Michael F. Mahoney
Chairman and Chief Executive Officer at Boston Scientific
Thanks, Lauren, and thank you, everyone, for joining us here today. We're very proud of our performance in the third quarter, particularly in light of the ongoing macroeconomic and supply chain headwinds. Our performance continues to be supported by the strength and diversification of our innovative portfolio and the winning spirit of our global team.
Third quarter '22 total company operational sales grew 14% versus prior year and organic sales grew 11.5%, which does exceed the high end of our guidance range of 8% to 10%. This performance is a testament to our category leadership strategy and focus on innovation with strong commercial execution. Six of eight of our business units grew double-digits organically, and we believe that nearly all of our businesses and regions grew faster than their respective markets.
Third quarter adjusted EPS of $0.43 grew 6.3% versus prior year at the low end of our guidance range of $0.43 to $0.45, attributable to increased FX headwinds and slightly higher spend within the quarter. We have grown 9.2% organically year-to-date through third quarter. And in light of this performance, we are increasing our full year '22 guidance for operational growth to approximately 11.5% and organic growth to approximately 9%. For fourth quarter '22 revenue, we're guiding to operational growth of 8.5% to 10.5% and organic growth of 7% to 9%.
We're also updating our full year '22 adjusted EPS guidance to $1.71 to $1.74 primarily related to the ongoing headwind from foreign exchange. Our fourth quarter '22 adjusted EPS estimate is $0.45 to $0.48.
Throughout 2022, we have maintained our goal to improve operating margins. While our goal remains, we feel it's prudent to provide an updated adjusted operating margin target of approximately 26% considering the continued macroeconomic pressures. On a full year basis, this does represent approximately 70 basis points of margin expansion versus our 2021 rate of 25.3%.
I'll now provide additional third quarter highlights, along with some comments on future outlook. Regionally, the US delivered operational growth of 12% versus prior year. Strong growth was realized across most all of our business units, particularly cardiovascular and endoscopy, and included an approximate 300 basis point tailwind from acquisitions.
Middle East -- I'm sorry -- Europe, Middle East and Africa grew 15% on an operational basis versus prior year. We continue to see excellent execution fueled by our innovative portfolio with seven of the eight business units growing double-digits. Sales growth accelerated within our growth in emerging market countries within Europe, with notable strength across cardiology and peripheral interventions.
In Asia-Pac, we grew 15% operationally with strong growth in China, India and ASEAN countries. While our Japan results saw some impact from COVID within the quarter, we continue to see strength driven by new products, including POLARx, WATCHMAN, FLX and Rezum. Our team in China delivered excellent results in the third quarter with growth of 36%. Growth is primarily driven by our ICTx business within cardiovascular, PI and our CRM business units, supported by new and ongoing product launches across the portfolio.
Turning to Latin America. The team executed another exceptional quarter, growing 29% operationally. All business units in major markets grew double-digits in the third quarter. And across the portfolio, more than 10 new products were launched enabled by remote training and support.
I'll now provide some thoughts on our business units, starting with Urology and Public Health, which grew organic sales 13% and 16% on an operational basis. The stone management, prosthetic urology and prostate health franchises all grew double-digits in the third quarter, with balanced performance across the regions. We continue to focus on global expansion and are pleased to have received approval and commenced the launches of SpaceOAR in both Korea, Mexico and Rezum in Japan.
Our Lumenis acquisition did turn organic in September and we remain excited about the global opportunity ahead with the MOSES laser technology, LithoVue single-use flexible ureteroscopes, and our broad portfolio of stone management products.
In Endoscopy, sales grew 10% organically. This category-leading business continues to focus on product innovations, enhanced by best-in-class physician education and training. Growth in the quarter was driven by our biliary and single-use imaging franchises with ongoing market development activities, enabling increased utilization of EXALT D and other key products.
In Neuromodulation, organic revenue grew 3%. Our pain franchise sales were flat year-over-year, below our expectations with ongoing reimbursement challenges impacting US procedures for both Vertiflex and spinal cord stimulation. In SCS, while international growth was very strong with broad demand for WaveWriter Alpha, our US SCS sales were impacted by preauthorization denials despite strong patient demand and ongoing physician interest in our FAST therapy. We have a team in place focused on supporting the preauthorization documentation requirements. However, we do anticipate that challenges will continue to persist in the fourth quarter.
In Deep Brain Stimulation, the US, EMEA and LatAm regions grew double-digits in the third quarter. Globally, we're seeing stable underlying DBS procedure growth, and we continue to see momentum in the US as we moved into full launch of our STIMVIEW XT integrated imaging and programming platforms.
Cardiology delivered another excellent quarter with organic sales growing 13% and operational sales growing 16%. Within cardiology, interventional cardiology therapies, organic sales grew 11%. This coronary therapies franchise performed well in the third quarter, driven by strong performance in our international regions, particularly with our differentiated imaging franchise.
Importantly, we recently completed an enrollment in our AGENT IDE trial. This is the very first US trial for a coronary drug-coated balloon to treat in-stent restenosis. And we expect to launch in Japan in '23, in the US in 2024.
Our structural heart valves franchise did grow double-digits in the third quarter again with continued strength in Europe with our ACURATE neo2 TAVR platform. Additionally, results from the PROTECTED TAVR trial were presented as a late breaker at TCT. Recall the PROTECTED TAVR trial studied our cerebral embolic protection device, SENTINEL, with TAVR versus unprotected TAVR.
With a reduction in the primary endpoint of overall stroke, while the reduction in the primary endpoint of overall stroke did not reach statistical significance, a secondary analysis demonstrated a clinically meaningful 63% relative risk reduction in severe disabling stroke.
Turning to WATCHMAN. Organic sales grew 26% in the third quarter. Global growth continues to be very strong, further supported by the US FDA approval of an expanded label to include DAPT, giving physicians and patients choice of DAPT or OAC in the first 45 days post implant.
We continue to focus on innovation in this space with the Trusteer, which is our new steerable sheath, and we also highlighted our next-generation FLX device, WATCHMAN FLX PRO at our TCT investor event in September. We expect FLX PRO to build on our second-generation FLX with additional sizes in the device coding designed to enhance healing.
In Cardiac Rhythm Management, organic sales grew 7% versus prior year. We had another strong quarter of performance as we continue to focus on lifetime patient management from diagnostics to implant with our broad portfolio. Within core CRM, our low-voltage franchise grew mid-single digits and high-voltage grew low single digits. Our diagnostics franchise continues to perform very well. We're pleased to have received CE Mark for our implantable cardiac monitor, LUX-Dx, and we have commenced our commercial launch.
Electrophysiology sales grew 26% on an organic basis and 83% on an operational basis. We continue to see strength in our comprehensive international portfolio, which grew 45% organically. And this includes two months of contribution from FARAPULSE. Physician demand for POLARx in Japan and FARAPULSE and POLARx in Europe remains very strong, and we continue to see increased utilization at existing centers, while we are expanding into new accounts.
In addition, we're pleased to have launched FARAPULSE in Australia and Singapore under special access, and we anticipate approval in '23. The Baylis integration continues to go well with the differentiated transseptal access portfolio growing double-digits in the quarter and remains on track to achieve our full year expectations.
In Peripheral Interventions, organic sales grew 12% with broad growth across all major franchises and regions. In Arterial, our differentiated drug-eluting portfolio grew double-digits in the quarter and we received FDA approval for a line extension of ELUVIA and commenced launch of the longest length of drug eluting stent for peripheral arterial disease in the US.
The Interventional Oncology business had another very strong quarter with great growth and continued strength in our cancer therapies, ICX and TheraSphere. We're pleased to have closed on the acquisition of Obsidio and the gel embolic material technology. Obsidio is the first gel embolic with an indication for the peripheral vasculature and a complementary addition to our portfolio. We look forward to launching this technology within the US in 2023.
In alignment with our overall commitment to progress our environment, social and governance efforts, the PI division announced collaboration with a health care data platform, TruVida, aiming to provide insights to help better address health care disparities within various PI disease states. We remain committed to driving sustainable innovation to Boston Scientific. And despite the persistent macroeconomic pressures, we continue to invest for the long-term in R&D, execute strategic tuck-in M&A with a focus on improving patient outcomes today and into the future.
We're also excited about the opportunities ahead and remain focused on our long-term financial goals, continuing to grow sales faster than the markets, operating margin expansion, double-digit adjusted EPS growth and strong adjusted free cash flow generation.
Before I turn it over to Dan, I do want to take a moment to share that our Chief Medical Officer, Dr. Ian Meredith, will be retiring in April of 2023. We're extremely grateful for his strong contributions, particularly as dedication to patients, clinical science and meaningful innovation, and his great sense of humor.
With that, I'll now turn things over to Dan to review our financial performance in more detail.