Medtronic Q4 Earnings Call Highlights

Key Points

• Medtronic posted strong fiscal Q4 and full-year results, with revenue of $9.8 billion in the quarter and $36.4 billion for the year, both above expectations. Management said it was the company’s strongest top-line performance in a decade, driven by growth across cardiac ablation, diabetes, medical-surgical, and neuroscience businesses.
• Cardiac ablation was the standout growth engine, as Cardiac Ablation Solutions surged 78% worldwide and pulsed field ablation jumped 145% globally. Medtronic said its CAS business is now annualizing at more than $2 billion and expects continued outgrowth versus the broader market in fiscal 2027.
• The company guided for continued growth in fiscal 2027, forecasting organic revenue growth of 6.75% to 7.25% and adjusted EPS of $5.90 to $6.00. The outlook includes the newly separated MiniMed diabetes business and factors in an expected $250 million tariff hit to cost of goods sold.

Medtronic NYSE: MDT reported what executives described as its strongest top-line performance in a decade, as growth in cardiac ablation, diabetes, medical-surgical products and select neuroscience platforms helped drive fiscal fourth-quarter and full-year results above expectations.

Chairman and Chief Executive Officer Geoff Martha said the company generated $9.8 billion in revenue in the fourth quarter of fiscal 2026, up 9.9% on a reported basis and 6.6% organically. For the full fiscal year, revenue was $36.4 billion, up 8.4% reported and 5.8% organically. Adjusted earnings per share were $1.55 for the quarter and $5.53 for the year.

“These results represent the compounding impact of deliberate choices we've made across strategy, operations, and culture,” Martha said, citing execution in foundational businesses such as cardiac rhythm management, cranial and spinal technologies, and surgical products, as well as progress in higher-growth platforms.

Cardiac Ablation Remains a Key Growth Driver

Cardiac Ablation Solutions was a standout in the quarter, with Martha reporting 78% worldwide growth and an additional eight points of U.S. share. Pulsed field ablation grew 145% globally, supported by the company’s Sphere-9 technology and Affera platform.

Chief Financial Officer Thierry Piton said the cardiovascular portfolio grew 10% in the quarter, including 14% in the U.S. and 7% internationally. Within that segment, CAS grew 78%, including 124% in the U.S. Piton said the CAS business is now annualizing at more than $2 billion in revenue and is on track to reach $2 billion on a trailing basis in the first quarter of fiscal 2027.

Martha said Medtronic increased its U.S. Affera installed base by 40% sequentially and is rolling out Prism 2, its next-generation mapping software. The company also launched Sphere-9 in Japan and received FDA approval for a U.S. ventricular tachycardia pivotal trial, which it plans to begin enrolling in the first half of fiscal 2027.

In response to an analyst question, Martha pushed back on concerns that CAS would slow materially as a growth contributor. He said the company expects the CAS market to grow in the mid- to high-teens in fiscal 2027 and expects Medtronic to grow at more than twice the market rate.

Symplicity, Hugo and Altaviva Show Early Momentum

Martha highlighted progress for Symplicity Spyral, the company’s renal denervation therapy for hypertension. He said the company’s physician finder now includes 200 doctors across more than 300 accounts and that average weekly procedure volumes have doubled since a national coverage determination. Symplicity is annualizing at $100 million, he said.

The company also pointed to growing adoption of Hugo, its surgical robotics system. Martha said worldwide procedure volume growth is running two to three times the market and utilization is increasing. Medtronic launched Hugo for urology in the U.S. last quarter and has submitted to the FDA for 510(k) clearance for general surgery and gynecologic indications, as well as its LigaSure RAS vessel sealer.

Touch Surgery, Medtronic’s digital surgery ecosystem, has more than 1,400 installations, up more than 30% sequentially, Martha said.

Altaviva, the company’s therapy for urge urinary incontinence, is also gaining traction, according to Martha. He said Medtronic has trained nearly 1,000 physicians since launch, with active implanters up threefold sequentially and patients treated up 2.5 times.

Segment Results Mixed but Broadly Positive

Piton said Cardiac Rhythm Management grew 5% in both U.S. and international markets. Defibrillation delivered mid-single-digit growth, including high-teens growth in ICDs and mid-60s growth in EV-ICD. Cardiac pacing therapies also grew in the mid-single digits, supported by Micra and the SelectSecure 3830 lead for conduction system pacing.

Structural heart performance was flat, with stronger international results offset by softer U.S. performance. Martha said the TAVR business experienced a slowdown tied to low-risk data but had stabilized over the prior eight to 10 weeks. Piton said the company incorporated that stabilization into its outlook.

Neuroscience revenue grew 3% globally, including 6% internationally. Cranial and Spinal Technologies grew 3% in both the U.S. and international markets, while core spine grew 6%. Piton said the launch of Stealth AXiS helped drive low double-digit growth in navigation and described the platform as a “force multiplier” across planning, robotics and the AiBLE ecosystem.

Medical-Surgical revenue grew 5% globally, including 8% in the U.S. Surgical revenue increased 3%, driven by high-single-digit growth in advanced energy and wound management and a greater contribution from Hugo, partially offset by continued pressure in bariatrics. Endoscopy grew in the high single digits, while acute care and monitoring rose 11%.

MiniMed IPO and Capital Deployment

During the quarter, Medtronic completed the MiniMed IPO, establishing the diabetes business as a standalone publicly traded company while Medtronic remains the majority shareholder during the separation process. Piton said diabetes revenue grew 15% reported and 8.1% organic in the quarter, driven by international execution and U.S. momentum in continuous glucose monitoring and new patient starts.

Martha said the decision to separate MiniMed was not due to a lack of confidence in the business, but rather reflected Medtronic’s focus on areas where its broader technology platforms and commercial footprint can create greater leverage. He said diabetes is a structurally lower-margin business, while the rest of Medtronic is accelerating.

The company also emphasized increased capital deployment. Martha cited the closed acquisition of CathWorks and announced plans to acquire Scientia and SPR Therapeutics, along with investments in Beluga Medical and CardioACC. Piton said Medtronic closed or announced nearly $2 billion of additional investments in the quarter and made 16 venture investments during fiscal 2026 totaling approximately $250 million.

Fiscal 2027 Guidance Includes Extra Selling Week

For fiscal 2027, Piton said Medtronic expects organic revenue growth of 6.75% to 7.25%, including approximately 11.5% to 12% growth in the first quarter. The guidance includes the diabetes business and reflects the benefit of an additional selling week, which is expected to add about 125 basis points to full-year growth and 500 to 600 basis points to first-quarter growth.

Medtronic guided fiscal 2027 adjusted EPS to a range of $5.90 to $6.00. First-quarter EPS is expected to be $1.38 to $1.40.

Piton said fiscal 2027 guidance assumes a $250 million tariff impact to cost of goods sold, including $75 million in the first quarter. He said the company has not assumed any government refund. Excluding tariffs, fiscal 2027 gross margin is expected to be roughly in line with the prior year, while operating margin is expected to rise 60 basis points due to the absence of Blackstone milestone payments and operating leverage.

Martha closed the call by saying the company is positioned for “durable, innovation-led growth” as it invests in robotics, digital tools, artificial intelligence, advanced electronics, targeted acquisitions and market development.

About Medtronic NYSE: MDT

Medtronic plc 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).

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