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Structural Heart: Clips, Valves and a PaymentNarrow moat

Abbott Laboratories (ABT) — moat facet

Abbott's Structural Heart business more than doubled from 2017 to 2025, but its US comparable sales fell 0.9% in Q2 2026.

Structural Heart is the part of Abbott's device business that repairs valves without opening the chest, and it has grown well. Sales were $1,083 million in 20171 and $2,523 million in 20252, 2.33 times as much3. Abbott names TriClip, Navitor and MitraClip as the drivers4.

Abbott Structural Heart sales ($M)1,08320171,40020191,61020211,94420232,5232025Abbott Forms 10-K FY2019, FY2021, FY2023 and FY2025, product-line sales
Grown 2.3 times since 2017.

The moat in this kind of device is clinical evidence and surgeon training. A heart team that has learned to deliver one clip, with outcomes it can measure, does not change devices lightly, and a new rival needs its own trials to get through the door.

The second quarter of 2026 showed a crack. Structural Heart sales rose 2.7% reported but fell 9.8% in the United States5. On a comparable basis, which strips out currency and the compensation payments from a competitor, US sales fell 0.9%6. Part of the reported fall is that Amulet moved to Electrophysiology on 1 January 2026, taking $55 million of second-quarter 2025 sales with it7.

There is also money from a rival in the history. Abbott's Structural Heart business received $89 million of compensation payments in 2025 "as part of a multi-year agreement with a competitor"8, and the final payment came in the first quarter of 20269. The Competitors page covers what kind of relationship that was.

Abroad, the business is still growing fast. International Structural Heart sales were $372 million in the second quarter of 2026, up 12.1% reported and 10.2% comparable10, and $726 million in the first half, up 18.1% reported11. The weakness is concentrated in the United States, where the line sold $225 million in the quarter12.

The first half of 2026 gives a fuller picture than one quarter. Structural Heart sold $1,175 million, up 5.7% reported and 6.2% on a comparable basis13, with international sales of $726 million up 18.1% reported14. The business is still growing; the question is where.

The falsifier is American demand. If US comparable growth stays negative for the rest of 2026 while international sales keep rising, the problem is Abbott's devices at home, not the category.

Moat trajectory: Holding steady

US Structural Heart -9.8% reported, -0.9% comparable in Q2 2026; international +10.2% comparable.

The number that tests this moat
Reported
Structural Heart US comparable growth, latest quarter
-0.9% (Q2 2026), against +10.2% internationally

Whether the valve-repair franchise still grows at home; a negative US figure all year would mean it does not.

Source: Abbott Q2 2026 earnings release ↗
⚠ Threats to the moat
⚠ THREAT 01
A Home Market Turning Soft
Abbott's US Structural Heart sales fell 2.2% on a comparable basis in the first half of 2026 while international sales rose 12.4%.
References
  1. ReportedSales were $1,083 million in 2017 and $2,523 million in 2025, 2.33 times as much.
    Abbott Laboratories Form 10-K for 2019 - the four reportable segments with Diabetes Care folded into Medical Devices from the fourth quarter of 2019 and 2017-2018 recast, product-line sales for 2017-2019, net earnings and EPS for 2017-2019 including the 2017 tax reform charge, and the balance sheet at 31 December 2019. — FY2019 · publ. February 2020 · source ↗
  2. ReportedSales were $1,083 million in 2017 and $2,523 million in 2025, 2.33 times as much.
    Abbott Laboratories Form 10-K for 2025 (year ended 31 December 2025) - Item 1 business and the segment note: the four segments, sales and operating earnings, employees, manufacturing sites, customers and geography. — FY2025 · publ. 20 February 2026 · source ↗
  3. Moat Explorer calcSales were $1,083 million in 2017 and $2,523 million in 2025, 2.33 times as much.
    Moat Explorer calculation from Abbott Laboratories reported figures ($ millions unless stated; calendar years). Medical Devices: share of total reportable segment operating earnings 3,011 / 6,916 = 43.5% (2017), 4,533 / 13,422 = 33.8% (2021), 7,212 / 11,800 = 61.1% (2025); first half 2026 3,862 / 6,122 = 63.1%. Share of segment sales 21,387 / 44,311 = 48.3% (2025); first half 2026 11,392 / 23,750 = 48.0%. Segment margin 3,011 / 10,325 = 29.2% (2017), 3,038 / 11,787 = 25.8% (2020), 4,533 / 14,485 = 31.3% (2021), 7,212 / 21,387 = 33.7% (2025); Q2 2026 1,969 / 5,853 = 33.6%, Q2 2025 1,796 / 5,369 = 33.5%. Sales growth 2017-2025 (21,387 / 10,325)^(1/8) - 1 = 9.5% a year; operating earnings 2025 7,212 / 6,153 - 1 = +17.2%; sales 2025 21,387 / 18,986 - 1 = +12.6%. Diabetes Care 7,998 / 1,414 = 5.66 times (2017 to 2025); share of Medical Devices 1,414 / 10,325 = 13.7% (2017), 2,524 / 12,239 = 20.6% (2019), 4,328 / 14,485 = 29.9% (2021), 5,761 / 16,887 = 34.1% (2023), 7,998 / 21,387 = 37.4% (2025); share of company 7,998 / 44,328 = 18.0%; CGM share of Diabetes Care 7.6bn / 7.998bn = 95%. CGM growth 2019-2025 (7.6 / 1.842)^(1/6) - 1 = 26.6% a year. Abbott CGM sales over DexCom revenue 7,600 / 4,662.0 = 1.63 times. DexCom distributor share 3,959.0 / 4,662.0 = 84.9%. Product lines 2017 to 2025: Electrophysiology 2,764 / 1,353 = 2.04 times; Structural Heart 2,523 / 1,083 = 2.33 times; Heart Failure 1,448 / 643 = 2.25 times; Rhythm Management 2,649 / 2,132 - 1 = +24.2%; Neuromodulation 1,010 / 808 - 1 = +25.0%; Vascular 2,995 / 2,892 - 1 = +3.6%. Rhythm Management, Heart Failure, Vascular and Neuromodulation together 2,649 + 1,448 + 2,995 + 1,010 = 8,102 (2025) against 2,390 + 1,279 + 2,837 + 962 = 7,468 (2024), +8.5%. Diagnostics: margin 1,912 / 7,713 = 24.8% (2019), 6,237 / 15,526 = 40.2% (2021), 6,640 / 16,469 = 40.3% (2022), 2,433 / 9,988 = 24.4% (2023), 1,740 / 8,937 = 19.5% (2025); Q2 2026 499 / 3,092 = 16.1%, Q2 2025 372 / 2,173 = 17.1%. Share of segment operating earnings 6,640 / 12,831 = 51.7% (2022), 1,740 / 11,800 = 14.7% (2025). Sales 2025 8,937 / 9,341 - 1 = -4.3%. COVID testing share of Diagnostics sales 2022 8.4bn / 16.469bn = 51%, about half. Core Laboratory 5,360 / 4,063 - 1 = +31.9%. Rapid Diagnostics 2,454 / 10,061 - 1 = -75.6% (2022 to 2025). Point of Care 606 / 550 - 1 = +10.2%. Molecular 2020 peak 1,438 / 463 = 3.11 times 2017. Cancer Diagnostics share of Diagnostics Q2 2026 919 / 3,092 = 29.7%. Exact Sciences US share of 2025 sales 3,145 / 3,247 = 96.9%; purchase price over 2025 sales 20.6bn / 3.247bn = 6.3 times. China net sales 1,907 / 2,253 - 1 = -15.4% (2023 to 2025); China share of company 2,253 / 40,109 = 5.6% (2023), 1,907 / 44,328 = 4.3% (2025). Nutrition: margin 1,741 / 6,975 = 25.0% (2015), 1,705 / 7,409 = 23.0% (2019), 1,763 / 8,294 = 21.3% (2021), 706 / 7,459 = 9.5% (2022), 1,333 / 8,154 = 16.3% (2023), 1,558 / 8,451 = 18.4% (2025); Q2 2026 368 / 2,144 = 17.2%, Q2 2025 418 / 2,212 = 18.9%. Q2 operating earnings 368 / 418 - 1 = -12.0%. Sales 2021 to 2025 8,451 / 8,294 - 1 = +1.9%. Share of company sales 6,925 / 27,390 = 25.3% (2017), 7,409 / 31,904 = 23.2% (2019), 8,294 / 43,075 = 19.3% (2021), 8,154 / 40,109 = 20.3% (2023), 8,451 / 44,328 = 19.1% (2025). US Pediatric 2022 1,562 / 2,192 - 1 = -28.7%. International Adult 3,029 / 1,782 - 1 = +70.0% (2017 to 2025); share of Nutrition 3,029 / 8,451 = 35.8%. International Pediatric 1,816 / 2,112 - 1 = -14.0%. Sturgis: recalled brands 479 / 1,200 - 1 = -60%; Nutrition operating earnings 706 / 1,763 - 1 = -60%. Established Pharmaceuticals: margin 658 / 3,720 = 17.7% (2015), 848 / 4,287 = 19.8% (2017), 904 / 4,486 = 20.2% (2019), 889 / 4,718 = 18.8% (2021), 1,206 / 5,066 = 23.8% (2023), 1,290 / 5,536 = 23.3% (2025); Q2 2026 382 / 1,499 = 25.5%. Sales 5,536 / 3,720 - 1 = +48.8% (2015 to 2025); (5,536 / 4,287)^(1/8) - 1 = 3.2% a year (2017 to 2025). Key Emerging Markets share 4,167 / 5,536 = 75.3%. Segment sales growth 2025: Medical Devices +12.6%, Established Pharmaceuticals 5,536 / 5,194 - 1 = +6.6%, Nutrition 8,451 / 8,413 - 1 = +0.5%, Diagnostics -4.3%; net sales 44,328 / 41,950 - 1 = +5.7%. US share of 2025 net sales 17,126 / 44,328 = 38.6%; international share Q2 2026 7,377 / 12,593 = 58.6%. Further: Structural Heart compensation payments 89 / 2,523 = 3.5% of 2025 line sales. Diabetes Care added 7,998 - 6,805 = 1,193 in 2025. One point of CGM growth on 7.6bn = about 76. Medical Devices share of segment assets 10,689 / (3,540 + 4,791 + 8,273 + 10,689 = 27,293) = 39.2%. Total debt over total assets 32,608 / 109,215 = 29.9% (30 June 2026), 12,929 / 86,713 = 14.9% (end 2025). Net debt over Abbott shareholders' investment 27,005 / 51,110 = 0.53. Market value 173.21 / 217.86 - 1 = -20.5% (end 2025 to 5 October 2026). Second pass: US Structural Heart first half 2026 449 / 1,175 = 38.2%. Rapid Diagnostics 2,454 / 4,376 = 56% of 2020. Diagnostics Q2 2026 operating earnings 499 / 372 - 1 = +34.1%. Nutrition sales (8,451 / 6,925)^(1/8) - 1 = 2.5% a year (2017 to 2025); 8,451 / 7,409 - 1 = +14.1% (2019 to 2025). US Adult Nutrition 1,448 / 1,254 - 1 = +15.5% (2017 to 2025). Adult nutrition 3,029 + 1,448 = 4,477; pediatric 2,158 + 1,816 = 3,974 (2025). Total segment operating earnings 11,800 / 13,422 - 1 = -12.1% (2021 to 2025); Medical Devices 7,212 / 4,533 - 1 = +59.1%. First half 2026 dividends over operating cash flow 2,200 / 3,803 = 57.9%. DexCom revenue 2023 3,095.6 + 526.7 = 3,622.3; 4,662.0 / 3,622.3 - 1 = +28.7%; Abbott CGM 7.6 / 5.3 - 1 = +43.4% (2023 to 2025). US share of first half 2026 sales 9,490 / 23,757 = 39.9%. Diagnostics RPO 6,200 / 8,937 = 69% of 2025 Diagnostics sales; 6,200 / 5,360 = 1.16 times Core Laboratory sales. Libre 7.6 / 1.128 = 6.7 times (2018 to 2025). Medical Devices and Established Pharmaceuticals RPO 455 + 243 = 698, / 6,898 = 10.1%. Cash, debt and dividends: free cash flow 9,566 - 2,171 = 7,395 (2025), 8,558 - 2,207 = 6,351 (2024), 7,261 - 2,202 = 5,059 (2023); after dividends 7,395 - 4,116 = 3,279, about $3.3 billion. Dividends paid over free cash flow 4,116 / 7,395 = 55.7%; over net earnings 4,116 / 6,524 = 63.1%; 2025 dividend per share over adjusted EPS 2.40 / 5.15 = 46.6%; annual dividend 4 x 0.63 = 2.52 over trailing EPS 3.09 = 81.6%. Dividend per share 2.40 / 0.98 = 2.45 times, (2.45)^(1/10) - 1 = 9.4% a year (2015 to 2025). Total debt 3,033 + 9,896 = 12,929 (end 2025), 3,005 + 29,603 = 32,608 (30 June 2026); net debt 12,929 - 8,522 - 417 = 3,990 (end 2025), 32,608 - 5,104 - 499 = 27,005 (30 June 2026), 14,679 - 7,279 = 7,400 (end 2023), 14,125 - 7,967 = 6,158 (end 2024); 27,005 / 3,990 = 6.8 times. Remaining performance obligations 6,200 + 455 + 243 = 6,898, about $6.9 billion; Diagnostics share 6,200 / 6,898 = 90%; beyond 36 months 100% - 52% - 18% = 30%; over trailing twelve-month sales 6,898 / 46,585 = 14.8%, about 15%. Trailing twelve months to June 2026: net sales 44,328 - 21,500 + 23,757 = 46,585; net earnings 6,524 - 3,104 + 2,005 = 5,425; diluted EPS 3.72 - 1.77 + 1.14 = 3.09. Expected amortization 1.5bn (2030) / 2.6bn (2026) - 1 = -42%. Analyst target 120.26 / 100.10 - 1 = +20.1%. 2026 adjusted EPS guidance midpoints (5.55 + 5.80) / 2 = 5.675 (January), (5.38 + 5.58) / 2 = 5.48 (April), (5.45 + 5.60) / 2 = 5.525 (July). Year-end market value (stockanalysis) over net earnings and net sales: 2015 66.99bn / 4,423 = 15.15, / 20,405 = 3.283; 2016 56.55 / 1,400 = 40.39, / 20,853 = 2.712; 2017 99.34 / 477 = 208.26, / 27,390 = 3.627; 2018 127.04 / 2,368 = 53.65, / 30,578 = 4.155; 2019 153.61 / 3,687 = 41.66, / 31,904 = 4.815; 2020 194.06 / 4,495 = 43.17, / 34,608 = 5.607; 2021 248.87 / 7,071 = 35.20, / 43,075 = 5.778; 2022 191.43 / 6,933 = 27.61, / 43,653 = 4.385; 2023 191.09 / 5,723 = 33.39, / 40,109 = 4.764; 2024 196.18 / 13,402 = 14.64, / 41,950 = 4.677; 2025 217.86 / 6,524 = 33.39, / 44,328 = 4.915; 5 October 2026 173.21bn / 5,425 = 31.93, / 46,585 = 3.718 - segment shares, growth, Established Pharmaceuticals and geography. — FY2015-Q2 2026 · publ. October 2026 · source ↗
    Method: Arithmetic on figures reported in Abbott Laboratories Forms 10-K and 10-Q and earnings releases, the DexCom Form 10-K, and stockanalysis.com market values; each operand is stated in the source line.
  4. ReportedAbbott names TriClip, Navitor and MitraClip as the drivers.
    Abbott Laboratories Form 10-K for 2025 (year ended 31 December 2025) - Item 1 and MD&A for Medical Devices: Diabetes Care, continuous glucose monitors and the cardiovascular and neuromodulation businesses. — FY2025 · publ. 20 February 2026 · source ↗
  5. ReportedStructural Heart sales rose 2.7% reported but fell 9.8% in the United States.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
  6. ReportedOn a comparable basis, which strips out currency and the compensation payments from a competitor, US sales fell 0.9%.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
  7. ReportedPart of the reported fall is that Amulet moved to Electrophysiology on 1 January 2026, taking $55 million of second-quarter 2025 sales with it.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
  8. ReportedAbbott's Structural Heart business received $89 million of compensation payments in 2025 "as part of a multi-year agreement with a competitor", and the final payment came in the first quarter of 2026.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
  9. ReportedAbbott's Structural Heart business received $89 million of compensation payments in 2025 "as part of a multi-year agreement with a competitor", and the final payment came in the first quarter of 2026.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
  10. ReportedInternational Structural Heart sales were $372 million in the second quarter of 2026, up 12.1% reported and 10.2% comparable, and $726 million in the first half, up 18.1% reported.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
  11. ReportedInternational Structural Heart sales were $372 million in the second quarter of 2026, up 12.1% reported and 10.2% comparable, and $726 million in the first half, up 18.1% reported.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
  12. ReportedThe weakness is concentrated in the United States, where the line sold $225 million in the quarter.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - total sales, income statement, specified items, tax rate, guidance and the dividend. — Q2 2026 · publ. 16 July 2026 · source ↗
  13. ReportedStructural Heart sold $1,175 million, up 5.7% reported and 6.2% on a comparable basis, with international sales of $726 million up 18.1% reported.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
  14. ReportedStructural Heart sold $1,175 million, up 5.7% reported and 6.2% on a comparable basis, with international sales of $726 million up 18.1% reported.
    Abbott Laboratories second-quarter 2026 earnings release, Form 8-K exhibit 99.1 - sales by segment and business, comparable growth, income statement, specified items, guidance and the 410th consecutive quarterly dividend - Medical Devices sales by business, continuous glucose monitors, Amulet and TECTONIC. — Q2 2026 · publ. 16 July 2026 · source ↗
Sources
Generated October 6, 2026