美敦力 (MDT) 2023 Q3 法說會逐字稿

Good morning. I'm Ryan Weispfenning, Vice President and Head of Medtronic Investor Relations. Welcome to Minnesota, where signs of spring are in the air. I appreciate that you're joining us today for Medtronic's fiscal 2023 Third Quarter Earnings Video Webcast.

早上好。我是 Ryan Weispfenning，副總裁兼美敦力投資者關係主管。歡迎來到明尼蘇達州，那裡空氣中瀰漫著春天的氣息。感謝您今天加入我們，觀看美敦力 (Medtronic) 2023 財年第三季度收益視頻網絡直播。

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 third quarter, which ended on January 27, 2023, as well as our outlook for the remainder of the fiscal year. After our prepared remarks, the executive VPs from each of our four segments will join us, and will take questions from the sell-side analysts that cover the company. Today's program should last about an hour.

在我們進去聽取準備好的發言之前，我將分享有關今天網絡廣播的一些細節。和我一起的是美敦力董事長兼首席執行官 Geoff Martha；和美敦力首席財務官 Karen Parkhill。 Geoff 和 Karen 將對截至 2023 年 1 月 27 日的第三季度業績以及我們對本財年剩餘時間的展望發表評論。在我們準備好的發言之後，我們四個部門中每個部門的執行副總裁將加入我們的行列，並將回答涵蓋公司的賣方分析師的問題。今天的節目應該持續一個小時左右。

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.

今天早上早些時候，我們發布了一份新聞稿，其中包含我們的財務報表以及部門和地區收入摘要。我們還發布了一份收益演示文稿，其中提供了有關我們業績的更多詳細信息。可以在我們的收益新聞稿或我們的網站 investorrelations.medtronic.com 上訪問該演示文稿。

During today's program, many of the statements we make may be considered forward-looking statements, and actual results may differ materially from those projected in any forward-looking statement. Additional information concerning factors that could to cause actual results to differ is contained in our periodic reports and other filings that we make with the SEC and we do not undertake to update any forward-looking statement.

在今天的節目中，我們所做的許多陳述可能被視為前瞻性陳述，實際結果可能與任何前瞻性陳述中預測的結果存在重大差異。有關可能導致實際結果不同的因素的更多信息包含在我們的定期報告和我們向美國證券交易委員會提交的其他文件中，我們不承諾更新任何前瞻性聲明。

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 revenue from our Q1 acquisition of Intersect ENT, references to sequential revenue changes compared to the second quarter of fiscal '23 and are made on an as-reported basis, and all references to share gains or losses refer to revenue share in the fourth calendar quarter of 2022 compared to the calendar quarter of 2021, unless otherwise stated.

除非我們另有說明，否則所有比較都是按年比較，收入比較是在有機基礎上進行的，不包括外彙的影響，以及我們第一季度收購 Intersect ENT 的收入，參考連續收入變化到 23 財年第二季度，並按報告的基礎進行，除非另有說明，否則所有提及的份額收益或損失均指 2022 年第四個日曆季度與 2021 年日曆季度相比的收入份額。

Reconciliations of all non-GAAP financial measures can be found in our earnings press release or on our website at investorrelations.medtronic.com. And 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.

所有非 GAAP 財務指標的對賬可在我們的收益新聞稿或我們的網站 investorrelations.medtronic.com 上找到。最後，我們的 EPS 指引不包括本財年將報告為非 GAAP 收益調整的任何費用或收益。

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

有了這個，讓我們進入演播室，聽聽這個季度的情況。

(presentation)

（推介會）

Hello, everyone, and thank you for joining us today. We reported our Q3 results this morning, and we executed to deliver a top and a bottom line that were ahead of our guidance and Street expectations. We are urgently forging the path to durable growth, and there are many proof points of our progress in these results.

大家好，感謝您今天加入我們。我們今天早上報告了第三季度的業績，我們執行了高於我們的指導和華爾街預期的最高和最低利潤。我們正在緊急開闢通往持久增長的道路，並且有許多證據表明我們在這些成果中取得了進展。

Our cardiovascular and our neuroscience portfolios had strong high single-digit organic growth as we launch new products and demonstrated continued strength in our established market-leading cardiac rhythm management and spine franchises. And at the same time, some of the recent revenue headwinds that have held back our growth are subsiding, including product availability in businesses like Surgical Innovations, Cardiac Diagnostics, Aortic and ENT.

隨著我們推出新產品，我們的心血管和神經科學產品組合實現了強勁的高個位數有機增長，並在我們已建立的市場領先的心律管理和脊柱特許經營中展示了持續的實力。與此同時，最近阻礙我們增長的一些收入逆風正在消退，包括外科創新、心臟診斷、主動脈和耳鼻喉等業務的產品可用性。

The aggressive transformation at Medtronic is advancing. We're focused on reducing complexity, enhancing our culture, improving capital allocation and portfolio management and upgrading our global manufacturing operations and supply chain capabilities. At the same time, we're progressing on our plans for significant cost reductions. These are aimed at partially mitigating the continued impacts from macro conditions such as inflation and effects on our profitability and cash flow.

美敦力的激進轉型正在推進。我們專注於降低複雜性、增強我們的文化、改善資本配置和投資組合管理以及提升我們的全球製造業務和供應鏈能力。與此同時，我們正在推進大幅削減成本的計劃。這些旨在部分減輕宏觀條件的持續影響，例如通貨膨脹以及對我們的盈利能力和現金流的影響。

These cost reductions also create room in our P&L so that we can increase our growth investments, and I'm very encouraged by the rebound in our revenue growth despite procedure volumes remaining a little softer in a few markets and volume-based procurement in China. We are confident in delivering durable revenue growth over the coming quarters as recent revenue headwinds continue to dissipate and we execute across our businesses.

這些成本降低也為我們的損益創造了空間，以便我們可以增加增長投資，儘管在中國的一些市場和基於批量的採購中，程序量仍然略微疲軟，但我對收入增長的反彈感到非常鼓舞。我們有信心在未來幾個季度實現持久的收入增長，因為最近的收入逆風繼續消散，我們在我們的業務中執行。

So let's take a closer look at our Q3 results. As I highlighted at an investor conference last month, we're thinking about our portfolio of businesses in three groups: highest growth, synergistic and established market leaders. So I'll start with our established market leaders, a group of our largest businesses that make up about half of our revenue. Both our cardiac rhythm and spine businesses had really good quarters, growing 8% and 5%, respectively.

因此，讓我們仔細看看我們第三季度的結果。正如我在上個月的一次投資者會議上強調的那樣，我們正在考慮將我們的業務組合分為三組：最高增長、協同和成熟的市場領導者。因此，我將從我們成熟的市場領導者開始，這是我們最大的一組業務，約占我們收入的一半。我們的心律和脊柱業務的季度表現都非常好，分別增長了 8% 和 5%。

In CRM, we continue to see strong market adoption of our micro-leadless pacemakers, which grew 14%, and our Defibrillation Solutions business grew 7% as replacement headwinds are moderating. And just last week, we received CE Mark for our Aurora Extravascular ICD.

在 CRM 方面，我們繼續看到市場對我們的微型無引線起搏器的強勁採用，增長了 14%，而我們的除顫解決方案業務增長了 7%，因為更換逆風正在緩和。就在上週，我們的 Aurora 血管外 ICD 獲得了 CE 標誌。

In Cranial & Spinal Technologies, we delivered another strong quarter, with 6% growth in Core Spine, including 12% growth in the United States and 8% growth in Neurosurgery. This is driven by our market-leading ecosystem of Aible-enabling technology and the associated pull-through of our best-in-class spinal implants. From our AI-enabled surgical planning platform to our patient-specific and differentiated spine implants, to our imaging navigation and robotic technologies, we're differentiating ourselves with spine surgeons around the world.

在 Cranial & Spinal Technologies，我們又創造了一個強勁的季度，Core Spine 增長了 6%，其中美國增長了 12%，神經外科增長了 8%。這是由我們市場領先的 Aible 支持技術生態系統和我們一流的脊柱植入物的相關牽引力推動的。從我們支持 AI 的手術規劃平台到我們的患者特異性和差異化脊柱植入物，再到我們的成像導航和機器人技術，我們正在與世界各地的脊柱外科醫生脫穎而出。

Turning to our Surgical Innovations business. SI grew sequentially as we made solid progress recapturing the share that we lost due to supply challenges over the last 3 quarters. Year-over-year, SI declined as a result of expected stapling BBP tenders in China. But excluding China sales, SI grew 5% in Q3.

轉向我們的外科創新業務。 SI 連續增長，因為我們取得了堅實的進展，重新奪回了過去 3 個季度因供應挑戰而失去的份額。與去年同期相比，由於預期在中國裝訂 BBP 招標，SI 有所下降。但不包括中國銷售額，SI 在第三季度增長了 5%。

Look, surgeons around the world prefer our advanced surgical products, and we expect them and we're seeing in SI to continue. In particular, in our leading advanced energy franchise, we're seeing strong adoption of our recently launched cordless Sonicision 7, and we're preparing to launch our recently approved LigaSure XP. So we're on the right path with our established market leader businesses. And at the same time, we're advancing our position in high secular growth med tech markets. These businesses are contributing about 20% of our revenue today and collectively growing above our company average. We're investing disproportionately in these businesses and expect them to become an even bigger part of our growth over time.

看，世界各地的外科醫生都更喜歡我們先進的外科產品，我們希望它們和我們在 SI 中看到的那樣繼續下去。特別是，在我們領先的高級能源專營權中，我們看到了我們最近推出的無繩 Sonicision 7 的廣泛採用，並且我們正準備推出我們最近批准的 LigaSure XP。因此，我們與成熟的市場領導者業務走在正確的道路上。與此同時，我們正在提升我們在長期高速增長的醫療技術市場中的地位。如今，這些業務貢獻了我們約 20% 的收入，並且總體增長高於我們公司的平均水平。我們對這些業務的投資不成比例，並期望它們隨著時間的推移成為我們增長的更大部分。

So starting with Structural Heart. While the TAVR market continued to be impacted by health care staffing challenges and COVID in Japan, we drove 11% growth in Q3, including 12% growth in the United States. We're seeing great physician reception for our Evolut FX system, which just completed its full quarter of launch in the U.S. Evolut FX combines industry-leading durability with enhanced and predictable valve deployment.

所以從 Structural Heart 開始。雖然 TAVR 市場繼續受到日本醫療保健人員配置挑戰和 COVID 的影響，但我們在第三季度推動了 11% 的增長，其中包括美國 12% 的增長。我們看到我們的 Evolut FX 系統受到了醫生的熱烈歡迎，該系統剛剛在美國完成了整個季度的發布。Evolut FX 結合了行業領先的耐用性和增強且可預測的閥門部署。

And in addition, data was presented during the quarter at PCR London Valves, showing Evolut FX's commissural alignment has improved significantly, which is important for coronary access and valve hemodynamics. Now looking ahead, we will continue to bring Evolut FX around the world and we are currently seeking approval in the Japanese and European markets.

此外，本季度在 PCR London Valves 上公佈的數據顯示，Evolut FX 的連合排列得到了顯著改善，這對于冠狀動脈通路和瓣膜血流動力學非常重要。現在展望未來，我們將繼續將 Evolut FX 帶到世界各地，我們目前正在尋求日本和歐洲市場的批准。

In Cardiac Ablation Solutions, we grew 3% globally as provincial China VBP tenders weighed on our results. Outside of China, CAS grew in the high single digits, including low double-digit growth in the United States on the continued strong adoption of our leading Arctic Front cryoablation technology.

在心臟消融解決方案方面，我們在全球範圍內增長了 3%，因為中國省級 VBP 招標對我們的業績造成了壓力。在中國以外，CAS 以高個位數增長，包括美國的低兩位數增長，這得益於我們領先的 Arctic Front 冷凍消融技術的持續強勁採用。

We're also advancing what we believe will become the leading pulse field ablation portfolio. And in 2 weeks, highly anticipated data for our PULSED AF pivotal trial will be released in the Late-Breakers session at ACC. The trial is evaluating our PulseSelect PFA catheter in both paroxysmal and persistent patients, and this will be the first results from an IDE trial in the PFA space, and we're on track to be one of the first companies with a PFA catheter in the U.S. market.

我們還在推進我們認為將成為領先的脈衝場消融產品組合的產品。兩週後，備受期待的 PULSED AF 關鍵試驗數據將在 ACC 的 Late-Breakers 會議上發布。該試驗正在陣發性和持續性患者中評估我們的 PulseSelect PFA 導管，這將是 PFA 領域 IDE 試驗的第一個結果，我們有望成為首批在 PFA 導管領域擁有 PFA 導管的公司之一美國市場。

We also continue to make progress on bringing our Affera mapping and navigation platform and Sphere-9 catheter to the market as we completed enrollment in our pivotal trial in the quarter. Sphere-9 can perform high-density mapping and deliver either PFA or RF energy, all from the same catheter. And given Sphere-9 is a focal point PFA catheter, it is highly complementary to our PulseSelect anatomical PFA fitter. Finally, our CAS business just launched the AcQCross transseptal access system with a zero exchange workflow and the only system approved for both mechanical and RF crossings.

隨著我們在本季度完成關鍵試驗的註冊，我們還在將我們的 Affera 映射和導航平台以及 Sphere-9 導管推向市場方面繼續取得進展。 Sphere-9 可以執行高密度映射並提供 PFA 或 RF 能量，所有這些都來自同一根導管。鑑於 Sphere-9 是焦點 PFA 導管，它與我們的 PulseSelect 解剖 PFA 裝配器高度互補。最後，我們的 CAS 業務剛剛推出了具有零交換工作流程的 AcQCross 穿刺進入系統，並且是唯一獲准同時用於機械和 RF 交叉的系統。

So when you think about our Arctic Front cryo solution, our DiamondTemp RF catheter, our PFA catheters, our left heart access solutions and our Affera map nav system, we're assembling a leading ecosystem of technologies to meaningfully increase our participation in the fast-growth 8 billion EP ablation space.

因此，當您想到我們的 Arctic Front 冷凍解決方案、我們的 DiamondTemp 射頻導管、我們的 PFA 導管、我們的左心通路解決方案和我們的 Affera 地圖導航系統時，我們正在組建一個領先的技術生態系統，以有意義地增加我們對快速-增長 80 億個 EP 消融空間。

In Surgical Robotics, we're making good progress as the second major player in this exciting space. We continue to see positive sales momentum with the rollout of our differentiated Hugo robotic system in many international markets. And we started our U.S. IDE trial for our urology indication during the quarter. Given less than 5% of surgical procedures globally are done robotically we expect our surgical robotics business to become a meaningful growth driver for Medtronic.

在手術機器人領域，作為這個激動人心的領域的第二大參與者，我們正在取得良好進展。隨著我們差異化的 Hugo 機器人系統在許多國際市場的推出，我們繼續看到積極的銷售勢頭。我們在本季度開始了我們的泌尿外科適應症的美國 IDE 試驗。鑑於全球只有不到 5% 的外科手術是通過機器人完成的，我們預計我們的外科手術機器人業務將成為美敦力有意義的增長動力。

In Neurovascular, we grew 9% and would have grown a couple of points more, if not for the China VBP. We continue to see very strong growth in several categories, including flow diversion, aspiration and stent retrievers. Given stroke is the #2 cause of death globally, and there is still very low therapy penetration, we see a long runway for high growth in this market that is approaching $4 billion.

在神經血管方面，我們增長了 9%，如果不是因為中國 VBP，我們還會增長幾個百分點。我們繼續看到幾個類別的強勁增長，包括分流、抽吸和支架回收器。鑑於中風是全球第二大死因，而且治療普及率仍然很低，我們認為這個市場的高速增長還有很長的路要走，接近 40 億美元。

And in Diabetes, we continue to see strong international growth, offset by declines in the U.S. where we lack our latest products. We remain focused on resolving our FDA warning letter and are ready for reinspection. We also remain in active review with the FDA on our submission of the MiniMed 780G system with the Guardian 4 sensor.

在糖尿病方面，我們繼續看到強勁的國際增長，但被我們缺乏最新產品的美國的下滑所抵消。我們仍然專注於解決我們的 FDA 警告信，並準備重新檢查。我們還與 FDA 就我們提交的帶有 Guardian 4 傳感器的 MiniMed 780G 系統進行積極審查。

Outside the U.S., our Diabetes business grew 18% on continued strong sales momentum of 780G and Guardian 4. The 780G is now launched in over 90 countries, up from 60 last quarter. We're seeing strong CGM attachment rates, which drove CGM growth up 34% outside the U.S. We continue to invest heavily in assembling our ecosystem of durable pumps, smart pens, patch pumps, sensors, algorithms and customer service with multiple programs under development, all with the intent of restoring strong growth of our important Diabetes franchise over the coming years.

在美國以外，由於 780G 和 Guardian 4 的銷售勢頭持續強勁，我們的糖尿病業務增長了 18%。780G 現已在 90 多個國家推出，高於上一季度的 60 個。我們看到強勁的 CGM 附件率，這推動 CGM 在美國以外地區增長了 34%。我們繼續大力投資組裝我們的生態系統，包括耐用泵、智能筆、貼片泵、傳感器、算法和客戶服務，以及正在開發的多個程序，所有這些都是為了在未來幾年恢復我們重要的糖尿病業務的強勁增長。

And in our synergistic businesses, we also had strong performances across several businesses. We grew double digits in Cardiac Diagnostics as we ramped up production of LINQ II. In Neuromodulation, we grew 12% in pain stim and the market continues to recover. And our GI business grew high single digits on strong adoption of GI Genius, which uses artificial intelligence to help physicians detect polyps during colonoscopies.

在我們的協同業務中，我們在幾項業務中也有出色的表現。隨著我們提高 LINQ II 的產量，我們在心臟診斷方面取得了兩位數的增長。在神經調節方面，我們在疼痛刺激方面增長了 12%，市場繼續復甦。我們的 GI 業務在 GI Genius 的大力採用下實現了高個位數增長，GI Genius 使用人工智能幫助醫生在結腸鏡檢查期間檢測息肉。

With that, I'll turn it over to Karen to discuss our third quarter financial performance and our guidance. Karen?

有了這個，我會把它交給凱倫來討論我們第三季度的財務業績和我們的指導。凱倫？

Thank you, Geoff. Our third quarter organic revenue increased 4.1%, exceeding our guidance and representing a significant acceleration from our first half results as we begin to put the acute supply chain challenges behind us. Our non-GAAP EPS of $1.30 landed above our guidance by $0.03 on higher revenue growth and increased interest income, and $0.06 if we take into account a larger currency headwind than expected at the beginning of the quarter.

謝謝你，傑夫。我們第三季度的有機收入增長了 4.1%，超過了我們的指導，並且隨著我們開始將嚴峻的供應鏈挑戰拋諸腦後，與上半年的業績相比有了顯著的加速。我們的非 GAAP 每股收益為 1.30 美元，比我們的指導高出 0.03 美元，原因是收入增長加快和利息收入增加，如果我們考慮到比本季度初預期更大的貨幣逆風，則為 0.06 美元。

Looking at our revenue from a geographic perspective, U.S. grew 2%, and our non-U.S. developed markets increased 6%, even with a 3% decline in Japan as COVID affected procedure volumes. Excluding Japan, non-U.S. developed markets increased 8%. Emerging markets grew 5%, impacted by an 8% decline in China from COVID and VBP provincial tenders in stapling, cardiac ablation and neurovascular. Outside of China, emerging markets actually grew 17%.

從地理角度來看我們的收入，美國增長了 2%，我們的非美國發達市場增長了 6%，儘管由於 COVID 影響了手術量，日本下降了 3%。除日本外，非美國發達市場增長 8%。新興市場增長 5%，受中國 COVID 和 VBP 縫合、心臟消融和神經血管領域招標下降 8% 的影響。在中國之外，新興市場實際上增長了 17%。

I would also note that China represented a 110 basis point headwind on our total company growth, which highlights the strength of the recovery in our other markets. VBP has affected us, more than many of our competitors, given the size and breadth of our business in China. However, we do expect that we are now through the majority of the impact.

我還要指出，中國對我們公司的總體增長造成了 110 個基點的逆風，這凸顯了我們其他市場的複蘇勢頭。鑑於我們在中國的業務規模和廣度，VBP 對我們的影響超過了我們的許多競爭對手。但是，我們確實希望我們現在已經度過了大部分影響。

Our adjusted gross margin declined in the quarter as we faced impacts from inflation and currency with currency driving about 1/3 of the change. These declines were expected and a result of inflationary pressures that occurred 2 to 3 quarters ago. Our incurred manufacturing variances have continued to be significant in the past few quarters. And as they roll off our balance sheet on to our P&L, we expect continued gross margin pressure in Q4 and next year. The gross margin impact translated into a decline in our adjusted operating margin as well. Although this was partially muted by expense control, and the benefit of our currency hedging program.

我們調整後的毛利率在本季度下降，因為我們面臨通貨膨脹和貨幣的影響，其中貨幣驅動了大約 1/3 的變化。這些下降是預期的，也是 2 到 3 個季度前發生的通脹壓力的結果。在過去的幾個季度中，我們產生的製造差異仍然很大。隨著它們從我們的資產負債表轉入我們的損益表，我們預計第四季度和明年的毛利率將繼續面臨壓力。毛利率的影響也轉化為我們調整後的營業利潤率的下降。儘管這部分因費用控制和我們的貨幣對沖計劃的好處而減弱。

Our balance sheet remains strong, and we continue to execute our enhanced capital allocation and portfolio management work, balancing future growth investments with returning a minimum of 50% of our free cash flow to shareholders, primarily in the form of our dividend. We see strong opportunities for organic growth investments internally, leading us to target R&D growth at or above revenue growth. And we continue to focus on supplementing our organic investments with tuck-in acquisitions.

我們的資產負債表依然強勁，我們繼續執行加強的資本配置和投資組合管理工作，平衡未來增長投資與向股東返還至少 50% 的自由現金流，主要以股息的形式。我們在內部看到了有機增長投資的巨大機會，這促使我們將研發增長目標定為等於或高於收入增長。我們繼續專注於通過收購來補充我們的有機投資。

We've also announced this fiscal year three businesses we intend to separate that account for about 8% of our revenue. And we're making progress towards completing those transactions. We expect to close our Renal Care joint venture with DaVita here in the fourth quarter, and continue to progress with the separation of our patient monitoring and respiratory interventions businesses, which we expect to occur sometime in the second half of next fiscal year.

我們還宣布了本財年我們打算拆分的三項業務，這三項業務約占我們收入的 8%。我們在完成這些交易方面取得了進展。我們預計將在第四季度關閉我們與 DaVita 的 Renal Care 合資企業，並繼續推進我們的患者監測和呼吸乾預業務的分離，我們預計這將在下一財年下半年的某個時候發生。

We have also closed on acquisitions that will contribute to our growth in the years ahead, including Affera, which expands our presence in cardiac ablation, and Intersect ENT, which adds unique sinus implants to our ENT portfolio. We have driven these moves to not only focus and streamline our portfolio, but also to improve our weighted average market growth rate over time.

我們還完成了有助於我們未來幾年增長的收購，包括擴大我們在心臟消融領域的業務的 Affera 和為我們的耳鼻喉科產品組合增加獨特鼻竇植入物的 Intersect ENT。我們推動這些舉措不僅是為了集中和精簡我們的產品組合，而且是為了隨著時間的推移提高我們的加權平均市場增長率。

Now turning to our guidance. Given our top and bottom line beat in the third quarter, we are raising our full year revenue growth and EPS outlook. On the top line, we expect our fourth quarter organic revenue growth to be in the range of 4.5% to 5%, which is unchanged from what was implied by our second half guidance that I gave last quarter.

現在轉向我們的指導。鑑於我們在第三季度的收入和利潤都超出預期，我們正在上調全年收入增長和每股收益預期。最重要的是，我們預計第四季度的有機收入增長將在 4.5% 至 5% 之間，這與我上個季度給出的下半年指引所暗示的沒有變化。

I would note that our organic growth guidance excludes the impact of currency and revenue from our Intersect ENT acquisition. And it also now excludes revenue from our Renal Care Solutions business as we expect the separation to occur during the fourth quarter. If recent exchange rates hold, foreign currency would have a negative impact on our fourth quarter revenue of $165 million to $215 million. Taking into account currency, Intersect ENT revenue and the partial quarter of Renal Care Solutions revenue, our guidance would imply reported revenue in the range of $8.2 billion to $8.3 billion.

我要指出的是，我們的有機增長指導不包括我們的 Intersect ENT 收購帶來的貨幣和收入的影響。而且它現在還不包括我們的腎臟護理解決方案業務的收入，因為我們預計分離將在第四季度發生。如果最近的匯率保持不變，外幣將對我們 1.65 億美元至 2.15 億美元的第四季度收入產生負面影響。考慮到貨幣、Intersect ENT 收入和部分季度的 Renal Care Solutions 收入，我們的指引意味著報告的收入在 82 億美元至 83 億美元之間。

We are also maintaining the fourth quarter revenue growth segment expectations that were implied by the back half guidance I gave last quarter. We continue to expect Cardiovascular to be up 5.5% to 6%, Medical Surgical to grow 2.5% to 3%, Neuroscience to increase 6.5% to 7% and Diabetes to decline in the low single digits, all on an organic basis.

我們還維持我上個季度給出的後半部分指導所暗示的第四季度收入增長部分預期。我們繼續預計心血管將增長 5.5% 至 6%，醫療外科將增長 2.5% 至 3%，神經科學將增長 6.5% 至 7%，糖尿病將以低個位數下降，所有這些都是有機的。

On the bottom line, we continue to drive significant expense reductions to partially offset the impact of inflation and foreign currency. Given our third quarter $0.03 beat, we raised the lower end of our fiscal '23 non-GAAP diluted EPS guidance by $0.03 to the new range of $5.28 to $5.30, including an unfavorable currency impact of approximately $0.21 at recent rates.

最重要的是，我們繼續推動大幅削減開支，以部分抵消通貨膨脹和外彙的影響。鑑於我們第三季度超出 0.03 美元，我們將 23 財年非 GAAP 稀釋後每股收益指引的下限提高了 0.03 美元，達到 5.28 美元至 5.30 美元的新範圍，其中包括按近期匯率計算的不利貨幣影響約為 0.21 美元。

For the fourth quarter, we expect non-GAAP diluted EPS to be in the range of $1.55 to $1.57. At recent rates, FX is about a $0.09 headwind to fourth quarter EPS. While we won't give guidance this fiscal year until our fourth quarter call in May, I did give some color on last quarter's call, and we'll remind you of it today.

對於第四季度，我們預計非 GAAP 稀釋後每股收益將在 1.55 美元至 1.57 美元之間。按照最近的匯率計算，外匯對第四季度每股收益的影響約為 0.09 美元。雖然我們要到 5 月份的第四季度電話會議才會給出本財年的指導，但我確實對上一季度的電話會議給出了一些說明，我們今天會提醒您。

We're encouraged by our recent progress on revenue growth. At the same time, current macro factors and our imperative to protect R&D investment are expected to create significant EPS headwinds next fiscal year. At recent rates, FX is a few hundred million dollar tailwind to fiscal '24 revenue and an approximate $0.27 headwind to EPS, which translates to a 5% headwind to EPS growth.

我們對最近在收入增長方面取得的進展感到鼓舞。與此同時，當前的宏觀因素和我們保護研發投資的必要性預計將在下一財年對每股收益造成重大阻力。按照最近的匯率，外匯對 24 財年的收入有幾億美元的順風，對每股收益有大約 0.27 美元的逆風，這意味著每股收益增長有 5% 的逆風。

While inflationary pressures are starting to moderate, we still see significant mid-single-digit inflationary impacts on our cost of goods sold as wage and raw material price increases continue to roll off our balance sheet and into our P&L. We are working to partially mitigate these headwinds through significant cost reductions. But both inflation and currency and to a lesser extent, interest and tax, are all looking to be headwinds that reduce our earnings power in fiscal '24.

雖然通貨膨脹壓力開始緩和，但隨著工資和原材料價格上漲繼續從我們的資產負債表上滾落並進入我們的損益表，我們仍然看到顯著的中個位數通貨膨脹對我們的銷售成本產生影響。我們正在努力通過大幅降低成本來部分緩解這些不利因素。但通貨膨脹和貨幣，以及在較小程度上，利息和稅收，都可能成為削弱我們在 24 財年的盈利能力的不利因素。

I would summarize by saying that as we navigate this period of increased macro headwinds, we will be driving disciplined cost reduction, and we are committed to investing in our future growth drivers and our turnaround as we firmly believe these important investments are necessary to drive durable revenue growth and long-term value creation.

我想總結一下，在我們渡過這個宏觀逆風增加的時期時，我們將推動有紀律的成本削減，我們致力於投資於我們未來的增長動力和我們的轉變，因為我們堅信這些重要的投資對於推動持久發展是必要的收入增長和長期價值創造。

Before I hand it back to Geoff, I want to take a moment to thank the thousands of employees across Medtronic who delivered this quarter. You are executing with excellence and accountability, leveraging our scale with differentiating capabilities and managing our resources to accelerate innovation. It is because of your efforts that we will create a durable growth company powered by our people as we continue our mission-driven work of alleviating pain, restoring health and extending life.

在我將它交還給 Geoff 之前，我想花點時間感謝本季度交付的美敦力公司數千名員工。您正在以卓越和負責任的方式執行，利用我們的規模和差異化能力並管理我們的資源以加速創新。正是由於您的努力，我們將繼續以減輕痛苦、恢復健康和延長生命為使命的工作，從而創建一家由我們的員工提供動力的持久增長公司。

Back to you, Geoff.

回到你身邊，傑夫。

Thank you, Karen. Now before we open the lines for questions, I'll make a few closing remarks. Last quarter, I noted that our aggressive agenda to transform this company would take time, and that's still true. But I hope you'll take away that we are operating with a high sense of urgency, which you can see reflected in our results this quarter.

謝謝你，凱倫。現在，在我們開始提問之前，我將做一些結束語。上個季度，我注意到我們改造這家公司的積極議程需要時間，現在仍然如此。但我希望您能意識到我們正在以高度的緊迫感開展業務，您可以在本季度的業績中看到這一點。

We're reducing our complexity, enhancing our capabilities and augmenting our management team with new leaders that bring an outside diverse perspective. We're also exercising decisive capital allocation and portfolio management, devoting more capital to high-growth opportunities and divesting noncore assets.

我們正在降低我們的複雜性，增強我們的能力，並通過帶來外部多元化視角的新領導者來擴充我們的管理團隊。我們還在進行果斷的資本配置和投資組合管理，將更多資本投入高增長機會並剝離非核心資產。

There is an intense focus from me, our Board, our management and our employees to create a company with sustainable growth that you can count on. We're in attractive markets with growing populations globally that can benefit from our therapies. And we fully expect to deliver durable revenue growth and turn our scale into a long-term competitive advantage and through this process, create tremendous value for our shareholders.

我、我們的董事會、我們的管理層和我們的員工都非常關注創建一家您可以信賴的可持續增長的公司。我們所處的市場極具吸引力，全球人口不斷增長，可以從我們的療法中受益。我們完全希望實現持久的收入增長，並將我們的規模轉化為長期競爭優勢，並通過這一過程為我們的股東創造巨大價值。

Now let's move to Q&A. We're going to try to get as many analysts as possible, so we ask you 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.

現在讓我們進入問答環節。我們將嘗試獲得盡可能多的分析師，因此我們要求您將自己限制在一個問題上，並且僅在需要時進行相關的跟進。如果您還有其他問題，可以在通話後聯繫 Ryan 和投資者關係團隊。

With that, Brad, can you please give the instructions for asking a question?

有了這個，布拉德，你能給出提問的說明嗎？

(Operator Instructions) Lastly, please be advised that this Q&A session is being recorded.

（操作員說明）最後，請注意，正在錄製此問答環節。

For today's session, Geoff, Karen and Ryan are joined by Que Dallara, EVP and President of the Diabetes operating unit; 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. (Operator Instructions)

在今天的會議上，執行副總裁兼糖尿病業務部門總裁 Que Dallara 與 Geoff、Karen 和 Ryan 一起參加了會議；執行副總裁兼心血管產品組合總裁 Sean Salmon；執行副總裁兼神經科學產品組合總裁 Brett Wall；執行副總裁兼醫療外科產品組合總裁 Bob White。 （操作員說明）

We'll take the first question from Robbie Marcus at JPMorgan.

我們將從摩根大通的 Robbie Marcus 那裡回答第一個問題。

Congrats on a nice quarter. Maybe I could start, and I appreciate, Karen, you're not giving formal guidance, but I was hoping you could discuss where the OpEx cuts are coming from. It sounds like you're going to continue to invest in R&D. So what exactly are you cutting? How aggressively are you cutting? Will this prevent any of your competitiveness on the top line?

祝賀一個不錯的季度。也許我可以開始，我很感激，凱倫，你沒有給出正式的指導，但我希望你能討論 OpEx 削減的來源。聽起來你要繼續投資研發。那你到底要剪什麼？你切割的力度有多大？這會阻止您在頂線的任何競爭力嗎？

And then I'll ask my follow-up as well. The Street has you at 3% EPS growth for next year. Do you think that's the right place for us to be based on your comments today?

然後我也會問我的後續行動。華爾街預測明年每股收益增長 3%。您認為我們今天應該根據您的意見發表意見嗎？

Yes. Thanks for your question, Robbie. When we look at our higher cost environment that we're facing, like many companies you've seen recently, we really have to evaluate our full cost structure and look for opportunities to reduce both spending and cost. So we're in the midst of that right now. We expect to drive a significant expense reduction to help partially offset the headwinds that we're facing and the investment that we believe we need to make.

是的。謝謝你的問題，羅比。當我們審視我們面臨的更高成本環境時，就像您最近看到的許多公司一樣，我們真的必須評估我們的全部成本結構並尋找減少支出和成本的機會。所以我們現在正處於其中。我們希望大幅削減開支，以幫助部分抵消我們面臨的不利因素和我們認為需要進行的投資。

When we look at next fiscal year, I'll just give you a little bit more comments on it. I know there's a desire to give EPS guidance early, but we're still working through our plan. And there are more than a typical number of moving pieces. So that's why we're sticking to our normal time line of giving guidance in Q4.

當我們審視下一個財政年度時，我會給你更多的評論。我知道人們希望儘早給出 EPS 指導，但我們仍在努力完成我們的計劃。並且有超過典型數量的移動件。所以這就是為什麼我們堅持在第四季度提供指導的正常時間線。

But when we look at revenue, we grew 4.1% in Q3, and our guidance for Q4 implies sequential improvement. We expect -- we've said that we expect to drive greater revenue growth in '24 than we have in '23, and we've said that we're focused on delivering durable mid-single-digit revenue growth over the longer term. So we like the progress that we've made recently, both on our recent revenue growth performance and on important things in our pipeline to drive that revenue growth. And we always have said that we believe our WAMGR is in the mid-single-digit range.

但是當我們看收入時，我們在第三季度增長了 4.1%，我們對第四季度的指導意味著連續改善。我們預計 - 我們已經說過，我們預計 24 年的收入增長將超過 23 年，我們已經說過，我們專注於在長期內實現持久的中個位數收入增長.因此，我們喜歡我們最近取得的進展，無論是在我們最近的收入增長表現上，還是在推動收入增長的重要方面。我們一直說我們相信我們的 WAMGR 處於中個位數範圍內。

But as we move down the P&L, we've got this delayed inflationary impact on our gross margin that you've seen this quarter, and that will continue in the next quarter in FY '24. We've seen inflation -- the pressures on inflation beginning to improve. But as you know, that's got a delayed impact on our P&L. We also have currency, interest and tax that are macro headwinds as well. And obviously, we've talked about the fact that we're going to continue to drive investments to drive the long-term growth and turnaround of this company.

但隨著我們降低損益表，我們在本季度看到了這種延遲的通貨膨脹對我們毛利率的影響，並將在 24 財年的下一個季度繼續。我們已經看到通貨膨脹——通貨膨脹的壓力開始改善。但如您所知，這對我們的損益產生了延遲影響。我們還有貨幣、利息和稅收等宏觀不利因素。顯然，我們已經談到了這樣一個事實，即我們將繼續推動投資以推動這家公司的長期增長和扭虧為盈。

We're still in the process of seeing how all that nets out with our significant expense reduction. And obviously, we're going to give guidance on our fourth quarter call in May. But we have said that this will be a tougher year on the bottom line where our earnings power will be significantly reduced. Hope that helps.

我們仍在研究如何通過大幅削減開支來抵消所有這些。顯然，我們將在 5 月份的第四季度電話會議上提供指導。但我們已經說過，這將是利潤更加艱難的一年，我們的盈利能力將大大降低。希望有所幫助。

Thanks, Robbie. Next question, please, Brad.

謝謝，羅比。下一個問題，請布拉德。

The next question comes from Larry Biegelsen at Wells Fargo.

下一個問題來自 Wells Fargo 的 Larry Biegelsen。

And I'll echo my congratulations on a nice quarter here. I'd like to focus on China, which declined high single digits in Q3. Can you talk about what you're seeing there in terms of procedure volumes coming back? And the VBP headwind, you gave a lot of helpful color in the JPMorgan slides on the percent of your -- the headwind in the first half and the percentage products impacted in fiscal '23 and fiscal '24.

我將在這裡祝賀一個不錯的季度。我想關注中國，它在第三季度下降了高個位數。你能談談你在那裡看到的手術量恢復情況嗎？而 VBP 的逆風，你在摩根大通的幻燈片中給出了很多有用的顏色——上半年的逆風以及 23 財年和 24 財年受影響的產品百分比。

I guess what I'm trying to understand is what would -- overall China growth, fiscal '23 and fiscal '24, how much of a headwind will that continue to be with VBP? And how does it impact your ability to grow mid-single digits in fiscal '24? I heard Geoff, you talked about durable growth a lot this morning. Should we be thinking more like 4 to 5 next year because of the VBP headwinds?

我想我想了解的是——中國整體增長、23 財年和 24 財年，VBP 將繼續面臨多大的阻力？它如何影響您在 24 財年實現中個位數增長的能力？我聽說傑夫，你今天早上談到了持久增長。由於 VBP 的逆風，我們明年是否應該考慮更多 4 到 5？

Yes. Thanks, Larry. Good to hear from you, and thanks for the question. Obviously, China is a big one for us. And yes, I'll turn it over to Karen to answer some of the kind of the details on the headwinds, what we're seeing here recently.

是的。謝謝，拉里。很高興收到你的來信，感謝你的提問。顯然，中國對我們來說是一個大國。是的，我會把它交給凱倫來回答一些關於逆風的細節，我們最近在這裡看到的。

Yes. So just -- it's hard for us to parse out this quarter the impact of procedures in VBP. So we're not doing that. But we have said on VBP that we expect to be 50% done with the impacts of VBP by the end of this fiscal year. And as we move into next fiscal year, we still do have some VBP to come, but we expect to be 80% done by the end of next fiscal year.

是的。因此，我們很難在本季度解析出 VBP 中程序的影響。所以我們沒有這樣做。但我們已經在 VBP 上說過，我們預計到本財年結束時將完成 50% 的 VBP 影響。隨著我們進入下一個財政年度，我們仍然會有一些 VBP，但我們預計到下一個財政年度結束時將完成 80%。

So this quarter, we had a VBP impact from stapling and cardiac ablation and a little bit in coils from Neurovascular. And as we look ahead into next fiscal year, we still do have some stapling, provincial tenders coming. And we've got a little bit more Neurovascular and some in some cardio businesses including cardiac rhythm, structural heart, aortic, peripheral vascular. But again, where the majority finished by the end of this fiscal year, and we've got a little bit more to go next fiscal year.

因此，本季度，我們對 VBP 產生了來自吻合和心臟消融的影響，以及來自神經血管的一些線圈。當我們展望下一個財政年度時，我們仍然會進行一些重要的省級招標。我們有更多的神經血管和一些心臟業務，包括心律、結構性心臟、主動脈、外周血管。但同樣，大多數人在本財年末完成，下個財年我們還有更多工作要做。

I mean just to clarify one thing, I mean, we think that 80% of our portfolio, as we've taken a step back, could be impacted by VBP. And that will all -- we're 50% of the way through, and the remaining 30%, we'll get in FY '24. We don't think the remaining 20% will be impacted by certain things that are nuanced or under the radar screen.

我的意思是澄清一件事，我的意思是，我們認為我們已經退後一步的 80% 的投資組合可能會受到 VBP 的影響。這就是全部——我們已經完成了 50%，剩下的 30%，我們將在 24 財年完成。我們認為剩下的 20% 不會受到某些細微差別或不為人知的事情的影響。

And what we're doing here is taking out some of our selling and marketing costs in China to offset the lower prices because this business is now more contracted through these VBPs. So the government is living up to the volume commitments from those VBPs at these lower prices.

我們在這裡所做的是扣除我們在中國的一些銷售和營銷成本，以抵消較低的價格，因為該業務現在通過這些 VBP 承包得更多。因此，政府正在以這些較低的價格履行這些 VBP 的數量承諾。

The discounts have gotten lower as they've gone on. I think the Chinese government has realized that med tech is not exactly like pharma, and we have more selling expenses than maybe pharma does because I think they modeled a lot of this off of pharma and based on my discussions with Chinese government officials. So that's good. And we're -- basically, we'll reset our business and grow from there.

隨著他們的進行，折扣越來越低。我認為中國政府已經意識到醫療技術並不完全像製藥，而且我們的銷售費用可能比製藥更多，因為我認為他們在很大程度上模仿了製藥，並根據我與中國政府官員的討論。所以這很好。而且我們 - 基本上，我們將重置我們的業務並從那裡發展。

And so, FY '24 will be another year where China is a bit of a headwind. We factor that into our guidance. We were taking out expenses and we'll rebase our business and grow from there. So a lot of thought, a lot of conversations with the Chinese government, a lot of thought here. Look, we're comfortable with our strategy.

因此，24 財年將是中國有點逆風的又一年。我們將其納入我們的指南。我們正在削減開支，我們將重新調整我們的業務並從那裡發展。所以想了很多，與中國政府進行了很多對話，在這裡想了很多。看，我們對我們的戰略感到滿意。

Okay. Thank you, Larry. Next question, please, Brad.

好的。謝謝你，拉里。下一個問題，請布拉德。

The next question comes from Vijay Kumar at Evercore ISI.

下一個問題來自 Evercore ISI 的 Vijay Kumar。

Congrats on the [printed]. I had a two-part and I'll ask them upfront. When you look at Q4, what is changing sequentially here, Karen? Because when I look at 3Q, you did 4% organic despite med center declining, continued Diabetes headwinds and China headwinds since Q4. What are these three pieces -- what are you assuming for those three buckets? And I think you mentioned the renal impact in Q4. Could you specify that?

恭喜[印刷]。我有兩部分，我會提前問他們。當你看 Q4 時，這裡有什麼順序變化，Karen？因為當我看第 3 季度時，儘管醫療中心下降，自第 4 季度以來持續的糖尿病逆風和中國逆風，你還是實現了 4% 的有機增長。這三個部分是什麼——您假設這三個桶是什麼？我想你在第四季度提到了對腎臟的影響。你能具體說明嗎？

And Geoff, for you, I understand you're not giving fiscal '24 guidance. But when you think about the incremental changes, right, what are the positive tailwinds and negative headwinds? Is China still declining in fiscal '24? What happens to Diabetes? Is that on the plus side or minus side? And any other plus or minus at a high level would be helpful.

傑夫，對你來說，我知道你沒有給出 24 財年的指導。但是當你考慮增量變化時，對吧，積極的順風和消極的逆風是什麼？中國在 24 財年仍在衰退嗎？糖尿病會發生什麼？這是正面還是負面？任何其他高水平的加減都會有所幫助。

Yes, Vijay, let me take the first part of your question. In terms of our Q4 revenue ramp, when we gave our second half guidance last quarter, we expected sequential improvement from the third quarter into the fourth quarter. And obviously, we're still expecting sequential improvement.

是的，Vijay，讓我回答你問題的第一部分。就我們第四季度的收入增長而言，當我們在上個季度給出下半年的指導時，我們預計從第三季度到第四季度的連續改善。顯然，我們仍然期待連續改進。

That's going to be driven by continued consistency of supply, which we expect, which has already improved across the portfolio and will continue to improve. We also have some recent product launches, like Evolut FX and Hugo, which will continue to ramp. You may recall, we have our HARMONY valve, which will return to market as well. And then we've also got some launches into new markets, like diabetic neuropathy that will begin to take some hold. And we've got reduced headwinds from things like vents and VBP in the quarter.

這將受到供應持續一致性的推動，我們預計供應的一致性已經在整個產品組合中得到改善，並將繼續改善。我們最近還推出了一些產品，例如 Evolut FX 和 Hugo，它們將繼續增加。您可能還記得，我們有 HARMONY 閥門，它也將重返市場。然後我們還向新市場推出了一些產品，例如糖尿病性神經病變將開始流行起來。我們在本季度減少了通風口和 VBP 等方面的不利因素。

You asked specifically about Renal Care. We do expect to close that joint venture with DaVita in the fourth quarter. So we simply noted that when we guided so that we didn't force you all to change your models mid-quarter. We just put it in now. I hope that helps.

您特別詢問了腎臟護理。我們確實希望在第四季度關閉與 DaVita 的合資企業。因此，我們只是注意到，當我們進行指導時，我們不會強迫大家在季度中期更改模型。我們現在就把它放進去。我希望這有幫助。

Just to finish off -- just to highlight one thing in Karen's commentary there. A big one will be continued turnaround of our Surgical Innovations business. That was really hit hard, as you guys know, by the supply chain issues. You saw a nice sequential improvement from Q2 to Q3, and you'll see another improvement from Q3 to Q4. And that -- Karen mentioned supply chain issues subsiding, a big area where you'll see that manifested is in Surgical Innovations.

只是為了結束——只是為了強調 Karen 的評論中的一件事。我們的外科創新業務將繼續扭虧為盈。正如你們所知，供應鏈問題確實給我們帶來了沉重打擊。你看到了從第二季度到第三季度的一個很好的連續改進，你會看到從第三季度到第四季度的另一個改進。那——凱倫提到供應鏈問題正在消退，你會看到一個很大的領域是外科創新。

When you look at FY '24, well, let's start with some of the known risks. You highlighted China VBP, and we -- Karen and I already talked about that a bit. That will still be an issue as we go from the 50% of our portfolio that's done in FY '23 to the -- to another 30% that gives us 80% by the end of FY '24. So that will be a headwind. I don't know what we've said whether China's growing or shrinking, but it's definitely not growing at our historic double-digit again next year.

當您查看 24 財年時，好吧，讓我們從一些已知的風險開始。你強調了中國 VBP，我們 - Karen 和我已經談過一點。這仍然是一個問題，因為我們從 23 財年完成的投資組合的 50% 到 24 財年末的另外 30% 使我們達到 80%。所以這將是一個逆風。我不知道我們所說的中國是在增長還是在萎縮，但明年肯定不會再以我們歷史性的兩位數增長。

The other -- and look, there's still work to be done on supply chain. I mean it's -- our supplier -- the supply chain out there is still a bit fragile. Although every quarter, it's getting better for us. And -- but as you look at some of the momentum, like you've seen from us from Q1 to Q2, from Q2 to Q3 and then implicit in our guidance is a nice acceleration kind of from Q3 to Q4. So we're excited about that, happy with the momentum.

另一個 - 看，在供應鏈方面仍有工作要做。我的意思是——我們的供應商——那裡的供應鏈仍然有點脆弱。儘管每個季度，我們的情況都在變好。而且——但是當你看到一些勢頭時，就像你從我們看到的從第一季度到第二季度，從第二季度到第三季度，然後在我們的指導中隱含的是從第三季度到第四季度的一個很好的加速。所以我們對此感到興奮，對勢頭感到滿意。

And as we look into FY '24, some of the specific businesses, you mentioned Diabetes. We're optimistic we're going to get 780G on the market here in the U.S., and that will have a nice impact on Diabetes plus continued performance in Europe. So that should be -- assuming that happens, that should help accelerate some of the growth in Diabetes.

當我們研究 24 財年的一些具體業務時，您提到了糖尿病。我們樂觀地認為，我們將在美國市場上推出 780G，這將對糖尿病以及歐洲的持續表現產生良好影響。所以這應該是 - 假設發生這種情況，那應該有助於加速糖尿病的一些增長。

Surgical Robotics is doing really well. And as we move into FY '24, have a bit more scale and a bit more impact on our numbers. Cardiac Ablation Solutions, I'm sure we'll get some questions on our mapping and navigation system as well as our various PFA catheters. You start to -- we'll start to feel some impact from them. And continued strong performance across the Neuroscience portfolio, I think, highlighted the CST or cranial spinal technologies business as well as you'll see continued strength in ENT. We'll anniversary the Intersect acquisition at some point and that goes organic.

手術機器人做得很好。隨著我們進入 24 財年，規模會更大一些，對我們的數字影響也會更大一些。心臟消融解決方案，我相信我們會收到一些關於我們的映射和導航系統以及我們各種 PFA 導管的問題。你開始 - 我們將開始感受到他們的一些影響。我認為，神經科學產品組合的持續強勁表現突出了 CST 或顱脊柱技術業務，你會看到 ENT 的持續增長。我們將在某個時候紀念 Intersect 的收購，這將是有機的。

So those are some of the things that we look at as -- in FY '24. But it's -- there's some, I think, broad supply chain recovery, especially in SI and then a couple of highlights, like I mentioned, CAS, Surgical Robotics, Diabetes in the U.S.

所以這些是我們在 24 財年看到的一些事情。但它是 - 我認為有一些廣泛的供應鏈復甦，特別是在 SI 中，然後是幾個亮點，就像我提到的，CAS，外科機器人，美國的糖尿病。

Thank you, Vijay. next question, please, Brad.

謝謝你，維杰。下一個問題，請布拉德。

The next question comes from Joanne Wuensch at Citi.

下一個問題來自花旗銀行的 Joanne Wuensch。

Nice sequential growth there. I have two questions. One is specific to the spine business. It was particularly strong this quarter. And I'm just a little bit curious about what you're seeing is driving that and how you think about it going forward.

那裡的連續增長不錯。我有兩個問題。一個是特定於脊柱業務的。本季度尤為強勁。我只是有點好奇你看到的是什麼在推動它，以及你如何看待它向前發展。

And then the other one is a little bit more esoteric. I heard the word urgent or urgently a couple of times throughout the early presentation. What does urgently forging mean? And how does that translate to sort of milestones that we can look forward to?

然後另一個更深奧一點。在整個早期演示過程中，我多次聽到“緊急”或“緊急”這個詞。急鍛是什麼意思？這如何轉化為我們可以期待的里程碑？

Well, thanks, Joanne, for the question. Maybe I'll start with the second one. Look, there is -- the word urgent, there's a lot of major change that we've got going on across the business. And I think it's important for people to understand the depth and breadth of those changes. And I know there's the desire to see things move quicker. And yes, we're in some ways, encouraged and we're encouraged by the progress, but we'd like to see it go faster as well. But the speed of the -- of our progress of getting the top line growth and adjusting our cost base to reflect the new reality with inflation and FX, on a company our size, the impact of these changes take a bit more time than -- they take some time.

好吧，謝謝喬安妮提出的問題。也許我會從第二個開始。看，有 - 緊急這個詞，我們在整個業務中正在進行很多重大變革。我認為讓人們了解這些變化的深度和廣度很重要。我知道人們希望看到事情進展得更快。是的，我們在某些方面受到鼓舞，我們對取得的進展感到鼓舞，但我們也希望看到它進展得更快。但是我們在實現收入增長和調整成本基礎以反映通貨膨脹和外彙的新現實方面取得進展的速度，對於我們規模的公司來說，這些變化的影響需要比 -他們需要一些時間。

But the actions that we're taking are -- we are moving quickly on these. And I think that's the idea here. So we're moving quickly on a number of things, whether be the changes -- all the investments and changes to our supply chain to the divestitures that we're working on to the integration of these acquisitions, like Affera and our -- moving our CAS business forward. There's just a lot going on and it's just important to understand that we're moving very quickly on these things, and the results are starting, and we're encouraged by -- that you're starting to see the results.

但我們正在採取的行動是——我們正在迅速採取行動。我認為這就是這裡的想法。因此，我們在很多事情上都在迅速採取行動，無論是變化——我們供應鏈的所有投資和變化，還是我們正在致力於整合這些收購的資產剝離，比如 Affera 和我們的——移動我們的 CAS 業務向前發展。發生了很多事情，重要的是要了解我們在這些事情上進展非常迅速，結果已經開始，我們感到鼓舞的是——你們開始看到結果。

When it comes to spine, look this quarter was strong, last quarter was strong, too. It was just offset by some of the -- the last couple of quarters offset a little bit by the China VBP. But if you look underneath it, we've been quoting that U.S. implant growth rates that have been in the double digits, I mean, that's very, very strong and something, especially for someone with our level of market share by far, again, the #1 market share player to be growing like that.

說到脊柱，看這個季度很強，上個季度也很強。它只是被一些抵消了——過去幾個季度被中國 VBP 抵消了一點。但如果你仔細觀察它，我們一直在引用美國的植入物增長率，一直是兩位數，我的意思是，這是非常非常強勁的，特別是對於到目前為止我們市場份額水平的人來說，排名第一的市場份額參與者將像這樣成長。

What's driving that is the enabling technology ecosystem. It's something we've been working on aggressively since 2015. You've got the robot, you've got navigation, you've got interoperative imaging, you've got powered instruments. Now you've got this AI-based surgical planning system that basically -- it's -- we're winning over the hearts and minds of physicians as they see where we're going and actually a real commitment to changing spine surgery with this arsenal of technology.

推動它的是支持技術生態系統。這是我們自 2015 年以來一直在積極努力的事情。你有機器人，你有導航，你有互操作成像，你有動力儀器。現在你有了這個基於 AI 的手術計劃系統，基本上 - 它是 - 我們正在贏得醫生的心，因為他們看到我們要去的地方，實際上是用這個武器庫改變脊柱手術的真正承諾的技術。

And we've integrated it and it's not -- it's starting to help the workflow and move faster and more efficient. All of this coming together, that's what's driving it. And at the same time, we've been able to invest in implants, so that the implants are still the latest and greatest. And I think Brett Wall and Skip Kiil and the team have done a really good job.

我們已經集成了它，但它並沒有——它開始幫助工作流程並更快、更高效地移動。所有這些匯集在一起，這就是它的驅動力。同時，我們已經能夠投資於植入物，因此植入物仍然是最新最好的。我認為 Brett Wall 和 Skip Kiil 以及團隊做得非常好。

I don't know, Brett, if you want to make any further comments on that?

我不知道，Brett，你是否想對此做進一步的評論？

Yes, Geoff. And Joanne, thanks for the question. This has been something we've been working on for a while, and the strategy is really coming together with this enabling technology that actually allows for better planning, better execution, better follow-up and assuming and assuring that you actually get the result that you want in the procedure.

是的，傑夫。喬安妮，謝謝你的提問。這是我們一直在努力的事情，該戰略確實與這種使能技術結合在一起，實際上可以更好地規劃、更好地執行、更好地跟進，並假設並確保您實際得到的結果是你想要的程序。

That technology along with best-in-class implants and biologics is providing this ecosystem that's terrific for the physician and actually institutions that want to use it. And actually, the strategy is playing out like we've wanted to do with the significant growth in the largest market, which is the U.S. And as Geoff mentioned, now we're on the second quarter of double-digit growth there in our Core Spine business in the U.S. And we like our strategy, technology and how this is playing out for us.

該技術連同一流的植入物和生物製劑正在提供這種生態系統，這對於想要使用它的醫生和實際機構來說非常棒。實際上，該戰略正在發揮作用，就像我們希望在最大的市場（美國）實現顯著增長一樣。正如傑夫所提到的，現在我們的核心市場正處於第二季度的兩位數增長美國的脊柱業務我們喜歡我們的戰略、技術以及這對我們的影響。

Thanks, Joanne. Next question, please, Brad.

謝謝，喬安妮。下一個問題，請布拉德。

The next question comes from Matt Miksic at Barclays.

下一個問題來自巴克萊銀行的 Matt Miksic。

I had two follow-ups, if I could, just quickly on Diabetes and TAVR. So Geoff, your comments this morning, I don't know if it's just tone or my own impression, but it seemed like incrementally, perhaps more confident and committed to Diabetes and just -- I know where you're at with the warning letter. But maybe if you could talk about whether you're incrementally more confident here than you were a few months ago and maybe talk about what the reentry to that market looks like, assuming that you can get that -- the letter lifted and the product back to the market.

如果可以的話，我很快就糖尿病和 TAVR 進行了兩次跟進。所以傑夫，你今天早上的評論，我不知道這只是語氣還是我自己的印象，但它似乎是漸進的，也許更有信心和致力於糖尿病，而且只是 - 我知道你在警告信中的位置.但也許如果你能談談你在這裡是否比幾個月前更有信心，也許可以談談重新進入那個市場的樣子，假設你能做到——信件被取消，產品又回來了去市場。

And then just briefly on TAVR. As you know, one of your major competitors in that market has talked a lot about staffing and trends in the U.S. Just anything that you would add in terms of sequential improvements or changes in that market, or whether you're continuing to see some of the staffing challenges that they referred to but don't seem to be holding back your growth quite so significantly in the U.S.?

然後在 TAVR 上簡單介紹一下。如您所知，您在該市場的主要競爭對手之一已經就美國的人員配置和趨勢談了很多。您可以在該市場的連續改進或變化方面添加任何內容，或者您是否繼續看到一些他們提到的人員配置挑戰似乎並沒有如此顯著地阻礙您在美國的增長？

Sure. Thanks for the questions, Matt. Yes, I'll start with the Diabetes one. I'm not incrementally more committed because I've been committed since day 1. I mean there's no -- have not blinked on Diabetes. So committed to the business? Yes. Is there more confidence? Yes. And that's because we're continuing to see the impact of our technology.

當然。謝謝你的問題，馬特。是的，我將從糖尿病開始。我並沒有因為從第一天起就一直致力於而逐漸更加投入。我的意思是沒有 - 沒有對糖尿病眨眼。如此致力於業務？是的。是不是更有信心了？是的。那是因為我們繼續看到我們技術的影響。

When we have our full suite of technology outside the U.S., we're seeing strong growth. But it's not just the growth that's encouraging, it's the patient feedback, the clinical results that we're getting, time and range and other important metrics from a clinical standpoint, but it's also the patient experience in terms of ease of use and things like that.

當我們在美國以外擁有全套技術時，我們就會看到強勁的增長。但令人鼓舞的不僅僅是增長，還有患者的反饋、我們獲得的臨床結果、時間和範圍以及從臨床角度來看的其他重要指標，還有患者在易用性和諸如此類的方面的體驗那。

And then on top of that, we've got this pipeline of technology that we've -- that's coming right behind it, new pipeline of sensors. We've submitted our Simplera sensor for approval. And we've got more behind that. And a lot of development programs that I have a view into. And then finally, the business is just executing better. And so all that together is giving me more confidence.

然後最重要的是，我們擁有我們擁有的技術管道——緊隨其後的是新的傳感器管道。我們已提交我們的 Simplera 傳感器以供批准。我們還有更多的支持。以及我對許多開發計劃的看法。最後，業務執行得更好。所以所有這些加在一起讓我更有信心。

I'll ask Que to make a comment. Que, do you want to add to that?

我會請 Que 發表評論。 Que，你想補充嗎？

Yes. I mean, as Geoff said, we continue to expand access for the 780G system and Guiding 4 sensor. It's in over 90 markets. And wherever we see 780G launch, we also see higher CGM attachment rates because physicians and patients recognize the value of automation -- automated insulin delivery in driving outcomes. And we expect to see a similar trajectory when 780G is available in the U.S. market.

是的。我的意思是，正如 Geoff 所說，我們將繼續擴大 780G 系統和 Guiding 4 傳感器的使用範圍。它在 90 多個市場。無論我們看到 780G 的推出，我們也會看到更高的 CGM 附著率，因為醫生和患者認識到自動化的價值——自動化胰島素輸送在推動結果方面的價值。當 780G 在美國市場上市時，我們預計會看到類似的軌跡。

And just to put a finer point on what Geoff said about our next-generation products, we submitted our next-generation sensor CGM for CE Mark last year, and we have also done that on a standalone basis to the FDA. And we continue to be very optimistic about the progress we're seeing in the market. The U.S. market needs new products, we all know that. But I think we're making forward movement on all aspects of the business.

為了更好地說明 Geoff 對我們下一代產品的看法，我們去年提交了用於 CE 標誌的下一代傳感器 CGM，我們還單獨向 FDA 提交了該文件。我們繼續對我們在市場上看到的進展非常樂觀。美國市場需要新產品，這一點我們都知道。但我認為我們正在業務的各個方面取得進展。

Thanks, Que. And on the TAVR question, look, this is an area that we've been really focused on. Obviously, it's a market where the therapy has a huge impact on patient outcomes, and then financially for us, it's an important driver. And we've been really focused on this team and this new model -- have been really focused on this team, and they've done a great job on a number of fronts in terms of training physicians and adding new reps, training new reps and adding them to field, training physicians on the new techniques, but more recently here launching our Evolut FX and the results we're getting there.

謝謝，闕。在 TAVR 問題上，看，這是我們真正關注的領域。顯然，這是一個治療對患者結果產生巨大影響的市場，然後對我們來說，這是一個重要的驅動因素。我們一直非常專注於這個團隊和這個新模式——一直非常專注於這個團隊，他們在培訓醫生和增加新代表、培訓新代表方面的許多方面都做得很好並將它們添加到現場，對醫生進行新技術培訓，但最近在這裡推出了我們的 Evolut FX 以及我們取得的成果。

And Sean -- but I think the team has done a great job, and we're starting to make up some ground here with the competition globally, but in particular in the U.S. And Sean, maybe you can add some comments to this.

和肖恩——但我認為團隊做得很好，我們開始在全球競爭中取得一些進展，尤其是在美國和肖恩，也許你可以對此發表一些評論。

Yes. Thanks, Geoff. We are seeing sort of mid-single-digit growth underlying for the U.S. market. And obviously, we're moving faster than that at 12% growth because of the launch of FX. And I think also this recognition that our valve hemodynamics is really playing out for better durability of that valve over time, which is becoming more and more important.

是的。謝謝，傑夫。我們看到美國市場潛在的中個位數增長。顯然，由於 FX 的推出，我們的增長速度超過了 12%。我還認為，隨著時間的推移，我們的瓣膜血流動力學確實在提高瓣膜的耐用性，這一點變得越來越重要。

So FX really levels the playing field on ease of use, which has been important, but also you can line the commisures up, which is great for coronary access. And as people are thinking about the lifetime of the valve, both durability and making sure that those corners are easy to get back into matters a lot. And that combination has played out well for us.

所以 FX 確實在易用性方面提供了公平的競爭環境，這一直很重要，而且您還可以將連線排成一行，這對冠狀動脈通路非常有用。當人們在考慮閥門的使用壽命時，耐用性和確保這些角很容易恢復到很重要的位置。這種組合對我們來說效果很好。

We do still see spotty procedure volume challenges. It's all around the world, most acutely this last quarter in Japan, as we said, there was a wave of COVID that impacted us. And also we're dependent on a particular faster access [chief] that was impacted by supply chain issues last quarter. That's been resolved. So the launch of FX in Japan, returning procedure volumes and no constraint from vascular sheets will help us to grow there. And of course, as Evolut FX rolls out around the world, we'll still perform well.

我們仍然看到參差不齊的程序量挑戰。它遍布世界各地，正如我們所說，上個季度在日本最為嚴重，有一波 COVID 影響了我們。而且我們還依賴於上個季度受到供應鏈問題影響的特定更快訪問 [chief]。那已經解決了。因此，在日本推出 FX、恢復手術量和不受血管片的限制將幫助我們在那裡發展。當然，隨著 Evolut FX 在全球範圍內的推出，我們仍然會表現出色。

The fundamentals of that market are still very, very strong. It's just all the multiple touch points of the health care system that are required to get a patient in for therapy and through that therapy. But we expect that's going to start to abate and get better with time.

該市場的基本面仍然非常非常強勁。這只是讓患者接受治療並通過該治療所需的醫療保健系統的所有多個接觸點。但我們預計隨著時間的推移，這種情況會開始減弱並變得更好。

Whether it be our structural heart business, TAVR or Diabetes, and Joanne asked about spine, and you mentioned she mentioned in the comment, what do you mean by urgent. What I like about the new -- the operating model we have is these businesses, we've got -- we've segmented them in the right way where we have clarity, transparency into their end markets. We're measuring them on, are you growing above. We have clarity on market growth. We're measuring them on, are you growing above or below the market and comp is tied to that.

無論是我們的結構性心臟業務、TAVR 還是糖尿病，Joanne 詢問了脊柱，你提到她在評論中提到，你所說的緊急是什麼意思。我喜歡新的——我們擁有的運營模式是這些業務，我們已經擁有——我們以正確的方式對它們進行了細分，我們對它們的終端市場有清晰、透明的了解。我們正在衡量它們，你是否在上面成長。我們對市場增長情況很清楚。我們正在衡量它們，你是在高於市場還是低於市場的情況下增長，而薪酬與此相關。

So it creates this sense of urgency that we think is having an impact. It was kind of overwhelmed for a while by supply chain challenges. But as those mitigate, you're starting to see the impact of some of the changes we made.

因此，它產生了我們認為正在產生影響的緊迫感。供應鏈挑戰一度使它不知所措。但隨著這些緩解，您開始看到我們所做的一些更改的影響。

Thanks, Matt. Next question, please, Brad.

謝謝，馬特。下一個問題，請布拉德。

The next question comes from Josh Jennings of Cowen and Company.

下一個問題來自 Cowen and Company 的 Josh Jennings。

I was hoping to just ask about the JV. We don't get JV in the patient monitoring and respiratory spin, just how we should be thinking about the impact to, I guess, standalone Medtronic earnings in '24, either from execution of those two moves or just any headwind in terms of the earnings power in '24 to just the initial staging of getting to the finish line on both of those 2 moves?

我只是想問問 JV。我們在患者監測和呼吸旋轉方面沒有合資企業，我想我們應該如何考慮對美敦力 24 年獨立收益的影響，無論是執行這兩項舉措還是任何逆風24 年的盈利能力只是在這兩個步驟中到達終點線的初始階段？

Yes. In terms of the impact on total Medtronic earnings power, the separations are going to have minimal impact. So -- and in terms of staging the moves so that we have minimal impact or disruption across the company, we have been very focused on that and have strong teams in place that are managing these separations really well. And we purposely put those teams in place as part of our new operating model. As we make these portfolio moves, we're focused on being best-in-class in how we do it.

是的。就對美敦力總盈利能力的影響而言，分拆的影響微乎其微。因此，在採取行動以使我們對整個公司的影響或乾擾最小化方面，我們一直非常關注這一點，並且擁有強大的團隊來很好地管理這些分離。我們特意將這些團隊部署到位，作為我們新運營模式的一部分。在我們進行這些投資組合變動時，我們專注於在我們的工作方式上做到一流。

Just a follow-up on the patient monitoring and respiratory spin. Is it possible that an unsolicited -- a suitor could come into play? And how should investors think about the kind of potential for a parallel path to open up where you're moving forward with a spin, but there could be potential suiters coming in to -- kicking the tires on those two businesses?

只是對患者監測和呼吸旋轉的跟進。一個不請自來的求婚者是否有可能發揮作用？投資者應該如何考慮開闢一條平行路徑的可能性，你正在向前推進，但可能會有潛在的追求者加入——踢這兩家公司的輪胎？

Yes. Thanks, Josh. We're focused on maximizing shareholder value with the separation. And we've announced the spin, we're moving forward with that. Should something come along that maximizes shareholder value, we'll certainly listen to it.

是的。謝謝，喬希。我們專注於通過分離實現股東價值最大化。我們已經宣布了旋轉，我們正在推進它。如果出現可以最大化股東價值的事情，我們當然會傾聽。

Thanks, Josh. Next question, please, Brad.

謝謝，喬希。下一個問題，請布拉德。

The next question comes from Cecilia Furlong at Morgan Stanley.

下一個問題來自摩根士丹利的 Cecilia Furlong。

Just a two-part question for me. First on Hugo and the Euro IDE in the U.S., if you could provide an update on just what you've seen early days in enrollment. And then separately, we've heard a lot about Italy impact. Just curious if you could frame how you're thinking about the potential impact to your business going forward.

對我來說只是一個分為兩部分的問題。首先是關於美國的 Hugo 和 Euro IDE，如果您可以提供有關您在註冊初期看到的內容的最新信息。然後分別地，我們聽到了很多關於意大利影響的消息。只是好奇您是否可以構建您如何考慮對您的業務發展的潛在影響。

Thanks, Cecilia. Good to hear from you. On the first one, I'll let Bob White answer the question on the Hugo neuro urology IDE enrollment and just overall progress, what we're seeing in the U.S. And then turn it over to Karen for the question on Italy. So Bob?

謝謝，塞西莉亞。很高興聽到你的消息。在第一個問題上，我將讓 Bob White 回答有關 Hugo 神經泌尿外科 IDE 註冊和整體進展的問題，我們在美國看到了什麼，然後將其轉交給 Karen 來回答有關意大利的問題。那麼鮑勃？

Great. Thanks, Geoff, and Cecilia. Thanks for the question. As you've noted, the trial enrollment is underway for expand neuro. First patients have been enrolled and proceeding nicely on that. So we're pleased with our progress on that IDE specifically.

偉大的。謝謝，Geoff 和 Cecilia。謝謝你的問題。正如您所指出的，expand neuro 的試驗註冊正在進行中。第一批患者已經入組，並且進展順利。因此，我們對該 IDE 的具體進展感到滿意。

And then just more broadly, to Geoff's point, last quarter, we saw accelerated installations of Hugo entered new markets across EMEA, APAC and LATAM. And again, if you think about where we're at around the world, with the geographic expansion and our CE Mark allowing us to expand in the new markets. And then in CE markets, we've also added our general surgery indication on top of urology and gynecology. So now we cover about 80% of robotic procedures in those markets.

然後更廣泛地說，就 Geoff 的觀點而言，上個季度，我們看到 Hugo 的安裝加速進入了 EMEA、APAC 和 LATAM 的新市場。再一次，如果你想想我們在世界各地的位置，隨著地域擴張和我們的 CE 標誌，我們可以在新市場上擴張。然後在 CE 市場，我們還在泌尿科和婦科之上增加了我們的普通外科適應症。所以現在我們涵蓋了這些市場中大約 80% 的機器人程序。

And what we've been pleased, and you asked a little bit about feedback, we're getting really good feedback. The system's been used now to successfully perform a range of urology, gynecological, general surgery procedures from kind of simple to complex. And we're seeing that Hugo is the flexible and versatile tool we designed it to be.

我們很高興，你問了一些關於反饋的問題，我們得到了非常好的反饋。該系統現已用於成功執行一系列從簡單到復雜的泌尿科、婦科、普通外科手術。我們看到 Hugo 是我們設計的靈活多用的工具。

So it's early innings in terms of -- again, this market has got tremendous growth opportunity. Only 5% of procedures are done globally that could be done robotically assisted. We remain very excited about the market, and we're pleased with where we are today.

因此，就-再次而言，這個市場已經獲得了巨大的增長機會。全球只有 5% 的程序可以在機器人輔助下完成。我們仍然對市場感到非常興奮，我們對今天的狀況感到滿意。

And Cecilia, on the Italy question, there is a law in Italy that requires companies that are -- that sell medical devices to make payments to the Italian government if those device expenditures exceed maximum ceilings. The law was put in place in 2015 and applies to expenditures from that year onward.

塞西莉亞，關於意大利問題，意大利有一項法律要求銷售醫療設備的公司在設備支出超過最高限額時向意大利政府付款。該法律於 2015 年實施，並從當年起適用於支出。

You've heard from some of our other competitors on this. The law is obviously applicable to the whole industry. And we filed an appeal along with many other companies in our industry on this.

您已經從我們的其他一些競爭對手那裡聽說過這一點。該法顯然適用於整個行業。我們與我們行業的許多其他公司一起就此提出了上訴。

In the third quarter, for the first time, actual claims were issued to Medtronic and our peers for the years '15 to '18. And so we did revise our existing accrual. We already had an accrual and we did add to it in the third quarter. That accrual is a reduction of revenue. For us, it wasn't too significant, but we do have a reserve on our books.

在第三季度，第一次向美敦力和我們的同行發出了 15 年至 18 年的實際索賠。因此，我們確實修改了現有的應計利潤。我們已經有了應計利潤，我們確實在第三季度增加了它。這種應計是收入的減少。對我們來說，這並不太重要，但我們的賬面上確實有儲備。

Thanks, Cecilia. Let's take the next question, please, Brad.

謝謝，塞西莉亞。布拉德，讓我們來回答下一個問題。

Your next question comes from Shagun Singh, RBC.

您的下一個問題來自 RBC 的 Shagun Singh。

Karen, one for you. Could you just elaborate on the components of the impact -- of the components of the EPS impact on growth next year? You called out inflation, FX, interest and taxes. Perhaps you can talk about how large the impact is this year and what the flow-through could be next year. And then I have a follow-up.

凱倫，一個給你。您能否詳細說明影響的組成部分——EPS 的組成部分對明年增長的影響？你提到了通貨膨脹、外匯、利息和稅收。或許你可以談談今年的影響有多大，明年的影響有多大。然後我有一個後續行動。

Yes. Thanks, Shagun. So obviously, we've said we're -- we've got tons of moving pieces on next fiscal year. So we're not ready to give real guidance. And so, to quantify, the impact from EPS growth is difficult.

是的。謝謝，沙根。很明顯，我們已經說過——我們在下一個財政年度有大量的活動。所以我們還沒有準備好提供真正的指導。因此，要量化每股收益增長的影響是很困難的。

But what I would say on currency, we talked about the fact that, that is a headwind. I mentioned that in the commentary. And just at recent rates, currency is about a 5% headwind to next fiscal year. So we did quantify that. We also said that inflation impacts are about a mid-single-digit impact for us next fiscal year. So those are two that we've quantified.

但我要說的是貨幣，我們談到了一個事實，那就是逆風。我在評論中提到了這一點。就最近的匯率而言，貨幣對下一財年的影響約為 5%。所以我們確實量化了這一點。我們還說過，通貨膨脹對我們下一財年的影響大約是個位數。所以這是我們量化的兩個。

In terms of interest and tax, those are more minor headwinds than inflation and currency but still headwinds that we need to face. And then, obviously, we've got investment that we intend to make to drive the long-term growth of this company. And where we see important investments, we're going to make them. And we've said that we think that we're going to drive R&D growth, at least in line with revenue. And when we have important investments to make, in some years, that may grow even more than revenue. So hopefully, that helps.

在利息和稅收方面，這些是比通貨膨脹和貨幣更小的逆風，但仍然是我們需要面對的逆風。然後，很明顯，我們已經有了打算進行的投資，以推動這家公司的長期發展。在我們看到重要投資的地方，我們將進行投資。我們已經說過，我們認為我們將推動研發增長，至少與收入保持一致。當我們有重要的投資要進行時，在某些年內，投資的增長甚至可能超過收入。希望這會有所幫助。

That's helpful. And I was just wondering if you could talk a little bit about the PULSED AF data readout at ACC. How meaningful do you think it could be. And just maybe broadly talk about the PFA opportunity and how your platform is differentiated.

這很有幫助。我只是想知道你是否可以談談 ACC 的 PULSED AF 數據讀出。你認為它有多大意義。也許只是廣泛地談論 PFA 機會以及您的平台如何與眾不同。

Sure. Thanks for the question. We're definitely excited about the data that's coming out at ACC and the PFA opportunity. I think Sean's best positioned to answer your question. Sean?

當然。謝謝你的問題。我們對 ACC 和 PFA 機會的數據感到非常興奮。我認為 Sean 最適合回答您的問題。肖恩？

Yes. Thanks, Shagun. So we have a trial coming out on the 6th, which will be the very first IDE trial done in the rigors of an FDA trial for a study in this field. So it's really a first dataset. And it is two patient populations in the single trials, both paroxysmal patients as well as persistent patients. And the endpoints are primary safety endpoint, primary efficacy endpoint.

是的。謝謝，沙根。因此，我們將於 6 日進行一項試驗，這將是 FDA 在該領域研究的嚴格試驗中進行的首次 IDE 試驗。所以它真的是第一個數據集。在單一試驗中有兩個患者群體，既有陣發性患者，也有持續性患者。終點是主要安全終點、主要療效終點。

And the rigorous trial design here under the auspices of an IDE trial mean that you have very frequent monitoring of the patients, and you get a true kind of look at the way this anatomical solution performs. I'd say anatomical solution because we have really two things in this bag of AF treatments. One is one where you isolate the pulmonary veins and then the Affera system allows you to astute point-by-point ablation with a highly differentiated catheter.

在 IDE 試驗的支持下，這裡嚴格的試驗設計意味著您可以非常頻繁地監測患者，並且您可以真正了解這種解剖解決方案的執行方式。我會說解剖學解決方案，因為我們在這袋 AF 治療中確實有兩件事。一種是隔離肺靜脈，然後 Affera 系統允許您使用高度分化的導管進行巧妙的逐點消融。

That system is an automatic mapping system that allows you to kind of map, ablate and then validate what you've done, and we'll put all of our catheters on to that ecosystem over time, including this anatomical catheter, the DiamondTemp as well as cryocatheters.

該系統是一個自動映射系統，允許您進行映射、消融然後驗證您所做的事情，隨著時間的推移，我們將把我們所有的導管都放到那個生態系統中，包括這個解剖導管、DiamondTemp 以及作為冷凍導管。

So we'll have a full array of all energies, cryo, radio frequency as well as postal ablation to treat a myriad of arrhythmias that occur across the entire space. So it really does put us on -- with the newest technology early in the phase of that highly differentiated on both the mapping system as well as the therapeutic catheter side. And there's a lot of excitement among physicians for what we're bringing to the field.

因此，我們將擁有所有能量、低溫、射頻以及郵政消融的完整陣列，以治療整個空間發生的無數心律失常。所以它確實讓我們投入了——在映射系統和治療導管方面高度差異化的早期階段採用最新技術。醫生們對我們為該領域帶來的成果感到非常興奮。

Thank you, Shagun. Brad, we've got time for two more questions, please.

謝謝你，沙根。布拉德，我們有時間再問兩個問題。

The next question comes from Travis Steed at BofA.

下一個問題來自美國銀行的 Travis Steed。

Karen, I do want to ask on the Q4 margin step-up. Q3 was a little bit light on margins from FX and currency. Just curious if there's anything other than improving revenue to drive the Q4 margin step up.

凱倫，我想問一下第四季度利潤率的提高。第三季度外彙和貨幣的利潤率有點低。只是好奇除了增加收入之外是否還有其他任何因素可以推動第四季度的利潤率上升。

And then I know you're not going to get much on FY '24, but curious if you could kind of frame the opportunity on the cost side. I don't know if there's enough to offset the mid-single-digit inflation or partly offset that or more than offset. Just a little bit of color on cost savings side would be helpful.

然後我知道你在 24 財年不會得到太多，但很好奇你是否可以在成本方面構建機會。我不知道是否足以抵消中等個位數的通貨膨脹或部分抵消或超過抵消。在節省成本方面只需一點點顏色就會有所幫助。

Yes. Thanks, Travis. So on Q4 margins, that will be -- revenue growth obviously helps. So we'll start there. But we also will be driving cost reduction starting last quarter and even more into the fourth quarter, that will help as well. And then Q4 typically is our highest margin quarter. So we're focused on that step-up and it's typical for us.

是的。謝謝，特拉維斯。因此，在第四季度的利潤率上，收入增長顯然有幫助。所以我們將從那裡開始。但我們也將從上個季度開始推動成本削減，甚至進入第四季度，這也將有所幫助。然後第四季度通常是我們利潤率最高的季度。所以我們專注於升級，這對我們來說很典型。

On the cost opportunity for FY '24, again, we're not going to size it right now. But we've said that we are focused on driving a significant cost reduction to help partially offset the impacts that we've got from the various headwinds and the investment that we need to make.

同樣，關於 24 財年的成本機會，我們現在不打算調整它的規模。但我們已經說過，我們專注於推動大幅降低成本，以幫助部分抵消我們從各種不利因素和我們需要進行的投資中獲得的影響。

Thanks, Travis. And we'll take our final question, please, Brad.

謝謝，特拉維斯。布拉德，我們將回答最後一個問題。

Our final question comes from Rick Wise at Stifel Nicolaus.

我們的最後一個問題來自 Stifel Nicolaus 的 Rick Wise。

Maybe I'll just -- in the interest of time here, just focus on -- back on one topic: Hugo. Geoff, it seems like you're seeing a good ramp in Europe. But maybe you could quickly update us on supply chain? Is that resolved, resolving, almost resolved? What's your thought about that process and your ability to meet the demand? Last quarter, you talked about backlog. Maybe you could give us some more color there.

也許我會——為了節省時間，只關注——回到一個話題：雨果。傑夫，您似乎在歐洲看到了良好的發展勢頭。但也許你可以快速更新我們的供應鏈情況？那是解決了，解決了，幾乎解決了嗎？您如何看待該流程以及您滿足需求的能力？上個季度，你談到了積壓。也許你可以給我們更多的顏色。

And specifically, just a little more detailed color about once Hugo is in place, the kind of adoption and maybe pull through of instrumentation you're seeing just to -- so we have a real -- a better sense of exactly where you are with Hugo.

具體來說，關於 Hugo 到位後的一些更詳細的顏色，你所看到的那種採用和可能通過的儀器 - 所以我們有一個真實的 - 更好地了解你在哪裡雨果。

Yes. Great to hear from you, Rick. Thanks for the question. I'll turn it over to Bob for some of the details there. But I'd say just on Hugo, what the evolution of the -- is the feedback that we're getting, right? I mean we felt confident in the design. And as we get closer to launch, I was spending more time with physicians that were involved with the design that they don't work for Medtronic, but they were involved, and they were very bullish on it and happy with the way the product turned out.

是的。很高興收到你的來信，里克。謝謝你的問題。我會把它轉交給鮑勃，了解那裡的一些細節。但我想就 Hugo 說，我們得到的反饋是什麼演變，對吧？我的意思是我們對設計充滿信心。隨著我們越來越接近發布，我花了更多時間與參與設計的醫生在一起，他們不為美敦力工作，但他們參與了，他們非常看好它，並對產品的轉變方式感到滿意出去。

But now we're getting feedback from physicians that are converting from the competition or have both and they're high-volume users and they have a high bar for robotic surgery and that feedback has been really, really strong. And that is, I think, is very encouraging. And that word is spreading, as I talk to U.S. physicians that don't have access to it yet because they're not part of the trial and they have a pretty detailed understanding of the robot and its features and its capabilities. And so we're getting -- and so that's just driving really strong adoption.

但是現在我們從正在從競爭中轉變或兩者都有的醫生那裡得到反饋，他們是大量用戶，他們對機器人手術有很高的標準，而且反饋非常非常強烈。我認為，這非常令人鼓舞。當我與美國醫生交談時，這個詞正在傳播，他們還沒有接觸到它，因為他們不是試驗的一部分，而且他們對機器人及其特性和能力有非常詳細的了解。所以我們得到了 - 所以這只是推動了非常強大的採用。

And I'll let Bob talk about any kind of constraints or supply chain and any other details on adoption now.

我現在讓 Bob 談談任何類型的限製或供應鏈以及關於採用的任何其他細節。

Yes. Thanks, Geoff. And Rick, thanks for the question. A couple of other points, I think, Rick, that would be helpful for you is we're now starting to fulfill repeat orders by customers, which is nice. So customers have not just bought one. They're coming back to buy additional ones.

是的。謝謝，傑夫。里克，謝謝你的提問。瑞克，我認為還有幾點對你有幫助，我們現在開始履行客戶的重複訂單，這很好。所以客戶不只是買了一個。他們會回來購買更多的。

And the other thing is we're seeing a mix really of both early robotic adapters and experienced accounts, which is nice because we built Hugo with the differentiator -- built with physicians' needs in mind. So we're excited with what we see there.

另一件事是我們看到了早期機器人適配器和經驗豐富的客戶的混合體，這很好，因為我們構建 Hugo 時考慮到了差異化因素——考慮到醫生的需求。所以我們對在那裡看到的東西感到興奮。

And with respect to the supply chain, as it relates to Hugo, a good pick of that is behind us. So we had -- I talked in previous quarters about hardening our supply chain and working through those manufacturing processes. That's all in the rearview mirror for us.

至於供應鏈，因為它與 Hugo 相關，我們已經完成了一個很好的選擇。所以我們 - 我在前幾個季度談到了加強我們的供應鏈並完成這些製造流程。這一切都在我們的後視鏡中。

And then as Geoff and Karen mentioned more broadly, for our surgical business, we've seen our supply chains improve dramatically through the year, and you see that in the sequential quarter-on-quarter growth in that business. So hopefully, that's helpful.

然後，正如 Geoff 和 Karen 更廣泛地提到的那樣，對於我們的外科業務，我們已經看到我們的供應鏈在這一年中得到了顯著改善，並且您可以在該業務的連續季度環比增長中看到這一點。希望這會有所幫助。

I think the -- Rick, I think on the pull-through -- for that pull through to have an impact, it's going to take a little bit of time. It's a big Surgical Innovations business we have, $6 billion or so. But I will point to the spine business, and Joanne asked the question earlier, 2 quarters in a row of double-digit implant growth in the U.S., which is 80% of the market. That is largely driven by pull-through of an ecosystem of technology that's hard to match, that takes a lot of expertise, a lot of balance sheet and a lot of time. And we spent a lot of time on this robot, and we've invested a lot into it, and it's not just the robot. It is visualization, it is the digital platform.

我認為 - 里克，我認為在拉動中 - 要使拉動產生影響，需要一點時間。這是我們擁有的一項大型外科創新業務，價值 60 億美元左右。但我會指出脊柱業務，Joanne 早些時候問了這個問題，美國的植入物連續兩個季度實現兩位數增長，佔市場的 80%。這在很大程度上是由難以匹配的技術生態系統的拉動推動的，這需要大量的專業知識、大量的資產負債表和大量的時間。我們在這個機器人上花了很多時間，也投入了很多，不僅僅是機器人。它是可視化的，它是數字平台。

And we're confident that, that ecosystem will be a differentiator for Medtronic and pull through instrumentation and be a durable growth driver for the company. And that's why we stuck with it for the last too many years to admit to, to get it to this point. And we feel like we have something to build from.

我們相信，該生態系統將成為美敦力的差異化因素，並通過儀器拉動並成為公司持久的增長動力。這就是為什麼我們在過去的太多年裡堅持不懈地承認，以達到這一點。我們覺得我們有東西可以建立。

Thank you, Rick. Geoff, please go ahead with your closing remarks.

謝謝你，里克。 Geoff，請繼續您的結束語。

All right. Well, thanks for the questions. Some great questions this morning. I really appreciate your support and continued interest in the company, and we hope you'll join us for our Q4 earnings broadcast, which we anticipate holding on Thursday, May 25 where we'll update you on the progress and how we finished our fiscal year and of course, a look ahead at fiscal '24.

好的。好吧，謝謝你的問題。今天早上有一些很好的問題。我非常感謝您對公司的支持和持續關注，我們希望您能加入我們的第四季度財報廣播，我們預計將於 5 月 25 日星期四舉行，屆時我們將向您通報進展情況以及我們如何完成財政年度年，當然還有 24 財年展望。

So with that, thanks again for spending time with us today. Please stay healthy and safe, and have a great rest of your day.

因此，再次感謝您今天與我們共度時光。請保持健康和安全，並度過愉快的一天。