Medtronic Q1 2024 Earnings Report

Medtronic EPS Results

• Actual EPS: $1.20
• Consensus EPS: $1.11
• Beat/Miss: Beat by +$0.09
• One Year Ago EPS: $1.13

Medtronic Revenue Results

• Actual Revenue: $7.70 billion
• Expected Revenue: $7.57 billion
• Beat/Miss: Beat by +$135.54 million
• YoY Revenue Growth: +4.50%

Medtronic Announcement Details

• Quarter: Q1 2024
• Date: 8/22/2023
• Time: Before Market Opens
• Conference Call Date: Tuesday, August 22, 2023
• Conference Call Time: 8:00AM ET

Medtronic (NYSE:MDT) is a global medical technology company that develops and manufactures a broad range of therapeutic devices and health care solutions. Headquartered legally in Ireland with principal operational offices in the United States, the company markets products to hospitals, physicians and health systems worldwide and has grown from its founding in 1949 into one of the largest medical-device manufacturers serving global health-care markets.

Medtronic’s offerings span several clinical areas, including cardiac rhythm and heart failure (pacemakers, implantable cardioverter‑defibrillators and related cardiac therapies), minimally invasive and surgical technologies (laparoscopic and advanced energy devices, visualization systems and surgical innovations), restorative therapies (spine and orthopedics, neuromodulation and neurovascular treatments) and diabetes management (insulin-delivery systems and glucose monitoring solutions). The company also supplies a range of hospital products and services that support perioperative and procedural care.

Medtronic operates on a global scale, serving customers in more than 150 countries through a combination of direct sales, distribution partners and clinical service programs. Its customers include hospitals, ambulatory surgery centers and specialty clinics, and the company emphasizes clinical collaboration, training and post-market support as part of its commercial approach. Medtronic maintains a significant research-and-development focus to advance new therapies and meet evolving regulatory and clinical requirements.

The company’s executive leadership team is responsible for steering Medtronic’s strategy around innovation, reimbursement and market access; Geoffrey S. Martha has served as chief executive in recent years. Medtronic’s business model centers on developing technology-enabled therapies, expanding clinical evidence, and scaling commercial capabilities to address chronic and acute conditions across diverse geographies.

Medtronic Q1 2024 Earnings Call Transcript

Key Takeaways

• Mid-single digit organic revenue growth and each of Medtronic’s four segments grew ~6%, leading to raised fiscal 2024 revenue guidance to 4.5% and EPS guidance to $5.08–$5.16.
• Diabetes business inflection: U.S. durable pump sales surged low-30s%, with a 30% increase in unique prescribers, over 50% of the 770G base upgrading to 780G, and high CGM attachment rates boosting revenue and economics.
• Margins stabilizing and improving: gross margin at ~65.5% supported by pricing gains offsetting inflation, operating margin up ~90 bps, and ongoing cost-out programs in global operations and supply chain.
• China headwinds: 4% growth was dampened by volume-based procurement and new sanctions in Russia, though management expects a return to high-single digit growth beyond FY 2024.
• Innovation acceleration: Appointed a Chief Technology & Innovation Officer to embed AI and robotics across businesses, aiming for differentiated therapies and enhanced customer experiences.

Presentation

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Good morning! I'm Ryan Weispfenning, Vice President and Head of Medtronic Investor Relations. I appreciate that you're joining us today for our fiscal 2024 first quarter video earnings webcast. We're broadcasting to you today from our operational headquarters here in Minnesota, where summer's in full force. Before we go inside to hear our prepared remarks, I'll share a few details about today's webcast. Joining me are Geoff Martha, Medtronic Chairman and Chief Executive Officer, and Karen Parkhill, Medtronic Chief Financial Officer. Geoff and Karen will provide comments on the results of our first quarter, which ended on July 28, 2023, and our outlook for the remainder of the fiscal year. After our prepared remarks, the executive VPs from each of our 4 segments will join us, and we'll take questions from the sell side analysts that cover the company. Today's program should last about an hour.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Earlier this morning, we issued a press release containing our financial statements and divisional and geographic revenue summaries. We also posted an earnings presentation that provides additional details on our performance. The presentation can be accessed in our earnings press release or on our website at investorrelations.medtronic.com. During today's program, many of the statements we make may be considered forward-looking statements. Actual results may differ materially from those projected in any forward-looking statement. Additional information concerning factors that could cause actual results to differ is contained in our periodic reports and other filings that we make with the SEC. We do not undertake to update any forward-looking statement.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Unless we say otherwise, all comparisons are on a year-over-year basis, and revenue comparisons are made on an organic basis, which excludes the impact of foreign currency and first quarter revenue in the current and prior year reported as Other, which stems from prior business separations. References to sequential revenue changes compared to the fourth quarter of fiscal 2023 and are made on an as reported basis, and all references to share gains or losses refer to revenue share in the second calendar quarter of 2023 compared to the second calendar quarter of 2022, unless otherwise stated. Reconciliations of all non-GAAP financial measures can be found in our earnings press release or on our website at investorrelations.medtronic.com. Finally, our EPS guidance does not include any charges or gains that would be reported as non-GAAP adjustments to earnings during the fiscal year.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

With that, let's head into the studio and hear about the quarter.

[Geoff Martha, Chairman and CEO at Medtronic]

Hello, everyone. Thank you for joining us today. We are pleased with the strong start of our fiscal year. We executed and delivered another quarter of mid-single-digit organic revenue growth. Our solid results were broad-based, with each of our 4 segments delivering 6% growth, driven by execution, innovation, and much improved underlying fundamentals in our markets and supply chain. We also continue to make great strides on our comprehensive transformation, which is designed to get at the root of what has held back our growth. We're executing large-scale functional improvements to global operations, supply chain, and quality. We're also decisively allocating capital, particularly to our programs in fast secular growth markets, as well as focusing our R&D investments on technology megatrends, like robotics and artificial intelligence, that will drive growth in our industry over the next decade.

[Geoff Martha, Chairman and CEO at Medtronic]

At the same time, we remain focused on our ongoing portfolio management efforts. Taken together, we expect this continued focus on executing our transformation will ensure durable top and bottom line growth and create value for our shareholders. Let's turn now to the details of our Q1 results. We had another strong quarter of growth from our largest businesses, Cranial and Spinal, Surgical, and Cardiac Rhythm. These businesses have durable, established leadership positions, and combined, they made up just under half of our revenue and grew 6% organic. Starting with Cranial and Spinal Technologies, we had another great quarter, growing 6% globally and 8% in the U.S., driven by our market-leading Aible ecosystem. We're seeing growth in both neurosurgery capital equipment and the associated pull-through of our best-in-class spinal implants and biologics as surgeons continue to adopt Aible.

[Geoff Martha, Chairman and CEO at Medtronic]

Neurosurgery grew 5%, including double-digit growth in Mazor Robotics and high single-digit growth in StealthStation navigation. Spine and biologics grew 7% globally and 9% in the U.S. These results demonstrate our successful strategy of offering surgeons a differentiated and innovative ecosystem, including our AI-enabled surgical planning platform and patient-specific customized implants, along with imaging, navigation, and robotic technologies. Now, moving to surgical, we grew 7%. Supply continued to improve, and this drove high single-digit growth in advanced surgical technologies. We had particular strength in advanced energy as we continue the rollout of our LigaSure XP and cordless Sonicision 7. Cardiac rhythm grew 5%, with mid-single-digit growth in defibrillation solutions, diagnostics, and cardiac pacing. Now within pacing, we had strong mid-teens growth in our Micra leadless pacemaker franchise, and we launched our next-generation Micra devices, AV2 and VR2, in the U.S.

[Geoff Martha, Chairman and CEO at Medtronic]

These tiny 0.8 cc devices have a battery life of 16 and 17 years respectively, 40% longer than our previous generation and well beyond average battery life of competing products. We're also seeing EPs rapidly adopt conduction system pacing as an alternative to traditional single or dual-chamber pacing. Our 3830 lead is the only one approved for conduction system pacing in the U.S., and it grew 45% in the quarter. Looking ahead, we're preparing to launch the Aurora EV-ICD later this year. Aurora is a game changer for the ICD space. It delivers the benefits of a traditional ICD, including the same size, longevity, and pacing features, but without leads in the heart or veins. Turning to our synergistic businesses, there were several notable performances this quarter. Cardiac surgery grew 8% again this quarter, with strength in perfusion and cannula.

[Geoff Martha, Chairman and CEO at Medtronic]

Our aortic and ANT businesses both grew double digits, driven in part by improved product availability. Peripheral vascular grew mid-single digits, with low double-digit growth in drug-coated balloons and high single-digit growth in superficial vein therapy. Neuromodulation grew mid-single digits in both pain stim and brain modulation, driven by new implants of Intellis with DTM and Percept PC with BrainSense. Just last week, we received CE mark approval for our next-generation spinal cord stimulator, Inceptiv, which will be available in Europe in the coming months. Inceptiv incorporates closed-loop therapy with ECAPs, the result of decades of Medtronic R&D to unlock the ability to listen and respond to signals along the spinal cord. Both our largest and synergistic businesses had really strong quarters, and our businesses that compete in high secular growth med tech markets, they did as well.

[Geoff Martha, Chairman and CEO at Medtronic]

All combined, these businesses made up 20% of our revenue and grew in the high single digits in Q1. We continue to disproportionately invest in these businesses, we expect them to become a larger part of our revenue mix and be large contributors to our durable growth in the future. Starting with Structural Heart, transcatheter valves grew 11% globally, including 12% growth in the U.S. and 21% growth in Japan. We continue to see improvements in the TAVR space and adoption of our differentiated Evolut FX valve. Evolut FX combines enhanced and predictable valve deployment with industry-leading durability. Next Monday, we're looking forward to the presentation of the NOTION 10-year data at ESC, which will look at the durability of the CoreValve and Evolut valves compared to surgery over a decade.

[Geoff Martha, Chairman and CEO at Medtronic]

In neurovascular, we grew mid-single digits when you exclude China, where the market is subject to volume-based procurement. Global growth was fueled by continued strength and flow diversion. We're seeing strong adoption of our Shield Technology for treating aneurysms, which is available on our Pipeline Flex and Pipeline Vantage flow diverters. Cardiac ablation solutions grew 5%. As you know, pulsed field ablation has become one of the most anticipated technologies in med tech, and we will be leading the way in bringing PFA catheters to market for both focal and single-shot segments. We're continuing the limited market release in Europe for our Affera Mapping and Ablation System, including our Sphere-9 focal catheter. Sphere-9 can perform both PFA and RF ablation and delivers high-density mapping, all from the same catheter.

[Geoff Martha, Chairman and CEO at Medtronic]

Turning to our single-shot PFA catheter, PulseSelect, we filed for approval with U.S. FDA and expect to be one of the first companies with a PFA catheter in the U.S. market. With our PFA catheters and the Affera MapNav system, combined with our leading Arctic Front cryo solution and differentiated AcQCross transseptal access system, we're poised to become a more meaningful player in the fast-growing $8 billion EP ablation space. In robotic surgical technologies, we increased our installed base as we continue the international rollout of our differentiated Hugo robotic system, we've activated new sites in our EXPAND URO U.S. pivotal trial, which continues to progress the plan. We expect Hugo to be a meaningful growth driver for us in the years ahead, given its differentiated value proposition, our leading position in minimally invasive surgery, and the low penetration of robotic surgery around the world.

[Geoff Martha, Chairman and CEO at Medtronic]

In Diabetes, we had a good quarter as we continue to see very strong demand for the MiniMed 780G AID system in markets around the world. 780G is a true second-generation AID system and is the only one with 5-minute adjustments and autocorrections and meal detection technology. We're getting great feedback that users are feeling a difference within 1 to 2 days. Our real-world evidence indicates that 90% of users are achieving or exceeding their glycemic targets when using our recommended settings, as well as getting burden reduction in their Diabetes management. This differentiated value proposition is showing up in our results. Non-U.S. developed markets grew 18%, our highest growth in 4 years, driven by both 780G adoption and increased CGM attachment rates. In the U.S., we're seeing great results and momentum from the 780G launch.

[Geoff Martha, Chairman and CEO at Medtronic]

First, the launch drove low 30s growth in our US durable pump sales. Second, we're seeing our prescriber base rapidly expand. Since we last talked to you at ADA in late June, we've had a 30% increase in unique prescribers, with now over 13,000 since launch. Third, we've had over half of our 770G install base upgrade or place an order for the 780G since launch. Not only is demand coming from our existing installed base, but we're also getting competitive conversions. Finally, we're seeing very high CGM attachment rates in the 780G install base, which will drive our economics and gives us confidence in accelerating growth. The turnaround in diabetes is real and underway, and I am pleased with the progress the team is making, and we're just at the beginning of this inflection point for the business.

[Geoff Martha, Chairman and CEO at Medtronic]

As we shared with you at our ADA Investor Briefing in June, we see the intensive insulin space moving from primarily standalone CGM today, to one that is smart dosing through either AID systems or smart MDI. We are well positioned for this trend. We continue to invest heavily in next generation durable pumps, smart pens, patch pumps, sensors, and algorithms, with multiple programs under development. Importantly, we're the only company assembling this complete ecosystem of differentiated technology for people living with diabetes. With that, I'll turn it over to Karen to discuss our financial performance and our fiscal 24 guidance raise. Karen?

[Karen Parkhill, CFO at Medtronic]

Thanks, Geoff. As Geoff mentioned, we had a strong start to our fiscal year, with 6% revenue growth coming in ahead of expectations. We also had good growth on the bottom line, with non-GAAP EPS of $1.20, up 6%. This was $0.09 above the midpoint of our guidance range, with $0.07 coming from better-than-expected operational performance and $0.02 from FX. We're focused on positioning Medtronic to drive durable growth. You've seen that over the last several quarters on the top line, and as we talked about on our last call, stabilizing and then ultimately improving gross margins remains a priority for us. The breadth of our revenue growth this quarter is notable.

[Karen Parkhill, CFO at Medtronic]

As Geoff mentioned, each of our 4 business segments grew 6%, and by geography, non-US developed and emerging markets both grew in the high single digits, with the U.S. growing mid-single digits. Western Europe grew 8% again this quarter, with high single-digit growth in Cardiovascular and Medical Surgical, and high teens growth in Diabetes. Emerging markets grew 8% and were affected by new sanctions in Russia and ongoing VBP impact in China. That said, China growth at 4% was better than expected, given some provincial VBP delays to later in the year and strong procedure recovery. Excluding China and Russia, emerging markets grew in the high teens, with mid-teens growth in Southeast Asia and the Middle East and Africa, and high teens growth in Latin America and South Asia.

[Karen Parkhill, CFO at Medtronic]

Turning to margins, our adjusted gross margin was relatively stable year-over-year and ahead of expectations, with better-than-expected pricing and less-than-expected impact from currency offsetting inflationary pressures. Our operating margin increased 90 basis points, driven by revenue outperformance and our focus on expense management, particularly in our G&A line. Below the operating profit line, our adjusted nominal tax rate was 15.8%, above expectations, driven by a change in Puerto Rico tax law. The change drove an approximate 120 basis point increase in our tax line, offset by a corresponding decrease in other operating expense, the change was net neutral to earnings. Turning to capital allocation. We're prioritizing investments in innovation as we disproportionately invest in high growth, high return opportunities. We do this through multiple channels, including organic R&D, minority investments, strategic partnerships, and disciplined acquisitions.

[Karen Parkhill, CFO at Medtronic]

At the same time, we prioritize returning a minimum of 50% of our free cash flow to our shareholders, primarily through our strong and growing dividend. We also continue to advance our active portfolio management. Last quarter, we moved our Renal Care Solutions business into a joint venture with DaVita. We've been focused on the separation of Patient Monitoring and Respiratory Interventions, and as we noted in our 10-K, we now expect to complete the separation in the first half of next fiscal year, if not sooner, as we've been evaluating different types of transactions to maximize shareholder value. We've always said a spin sets a high bar, and it remains the likely way we'll separate these businesses. Turning to guidance. With our outperformance in the first quarter and improved underlying fundamentals, we're raising our full year revenue and EPS guidance.

[Karen Parkhill, CFO at Medtronic]

We now expect fiscal 2024 organic revenue growth of 4.5%, an increase from the prior range of 4%-4.5%. This guidance excludes the impact of foreign currency and revenue from our new other segment. I direct you to the guidance slide in our earnings presentation for additional details. In the second quarter, we're expecting organic revenue growth to be in the range of 4%-4.5%. On a comp adjusted basis, this represents an acceleration over the first quarter. We expect a steady acceleration in underlying growth in the back half of the year as well. While the impact of currency is fluid, based on recent rates, foreign currency would have a neutral impact on full year revenue, including a favorable impact of $85 million-$135 million in the second quarter.

[Karen Parkhill, CFO at Medtronic]

Moving down the P&L, as we have said before, we expect inflation and currency pressures this fiscal year, and we do expect some of the delayed impact from the provincial VBPs that benefited us in the first quarter to come later in the year. However, you are beginning to see the results from the actions we are taking to drive structural changes in our global operations and supply chain. To give a few examples, we're moving to fewer, more strategic suppliers that are giving us better terms, and we're implementing improvements to run our factories more efficiently and reliably. There is more to come, and we expect this will drive stabilization in our gross margin over time and then improve it from there.

[Karen Parkhill, CFO at Medtronic]

On the bottom line, we're raising our fiscal 2024 non-GAAP diluted EPS guidance to the new range of $5.08-$5.16, an increase from the prior range of $5.00-$5.10. This is a $0.07 increase at the midpoint, in line with the first quarter operational beat. The guidance range continues to include an unfavorable 6% impact from foreign currency based on recent rates. The projected 6% annual FX impact is unchanged from May, as the $0.02 of FX upside in the first quarter is now offset later in the year. For the second quarter, we expect EPS of $1.16-$1.20, including a 6% unfavorable impact from foreign currency based on recent rates. Before sending it back to Geoff, I'd like to acknowledge our employees who are watching today.

[Karen Parkhill, CFO at Medtronic]

I truly appreciate your focus on driving change to execute well and deliver on our priorities. It is that focus that contributes to these results and fulfills our enduring mission to alleviate pain, restore health, and extend life for millions of patients around the globe. Thank you. Back to you, Geoff.

[Geoff Martha, Chairman and CEO at Medtronic]

Okay, thank you, Karen. Now, before we go to the analyst questions, I'll close with a few thoughts. First, Q1 was a strong start to our year, and we're establishing a track record of delivering dependable mid-single-digit growth. We're executing and bringing innovation to the market. We're making progress in countering the impacts that inflation and currency are having on our margins, and we expect this to lead to stabilization and then improvement over time. We're also seeing improved underlying fundamentals in our supply chain and in our markets, across our businesses and geographies. Like I said earlier, we're at the beginning of an inflection point in our diabetes business, and we're seeing strength in our established market-leading businesses like CRM and Spine. With our pipeline, we have several important growth catalysts that we expect to come to market over the coming quarters.

[Geoff Martha, Chairman and CEO at Medtronic]

We're on the right path and building momentum. Underneath all of this, what may be less visible to you are the steps we've taken to transform the company, tackling the root causes of what have made our growth less dependable in the past. We're ensuring a performance-driven culture, partially driven by a number of new leaders in the company. We're advancing our capital allocation and portfolio management priorities to take advantage of high growth opportunities, we're executing on the programs that we believe will lead to scale advantages, whether that's in our now centralized global operations and supply chain organization, or in how we go to market with large enterprise customers around the world, or in how we're leveraging core technologies and implementing new innovations across our businesses.

[Geoff Martha, Chairman and CEO at Medtronic]

To accelerate this last area, we created a new position of Chief Technology and Innovation Officer and hired Ken Washington this past quarter to fill that role. Ken was recently at Amazon, where he led consumer robotics, and before that, was Chief Technology Officer at Ford Motor Company and VP of the Advanced Technology Center at Lockheed Martin Space Systems. I look forward to sharing more details in the quarters ahead on how Ken is leading our efforts to leverage technologies like robotics and AI across the enterprise, which we believe will lead to new differentiated therapies for patients and better experiences for our customers. This is an extensive transformation.

[Geoff Martha, Chairman and CEO at Medtronic]

Yes, there's still work to be done, but you're seeing some of the benefits in our results, and you should expect to see more of this over time as we continue to work toward delivering durable revenue and earnings growth, which, combined with a growing dividend, is a winning formula for creating value for our shareholders. Let's move to Q&A, where we're going to try to get to as many analysts as possible. We ask you to limit yourself to just one question and only, if needed, a related follow-up. If you have additional questions, you can reach out to Ryan and the investor relations team after the call. I also want to note that today is the first time we have Mike Marinaro, who runs our surgical and our endoscopy businesses, joining us for the Q&A.

[Geoff Martha, Chairman and CEO at Medtronic]

Bob White's focus is on the PMRI businesses as we separate, which is a heavy lift, and we have Mike focused on the other two med surg businesses. Today, if you have questions on surgical or endoscopy, direct them to Mike, and PMRI, questions can go to Bob. With that, Brad, can you please give the instructions for asking a question?

[Operator]

For the sell-side analysts that would like to ask a question, please select the Participants button and click Raise Hand. If you're using the mobile app, press the More button and select Raise Hand. Your lines are currently on mute. When called upon, you will receive a request to unmute your line, which you must respond to before asking your question. Lastly, please be advised that this Q&A session is being recorded. For today's session, Geoff, Karen, and Ryan are joined by Que Dallara, EVP and President of Diabetes, Mike Marinaro, EVP and President of the Surgical and Endoscopy Businesses, Sean Salmon, EVP and President of the Cardiovascular Portfolio, Brett Wall, EVP and President of the Neuroscience Portfolio, and Bob White, EVP and President of the Medical Surgical Portfolio. We'll pause for a few seconds to assemble the queue.

[Operator]

We'll take the first question from Vijay Kumar at Evercore ISI. Vijay, please go ahead.

[Vijay Kumar, Senior Managing Director at Evercore ISI]

Hey, guys. Thanks for taking my question. Geoff, congrats on good friends here. Good execution. Maybe my first one on diabetes here. The 30% US growth numbers here, I think that's a revenue number. Do you know what the pump growth number was in US, and how much of this was existing customers? How much of this growth is driven by existing customers upgrading the 770G users versus new customer adds?

[Geoff Martha, Chairman and CEO at Medtronic]

Thanks, Vijay, for the question. Yeah. Well, first of all, let me just say we're, you know, really pleased with the momentum we have in Diabetes. I mean, I think we're on the kind of early stages of a growth acceleration there. You know, we're seeing great outcomes in patients. Like I mentioned in the commentary, a significant increase in unique prescribers, a much higher attachment rate of CGM, which will, you know, really impact our economics. That's where a lot of the profit comes from. We think this is durable and in line with the market trends, of, you know, time and range and moving, you know, to automated insulin delivery.

[Geoff Martha, Chairman and CEO at Medtronic]

We've got a nice pipeline coming down the path as well. You know, to answer those specific questions, I'm going to turn to, to Que, as you know, runs that business. Que, do you wanna touch on Vijay's specific questions?

[Que Dallara, EVP and President of Diabetes at Medtronic]

Yes. Thanks, Geoff. Thanks, Vijay. We're really pleased with the momentum we're seeing in the U.S. so far. In terms of what's driving the low 30s AID growth in the U.S., it's both our existing install base of 770G users that have upgraded. We've had more than 50% of that cohort upgrade or in the process of upgrading. We're also seeing growth coming from new patients. We've had the highest new patient growth in 3 years, and that's coming from MDI as well as competitive switches.

[Vijay Kumar, Senior Managing Director at Evercore ISI]

That's helpful to hear. Maybe, Geoff, one quick follow-up. A lot of questions here on China. The new anti-corruption campaign, you know, we're seeing some headlines, a lot of questions on how this could impact, you know, device companies. Maybe just talk about the high level what you're seeing in China. What was the VBP impact in the quarter? Any, any signs of perhaps the channel pausing here because of this new anti-corruption campaign? Thank you.

[Geoff Martha, Chairman and CEO at Medtronic]

Yeah, Vijay asked about the, the, the anti-corruption and VBP, so in China. Look, on the anti-corruption, I recognize that there are concerns out there, and we're, look, we're actively monitoring the situation, which is, you know, fluid in nature. I'll say that thus far, we, we're not seeing any material headwind for our business. You know, it is, you know, kind of pivoting to there's a linkage to VBP. It's worth noting that, you know, we, you could argue that we're somewhat a bit insulated from some of this anti-corruption with, you know, the coverage, you know, under VBPs.

[Geoff Martha, Chairman and CEO at Medtronic]

I mean, volume in this case is contracted and with the hospital, pricing is determined with VBP, and we're less reliant on, you know, the field team and distribution, which has also allowed us to take, you know, costs out to mitigate the price impact. So, you know, no impact at this point from the anti-corruption campaign that, that you, that you read about. Then regarding, you know, VBP, I mean, you know, this, it's, you know, we feel it's been a two-and-a-half-year kind of impact here, and we're, we're... For us, that fully, that impact, kind of, you know, fully takes in effect in this fiscal year, FY 2024. It's all in our guidance.

[Geoff Martha, Chairman and CEO at Medtronic]

As Karen pointed out in the commentary, you know, the China growth this past quarter was at 4%, which is slightly higher than we expected. Still well below, you know, where, what it used to be, but, and where we think it's gonna get back. You know, as we, kind of lap this, these last couple VBP areas in FY 2024, we expect this revenue to get back to, you know, historical high single-digit, low double-digit growth, you know, for us. Hope that answers the question. This is, this is something as you, you know, look forward, it's a, it's a, you know, multibillion dollars of revenue for the company that over the last couple of years has been negative, more recently flat, now starting to get positive.

[Geoff Martha, Chairman and CEO at Medtronic]

As we lap-- as we get out of FY 2024, again, we, we, I expect a tick up in, in this growth. That's coming.

[Karen Parkhill, CFO at Medtronic]

Thanks.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Thanks for the questions, Vijay. We'll take the next question, please, Brad.

[Operator]

Yeah. The next question comes from Robbie Marcus at JP Morgan. Robbie, please go ahead.

[Robbie Marcus, Managing Director and Senior Analyst at JPMorgan Chase & Co.]

Oh, great. Good morning. Congrats on a good quarter. Maybe to start, for Geoff or Karen, you know, as we think about guidance for the rest of the year, you raised the organic sales growth from the low end of 4%-4.5%, up to 4.5%. You did 6% in the first quarter. Maybe just walk us through why growth is going to decelerate for the rest of the year, and, you know, what, what are some of the factors affecting what could drive you above that? Thanks.

[Karen Parkhill, CFO at Medtronic]

Yeah, thanks for that question, Robbie. Appreciate it. You know, Q1 was a really great start to our year, and we're really pleased with the breadth of our performance. As Geoff mentioned, it's the third consecutive quarter that we've had of solid mid-single-digit growth. We're carrying the beat that we had in Q1 and raising our Q2 guide to 4%-4.5%. All of that puts our FY 2024 guidance at 4.5%. You know, it's still early in the year, and we're, we're focused on providing guidance that sets us up for success. You know, I've talked about some of the puts and takes that we've got. We're a little more optimistic on China. Geoff talked about it. We've had procedure volume recovery.

[Karen Parkhill, CFO at Medtronic]

We also had some of the VBP impacts that we expected in the first quarter, delayed into the, into the later in the fiscal year. We're expecting Russia to be a bigger drag given the new sanctions that were put in place in late May. We're focused on offsetting that just as we did in Q1, and we feel good about the improved underlying fundamentals. We're intensely focused on hitting our commitments. Just on the acceleration for the rest of the year, on a comp adjusted basis, you know, Q2 represents an acceleration from Q1, and then we expect continued acceleration into the back half, each quarter, of the fiscal year into the back half. Hopefully that answers your question.

[Robbie Marcus, Managing Director and Senior Analyst at JPMorgan Chase & Co.]

Yeah, great. Thank you. Maybe just one more on margins. You know, margin expansion, or the upside in the quarter came from gross margin. You know, SGNA, I know you had some reductions in the headcount. As we just try and think about operating margins, you know, for this year and going forward, how should we think about how much more there is to come out of SGNA and how much more upside, there is in gross margin moving back towards where we were pre-COVID? Thanks a lot.

[Karen Parkhill, CFO at Medtronic]

Yeah, thanks for the question, Robbie Marcus. Clearly, we're focused on driving margin expansion and ultimately on the gross margin getting back to pre-COVID levels over time. You know, we, we saw, you know, improved margins this quarter. You know, we're increasing our full year guidance on gross margin expectations given some of that outperformance. In Q1, we did have some better than expected currency and pricing, and some of that was due to timing, with some provincial tenders in China being delayed a bit. Some of the FX improvement that we saw this quarter, you know, we expect FX to impact us a little bit more in the back half of the year.

[Karen Parkhill, CFO at Medtronic]

As we think about margins, we are, we are making investments in our, in our global operations and supply chain to drive cost out of the organization. You know, I, I mentioned a couple of examples where we're, you know, where we're consolidating our suppliers and focused on, you know, improvements in our manufacturing operations to, to drive continued improvement. Over time, you know, we're focused on stabilizing and improving our margins. That, you know, that will continue to impact us on the operating margin line. You know, on SG&A, as you mentioned, we're focused on continuing to drive leverage in our SG&A line, as you've seen us do for a long period of time.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Okay. Thank you, Robbie. We'll take the next question, please, Brad.

[Operator]

The next question comes from Larry Biegelsen at Wells Fargo Securities. Larry, please go ahead.

[Larry Biegelsen, Managing Director and the Senior Equity Research Analyst at Wells Fargo Securities]

Good morning. Thanks for taking the question. I guess, two for Sean. You know, given the upcoming events here with the Symplicity, AdCom and then the Farapulse data this weekend. Sean, you know, how are you feeling about, you know, the Symplicity panel, tomorrow? If we see a positive recommendation, help us think about, you know, the timelines for approval and, and the ramp in the U.S. for renal denervation. Second, you know, we're going to see the Farapulse data this weekend as well. You guys are growing, you know, mid-single digits. Looks like a little bit below the market right now. What should we be looking for in the Farapulse data, and how are you feeling about being able to grow your AFib business, you know, at or above the market going forward? Thank you.

[Sean Salmon, EVP and President of the Cardiovascular Portfolio at Medtronic]

Excellent question, Larry. I guess starting with the AdCom panel, obviously, we've been very confident about the prospects of U.S. approval, and we're exquisitely well prepared for that panel. I'm not going to handicap the timing, but typically, you know, it's three to four months post-panel recommendation, you tend to see things. I'd say an approval in the second half of fiscal year 2024 is certainly in order with that kind of timing. You know, the ramp itself, of course, is going to be dictated by the pace of reimbursement, and we're well prepared on that front as well. As far as our pulsed field ablation, you know, we're looking forward to seeing the results like everyone else is.

[Sean Salmon, EVP and President of the Cardiovascular Portfolio at Medtronic]

This is a randomized trial, as you know, so that comparative efficacy compared to both Cryo and RF ablation for, for the populations being studied will be of interest to us. You know, I think our distinction really in pulse field is that we are the only player that has both a focal solution as well as an anatomic solution in the bag. The, the anatomic solution or single-shot market is about 15% of the, of the market, and the other 85% is what the point-by-point ablation will bring to us. So certainly very confident in both the both technologies, both the PulseSelect and Affera mapping and Sphere9 catheter system, which is very different than everything else that's out there. Then we look forward to bringing those to customers all around the world.

[Geoff Martha, Chairman and CEO at Medtronic]

All right. Thank you. Thanks, Larry. Next question, please, Brad.

[Operator]

The next question comes from Danielle Antalffy at UBS. Danielle, please go ahead.

[Danielle Antalffy, Managing Director and Senior Analyst at UBS]

Hey, good morning, everyone. Thanks so much for taking the question. Congrats, this was quite a good quarter. Just a quick question on GLP-1s. Geoff, I know this is probably an annoying question for you, but this is something that's been impacting the market broadly. Just curious, you guys touch on many, many areas within medical devices. How are you guys thinking about the impact of GLP-1s over the next, you know, I would say even few years, but maybe let's focus on more the next year as these drugs get more readily adopted?

[Geoff Martha, Chairman and CEO at Medtronic]

Sure. Thanks, Danielle, for the comments and the question. Yeah, it is interesting. It's a... First of all, I'd say it's an important class of drugs, and, you know, like you, we're monitoring to see how the GLP-1 therapy is being adopted. You know, that said, our initial work indicates minimal impact to our business. You know, when you, you know, bariatric, the one area we've seen some modest impact is bariatric. This is a, you know, this is a really small impact, and this is a, you know, relatively small part of our surgery business. We are hearing from, you know, the work we do is our internal analysis, plus, you know, dialogue that we're having with, you know, physicians, around the world.

[Geoff Martha, Chairman and CEO at Medtronic]

We actually operate obesity clinics in Europe as well. You know, they're talking about longer term, this could actually bring in the bariatric space, more patients into the funnel. Short term, we've seen some, some impact, again, modest and a relative bariatrics or relatively small part of our surgery business. Longer term, we'll see how it plays out. There's, there's a bit of optimism there, though. No impact in type one diabetes, which, you know, is the vast majority of our, you know, diabetes business. Just overall, I just, you know, don't see GLP-1s having a material impact on our business, you know, and, you know, medical device, you know, therapies at large. That's, that's, that's what our, our work is showing us at this point.

[Danielle Antalffy, Managing Director and Senior Analyst at UBS]

I guess just one quick follow-up to that, thinking about, again, the Diabetes business. Type 2 is a big growth area. You guys have an AID 10. What are your thoughts specifically on the Type 2 diabetes side of things? Thanks so much.

[Geoff Martha, Chairman and CEO at Medtronic]

Thanks. look, I think this is a, you know, AID for, you know, insulin-dependent, you know, patients, whether they're type 2 or type 1, is pretty underpenetrated. You know, we, we see way more upside there than headwinds. Thanks, Danielle. We'll take the next question, please, Brad.

[Operator]

The next question comes from Travis Steed at Bank of America. Travis, please go ahead.

[Travis Steed, Managing Director at Bank of America]

Hey, congrats on a good quarter. I, I guess I'll ask you about TAVR. Double-digit growth this quarter. Curious how much success you've had with the new valve versus the 5-year data. I know your competitor is going to have 5-year data pretty soon. The 21% Japan growth really stood out. Just curious if that's sustainable or if that was more of a one-off in the quarter.

[Geoff Martha, Chairman and CEO at Medtronic]

Well, first, before I turn it over to, before I turn it over to Sean, we are, you know, if you go back to the last couple of quarters, we are pleased with how our TAVR business is, you know, performing relative to competition and, and how the, the new valve is, is performing and, and also the pipeline for the future. you know, Sean, why don't you give the specifics on that question?

[Sean Salmon, EVP and President of the Cardiovascular Portfolio at Medtronic]

Sure. Travis, the new valve is certainly being well received wherever we've launched it. It's been launched in the U.S. and a number of other geographies and Japan, notably. The other thing that drove Japan growth was that we got a new indication for end-stage renal disease, which is something we've been lacking in Japan. It's a large consideration for that population that really helped drive, drive the performance. Yes, our long-term data have been really the signature of that device, and we'll see more of that this coming weekend, as well as the 10-year NOTION data. This is the first 10-year data being reported out for TAVR, will be on display. Then, of course, we have four-year data coming up on our low-risk study as well to look forward to this fall.

[Sean Salmon, EVP and President of the Cardiovascular Portfolio at Medtronic]

you know, we stand behind the valve performance all the way around, and whether it's the acute ease of use or the long-term durability of the valve.

[Geoff Martha, Chairman and CEO at Medtronic]

... It's really shining, and, and, we're getting a lot of traction from all of that.

[Chris Pasquale, Partner and Senior Research Analyst at Nephron Research]

That, that's helpful. Then the PMRI spend, I assume the time change is more because spends take longer than sales, but maybe some other comments on when we could see the Form 10. Can you confirm the operating margin profile of that business is still kind of slightly higher than overall Medtronic? Then do we need to wait for this to get through to see more on the portfolio management side of things? Thank you.

[Karen Parkhill, CFO at Medtronic]

Yeah, thanks, Travis. you know, I think there's nothing to read into this, other than we're focused on maximizing shareholder value. You know, we've been taking our time to evaluate the alternatives. We've said all along that a spin sets a high bar, and that remains the likely way that we'll separate. So we're expecting to close it first half of next fiscal year, if not sooner. In terms of, you know, Form 10, we'll, you'll see it when you see it. In terms of the margins of the business, yes, they are good margins and, you know, slightly higher than the company. Hopefully, that helps.

[Geoff Martha, Chairman and CEO at Medtronic]

Yeah. The business continues to perform well. Like Karen said, the margin profile has remained strong. Actually, the competitive dynamics, and particularly in the patient monitoring side of it, have probably improved a bit in our favor. It's a good business, and it, and I think with more focus, I think these numbers can even improve.

[Chris Pasquale, Partner and Senior Research Analyst at Nephron Research]

Great. Thanks a lot.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Thanks, Travis. Next question, please, Brad.

[Operator]

The next question comes from Matt Miksic at Barclays. Matt, please go ahead.

[Matt Miksic, Managing Director and Senior Equity Research Analyst at Barclays]

Hi, thanks so much. Question. Congrats on a really strong quarter across the board. There's lots to talk about, but maybe one question on diabetes, for Que, and then, and then one follow-up. Just, just, would love to hear how things are progressing with, you know, some of the programs that you talked about at ADA, the next gen sensor, in, you know, integrated testing, and the, patch, the other patch pump that you were in the process of acquiring here. If I, I could on, on that, Geoff mentioned something about a next gen, AID pump, and I know it's way early to even ask the question, but, but just curious if you are ready to share any hints about that.

[Matt Miksic, Managing Director and Senior Equity Research Analyst at Barclays]

Then, and then one quick follow-up, if I could.

[Que Dallara, EVP and President of Diabetes at Medtronic]

Thanks. Thank you for your questions. As you know, Simplera CGM, our next generation CGM, is under review with the FDA. We're in the process of doing that, and it's very difficult to put a precise timeline on when we expect to have approval, but that is progressing. In terms of the integration with 780G, we have completed adult enrollments for the clinical trial in Q1. We expect to complete the pedes enrollment in Q2, but that's at the clinical trial stage. We're also, in terms of the patch, we're making progress there as well in terms of completing that transaction, and we expect that we would close out the EOFlow acquisition at the end of again, this calendar year.

[Que Dallara, EVP and President of Diabetes at Medtronic]

Again, very sorry to disappoint you, but difficult to comment on our further programs. They're progressing as we expect in our internal timelines, but at this stage, it's a bit too early to put details on specific timing.

[Matt Miksic, Managing Director and Senior Equity Research Analyst at Barclays]

That's, that's, that's helpful and understandable. Just one, the follow-up is on, on sort of seasonality. You know, you've seen July here, and, you know, I know there's been a number of questions across the sector, given what we've seen over the last couple, everyone's been year, year to date, in surgeries and procedure volumes and so on. Just, just any sense of what kind of summer quarter we, we expect, you know, which for you, I guess, is August? You know, softer than usual, seasonally normal? You know, how would you describe what you've seen in July and what your expectations have built into your fiscal Q2 year? Thanks.

[Karen Parkhill, CFO at Medtronic]

I, I would just say, Travis, that, you know, the, the first few weeks of the quarter and what we've seen in July are tracking well. You know, we continue to have strength in the underlying performance and, you know, it's tracking to the expectations we set in our guidance.

[Matt Miksic, Managing Director and Senior Equity Research Analyst at Barclays]

That's fair. All right. Thanks so much.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Thanks, Matt. We'll take the next question, please, Brad.

[Operator]

The next question comes from Chris, Chris Pasquale at Nephron. Chris, please go ahead.

[Chris Pasquale, Partner and Senior Research Analyst at Nephron Research]

Thanks. Geoff, one for you, and then a quick follow-up for Karen. You mentioned artificial intelligence as one of the areas Medtronic is investing in. It's obviously a hot topic in the market more broadly. Could you provide any examples of the work you guys are doing there? Maybe talk about which businesses you see AI as being most relevant for in the near future.

[Geoff Martha, Chairman and CEO at Medtronic]

Sure. Well, you know, first of all, I think, you know, for the medical device industry, you know, the kind of the intersection of traditional biomedical, you know, engineering with these digital technologies, whether it be connectivity, or data analytics techniques like AI and deep learning, you know, robotics, these are all, you know, just a huge opportunity for the industry. This is... These are areas that, you know, we intend to, to, to lead in. You know, AI, we've got, you know, a number of, of businesses that have, you know, first of, of their kind, AI-powered solutions that have received regulatory approval by the FDA and, and other, regulatory bodies around the world.

[Geoff Martha, Chairman and CEO at Medtronic]

You know, you know, what we're seeing here is just, you know, improved outcomes and access. And it's, it's what it's a, you know, when you combine the AI with, with, you know, good data, you know, not just quantity, but the quality of data, and that data is labeled properly. You know, we're seeing, you know, the ability to even, you know, like, evolve, and improve the efficacy over time through the AI and even personalize it. The FDA, you know, has approved a couple of products for us in the cardiac rhythm space, and in spine and in GI, where you have, like, what they call a, a predetermined change control plan, where you're allowed to kind of approve, improve that efficacy over time.

[Geoff Martha, Chairman and CEO at Medtronic]

Some of the businesses that, that are impacted, like I mentioned, you know, are, you know, GI are now calling endoscopy space, where we have AI in the colonoscopies. Like, you're kind of redefining traditional colonoscopies, where the AI is finding, you know, polyps that physicians, you know, were missing. You know, this is, this is significant amount of polyps, and it's obviously good for patient outcomes because these can... There's a high correlation to, to cancer, colon cancer from these polyps, and it's also economically aligned with the hospital's interest as you find more polyps and remove them. You know, in other areas in our spine business, this is a, this is a, an industry that's being completely, you know, redefined by enabling technology, transformed and redefined by enabling technology.

[Geoff Martha, Chairman and CEO at Medtronic]

You know, we, we talk about robotics and imaging and navigation and powered instruments, but AI is a key piece of this. And we have thousands of, of surgeries in our AI, in our AI, that's powering our AI algorithm. With each of... You know, and spine is a complicated, you know, surgery, especially, you know, you know, whether it be a degen or, or for sure, deformity, complex cases, highly reliant on surgeon training. And the AI is really just improving outcomes here, especially, when it's combined with enabling technology. You know, I could go on.

[Geoff Martha, Chairman and CEO at Medtronic]

Cardiac Rhythm in our, in our monitoring, and our loop, LINQ monitoring business there, we are, you know, cutting down false positives, you know, for in detecting AFib by 50% using AI, and that's creating, you know, multiple hours of productivity for these clinics around the country. Given, you know, really driving the deployment of that technology. I'd say it's a huge opportunity. It's a differentiator. I mentioned we hired a new head of technology, Ken Washington, to really help us scale this across all our businesses and better partner with some big tech companies. We've talked about our partnership with NVIDIA. In the end, I'd say what we're going to see over the next couple of years is you may not be replacing...

[Geoff Martha, Chairman and CEO at Medtronic]

AI is not going to be replacing surgeons, but I tell you what, surgeons who use AI will be replacing surgeons that don't, and we are going to be right in the middle of that mix.

[Chris Pasquale, Partner and Senior Research Analyst at Nephron Research]

Thanks. Those are great examples. Karen, you mentioned price as a contributor to the gross margin strength in the quarter. Could you give us a sense for what price looks like across the company today, maybe how it compares to where you were a couple of years ago, and if you think that it's sustainable as we move into a less inflationary environment going forward?

[Karen Parkhill, CFO at Medtronic]

Yes, thanks for the question. As you've heard us talk about, we have been, building a, a pretty strong muscle around, pricing, and we're focused on ensuring that, you know, we price for the value that we deliver. Typically, historically, you know, pre-COVID, we would experience up to 200 basis points of pricing pressure every year, and we've been able to neutralize that these last couple of years, including this quarter. We obviously have had, you know, VBP pressure this year, and last year, we, we were able to neutralize that as well at the total company level. By quarter, you know, it, it, it may not be fully neutralized depending on how VBP hits us, but we do believe that this pricing muscle that we've built is going to be lasting.

[Karen Parkhill, CFO at Medtronic]

we, you know, we fully intend it-- intend to, you know, continue to track, monitor, talk about pricing so that even as we move into a, you know, lower inflationary environment, you know, we're focused on, on, you know, continuing this pricing, you know, muscle that we've built.

[Geoff Martha, Chairman and CEO at Medtronic]

I just want to reemphasize that, that last point there on, on kind of. We'll start with on margins. On gross margins, there was a question earlier, Karen went into detail. I'm not going to repeat that, but on, on gross margins, you know, the pricing muscle that we've been building, I think, I think we intend that to be enduring. Then, you know, Karen mentioned the cost of goods sold improvements that we're making, productivity around our cost of goods sold line, really driven by our, our new structure, strategy, and capabilities in our global operations and supply chain. That'll help all help gross margin.

[Geoff Martha, Chairman and CEO at Medtronic]

As you go down the P&L, you know, we're really focused on getting leverage from, from SG&A, you know, excited about, you know, stabilizing and then improving the margins over time.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Okay, thanks, Chris. We'll take the next question, please, Brad.

[Operator]

The next question comes from Jayson Bedford at Raymond James. Jayson, please go ahead.

[Jayson Bedford, Managing Director and Senior Equity Research Analyst at Raymond James]

Good morning. Can you hear me okay? Yeah, Jayson, we can hear you.

[Jayson Bedford, Managing Director and Senior Equity Research Analyst at Raymond James]

All right, thanks. Not to make this, a call all around gross margin, but I, I did have a question. You, you mentioned stabilization, and I just wanted to put a little context around that. What is the expected gross margin for fiscal 24?

[Karen Parkhill, CFO at Medtronic]

You know, at this point, like, when we gave our guidance back in May, we said we expected it to be around 65.25. At this point, we're expecting it to be about 65.5. You know, we've seen some improvement in the first quarter, and we're carrying some of that through.

[Jayson Bedford, Managing Director and Senior Equity Research Analyst at Raymond James]

Okay. And just, Karen, the dropdown for the rest of the year versus first quarter levels, revenue is higher. Is this just strictly a function of, of the VBP impact hitting more in the back half?

[Karen Parkhill, CFO at Medtronic]

Yes, it's both VBP and currency. You're right, you know, higher revenue growth clearly helps on the margin front. But we have seen some timing on VBP that we talked about. We also have some timing on FX. It was a little bit better than we expected, down the PNL in the first quarter, and we expect to give some of that back as we look at the currency impact, you know, going forward.

[Jayson Bedford, Managing Director and Senior Equity Research Analyst at Raymond James]

Thank you.

[Geoff Martha, Chairman and CEO at Medtronic]

Thanks, Jason. Brad, I think we have time for two more questions.

[Operator]

The next question comes from Joanne Wuensch at Citi. Joanne, please go ahead.

[Joanne Wuensch, Analyst at Citi]

Good morning, thank you very much for taking the question, and nice quarter or nice way to start the fiscal year. Two quick questions. Volumes we've seen throughout MedTech this season have been quite strong, which leads me to wonder, is this sort of a new normalized base or whether or not we're just catching up on some pent-up demand? I'd love your opinion on that. Then for Hugo, you talked about activating new sites in the United States. Can you give us maybe an update on the thoughts on timing of a launch in the U.S., and then anything else you can add for OUS robotic placements would be appreciated. Thank you.

[Geoff Martha, Chairman and CEO at Medtronic]

Sure, Joanne. Yeah, good to hear from you. Thanks for the questions. I'll take the first one, and then I'll turn it over to Mike Marinaro to handle the, the, the Hugo questions. You know, I think on procedure trends, you know, we're, we're, as Karen mentioned, I mentioned in the commentary, they're, they're definitely improved, and, you know, I'll start in the U.S., where, you know, we're up about 5, 5% or so. The, you know, across the board, we're seeing very good procedural trends. You know, and we're largely back to pre-COVID or better.

[Geoff Martha, Chairman and CEO at Medtronic]

Pre-COVID levels or better, you know, as, as you know, over the last, I don't know, 18 months or so, the, the rebound has been, I'd say, held back a bit by staffing issues, and those have seemed to have abated. And like I said, we're getting pretty broad-based procedural pickups and, and are back to Pre-COVID or even better levels. Outside of the U.S., I'd say it's even, it's even stronger. In Western Europe, high single digits, and the recovery in Europe is definitely in full swing.

[Geoff Martha, Chairman and CEO at Medtronic]

Latin America, high teens, and just our, like, our emerging market base, when you, you know, you got to pull out, you know, if you pull out China, which is VBP, and like I said before, this is, you know, we see the kind of the, the, the stabilizing year here for VBP, FY 2024, and then as you get into FY 2025, you get back to some higher, you know, higher growth in China like we've seen before. If you take out China and Russia with the sanctions, you know, we're in the, the teens, mid-teens and high teens, actually, in emerging markets. Emerging markets trends are strong. You know, I mentioned Latin America as a standout, Western Europe, pretty good trends. You know, we're not seeing like this.

[Geoff Martha, Chairman and CEO at Medtronic]

At least in the areas we're in, I've heard some area like, you know, orthopedics, there's been a, a pent-up demand, but we're not seeing it in the areas we're in. It's been a steady flow, versus a like a pent-up demand. I think that's good news for, for the industry. On the Hugo specific questions, I'd like to turn it over to Mike Marinero, who runs our surgical business, which includes Hugo and also our endoscopy, or formerly called GI business, reports up to him as well.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Yeah, thanks for the question, Joanne. Specifically on the U.S., we did comment that we added sites in the quarter, and that's true. We had, well, sites and enrollments and continue to progress according to plan in our Expand Euro study. We're pleased with the progress we're making there and seeing that progress continue here as we've moved into this quarter. More broadly, we've seen good progress, really, and continue to be encouraged about the progress we're making across the program. We're now selling in five regions around the globe, in Greater China, Asia, Western Europe, LATAM, North America, and Canada, and increased our installations again here in this quarter. I think importantly, we've also seen an increasing flow or steady flow of increasing indication approvals.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

We received the general surgery indication in Japan, and so now we have a full suite of approvals across general surgery, gynecology and urology in both Japan and Western Europe, which are two of the three largest markets around the globe. Of course, the U.S. is the largest, and that's, you know, one we remain incredibly focused on. Overall, we're seeing that the growth here in Hugo is contributing to the growth we've seen now in the surgical business across the last couple of quarters. It will become a more and more important part of our business as we move forward.

[Geoff Martha, Chairman and CEO at Medtronic]

Yeah, really, look, you know, excited about the setup we have for our business. It's a very large business for us that, you know, where the, the supply capacity has been an issue, that's, that's in a much better spot. The robots out there, Mike just walked through, you know, kind of indication expansion and, and, and geographic expansion and update on the U.S. trial. I like the setup, you know, and the competitive dynamics going forward over the next couple of years. You know, we got two major competitors, you know, one with robot, one without, and we're feeling pretty good about where we are with surgery.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Okay, thanks, Joanne. I, I still see a number of people in the queue, and I apologize that we won't be able to get to all of you today, given timing. We've got time for one more question. Please, Brad.

[Operator]

Our final question comes from Patrick Wood at Morgan Stanley. Patrick, please go ahead.

[Patrick Wood, US Medical Technology Equity Research at Morgan Stanley]

Fabulous. Thank you so much. I'll keep it to one, given the timing. You know, S&OP and supply chain is obviously not a very sexy topic, but, you know, you guys are doing a lot of work on that side. I'm just curious, you know, typically when we put processes and rationalization in place, there's kind of upfront costs and, like, your dual running systems, and it's kind of difficult for, for people to transition. Are you seeing any, you know, slight, let's say, short-term challenges or costs associated with that? Where the payback, you know, is obviously going to come in the next, I don't know, year or two. Just help us understand how that's looking for the business. Thanks.

[Geoff Martha, Chairman and CEO at Medtronic]

Well, let me, let me just start off by saying I appreciate your question on supply chain. It's been a big focus area for us. You know, I, I know 2,000 people at Medtronic that, that do think it's a pretty sexy place to be and are pretty proud of the work that we're doing. To answer the question, I'll turn it over to Karen on the cost question.

[Karen Parkhill, CFO at Medtronic]

Yeah. Thanks, Patrick. Yes, when we're, you know, working on improving processes and, and driving, you know, better costs down, it does take investment. That investment is included in the guidance that we've given and is, you know, it's part of the reason that our gross margins, you know, are, are not yet stable. We fully expect those investments to pay off over time and to help drive costs down more than inflation as we work to bring our gross margins up. Hopefully, that's helpful.

[Patrick Wood, US Medical Technology Equity Research at Morgan Stanley]

Amazing. Thank you.

[Ryan Weispfenning, VP and Head of Investor Relations at Medtronic]

Okay, thanks, Pat. Yeah, thanks, Patrick. Geoff, please go ahead with your closing remarks.

[Geoff Martha, Chairman and CEO at Medtronic]

Well, well, first of all, thanks, everyone, for the questions. You know, as always, we appreciate your support and your continued interest in Medtronic, and we look forward to updating you on our continued progress on our Q2 earnings broadcast, which we anticipate holding on Tuesday, November 21st. With that, thanks again for joining us.

Participants

Executives

• Geoff Martha, Chairman and CEO
• Karen Parkhill, CFO
• Que Dallara, EVP and President of Diabetes
• Ryan Weispfenning, VP and Head of Investor Relations
• Sean Salmon, EVP and President of the Cardiovascular Portfolio

Analysts

• Chris Pasquale, Partner and Senior Research Analyst at Nephron Research
• Danielle Antalffy, Managing Director and Senior Analyst at UBS
• Jayson Bedford, Managing Director and Senior Equity Research Analyst at Raymond James
• Joanne Wuensch, Analyst at Citi
• Larry Biegelsen, Managing Director and the Senior Equity Research Analyst at Wells Fargo Securities
• Matt Miksic, Managing Director and Senior Equity Research Analyst at Barclays
• Patrick Wood, US Medical Technology Equity Research at Morgan Stanley
• Robbie Marcus, Managing Director and Senior Analyst at JPMorgan Chase & Co.
• Travis Steed, Managing Director at Bank of America
• Vijay Kumar, Senior Managing Director at Evercore ISI