerative mitral regurgitation.
This is -- this first of its kind head-to-head randomized pivotal trial, powered for noninferiority, will be the first of several key pivotal trials evaluating the PASCAL technology. Additionally, at TCT, we expect three year data from the earlier class study. This growing contemporary body of clinical evidence will be important for the physician community considering transcatheter edge-to-edge repair treatments for mitral patients. We remain on track for U.S. FDA approval and CE Mark approval of PASCAL precision by year-end. This next-generation system is designed to facilitate precise navigation and an intuitive user experience, extending our differentiated platform.
This will allow us to expand PASCAL adoption in Europe, and we're pleased that we'll be launching the newest generation of PASCAL in the U.S. In mitral replacement, we continue to broaden our experience with both of our transcatheter mitral replacement therapies through the ENCIRCLE pivotal trial for SAPIEN M3 and the MISCEND study for EVOQUE Eos. Growing evidence with these sub-30-French transfemoral therapies furthers our confidence in book platforms. Turning to tricuspid. We also continue to make progress on enrolling the TRISCEND II pivotal trial for the EVOQUE replacement system and the Class II TR pivotal trial with PASCAL in patients with symptomatic severe tricuspid regurgitation. While we remain hopeful for year-end approval in Europe, uncertainties exist regarding the new MDR approval process for novel technologies seeking a CE Mark.
We remain committed to bringing the EVOQUE therapy to these tricuspid patients who have a very poor prognosis and few treatment options today. As we continue to build a body of compelling clinical evidence, we're pleased with the recent data from several late-breaking presentations. One-year results from our CLASS TR study presented at the American College of Cardiology Conference demonstrated significantly reduced TR, improved quality of life and maintain TR reduction. Also at the EuroPCR meeting, 30-day post-market data from our TriCLASP study was presented with 90% of the patients showing improvements in their quality of life. At upcoming medical conferences this year, we plan for contemporary evidence to be presented on both our PASCAL and EVOQUE platforms.
Turning to results. Second quarter global sales were $28 million, driven by the continued adoption of the PASCAL platform and activation of more centers across Europe. Our Q2 commercial performance was tempered by lower-than-expected market growth related primarily to COVID headwinds. We are now updating our full year guidance to $110 to $140 million, which represents approximately 60% underlying growth over the prior year and reflects a stronger-than-anticipated impact from foreign exchange as the vast majority of TMTT's business is in Europe. Bigger picture, we continue to be pleased with our progress forward on three key value drivers. We're advancing our comprehensive portfolio of differentiated therapies combined with contemporary clinical evidence and favorable real-world patient outcomes.
Together, this demonstrates the promise of these therapies for this significant unmet patient need and will help unlock this large market potential. In Surgical Structural Heart, second quarter 2022 global sales of $229 million increased 2% on an underlying basis over the prior year. We are encouraged to see global growth despite sales headwinds from the planned discontinuation of certain noncore cannula products as well as the COVID shutdown in China, which combined reduce growth by approximately 500 basis points. Our growth continues to be driven by increased penetration of our premium RESILIA products.
We've seen strong adoption of the MITRIS RESILIA valve in the U.S. since its initial launch in April. Building on the commercial success of INSPIRIS, we believe hospitals value the intuitive product features as well as the benefits of this innovative RESILIA tissue technology. Physician feedback in regions where MITRIS has been launched has been positive and initial clinical outcomes have been favorable. In the second quarter, we continued to bolster the overall body of RESILIA evidence. This includes a commenced trial subanalysis, which demonstrated the excellent performance of this tissue technology when treating bicuspid aortic valve disease, which was presented at the 2022 Annual Meeting of the American Association of Thoracic Surgeons in May. In a cohort of more than 200 patients averaging a relatively young 60 years of age, structural valve deterioration was 0 at five years.
In summary, we remain confident that our full year 2022 underlying sales growth will be in the mid-single-digit range for Surgical Structural Heart, driven by market adoption of our newest premium technologies and global surgical market growth. In Critical Care, second quarter sales of $211 million increased 3% on an underlying basis. As expected, growth was moderated by strong prior year comparisons. Sales growth was driven by increased adoptions of our Hypotension Prediction Index algorithm and our broad portfolio of sensors.
Additionally, we continued enrollment in the HPI Smart-BP trial focused on generating additional clinical evidence to support further adoption. Demand for the HemoSphere monitoring platform remains strong with a healthy pipeline of future opportunities. In summary, we continue to expect mid-single-digit underlying sales growth in 2022. We remain excited about our pipeline of Critical Care innovations as we shift our focus to Smart Recovery technologies designed to help clinicians make more informed decisions for their patients.
And now I'll turn the call over to Scott.