美敦力 (MDT) 2023 Q2 法說會逐字稿

Good morning. I'm Ryan Weispfenning, Vice President and Head of Medtronic Investor Relations, and welcome to snowing Minneapolis. I appreciate that you're joining us today for Medtronic's Fiscal Year 2023 Second Quarter Earnings Video Webcast.

早安.我是美敦力副總裁兼投資人關係主管Ryan Weispfenning，歡迎來到白雪皚皚的明尼亞波利斯。感謝您今天收聽美敦力2023財年第二季財報視訊網路直播。

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 second quarter, which ended on October 28, 2022. And as well as our outlook for the remainder of the fiscal year. After our prepared remarks, the executive VPs for 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.

在我們進入會議室聆聽準備好的發言之前，我將分享一些關於今天網路直播的細節。美敦力董事長兼執行長傑夫瑪莎 (Geoff Martha) 和財務長凱倫帕克希爾 (Karen Parkhill) 將與我一同出席。傑夫和凱倫將就我們截至2022年10月28日的第二季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結束後，我們四個部門的執行副總裁也將出席，我們將回答負責公司業務的賣方分析師的問題。今天的節目大約持續一個小時。

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各部門和地區收入摘要。我們也發布了一份收益報告，詳細介紹了我們的業績。您可以在我們的收益新聞稿中或造訪我們的網站 investorrelations.medtronic.com 取得該報告。

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 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的預測有重大差異。有關可能導致實際結果出現差異的因素的更多信息，請參閱我們向美國證券交易委員會 (SEC) 提交的定期報告和其他文件。我們不承擔更新任何前瞻性陳述的義務。

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.

除非我們另有說明，所有比較均以同比計算，收入比較按有機基礎進行，不包括外幣影響和我們第一季度收購 Intersect ENT 的收入。

Reference to sequential revenue changes compared to the first 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 third calendar quarter of 2022, compared to the third calendar quarter of 2021, unless otherwise stated.

與 23 財年第一季相比，營收的連續變動均以報告為基礎，所有提及的份額收益或損失均指 2022 年第三季與 2021 年第三季相比的營收份額，除非另有說明。

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

所有非 GAAP 財務指標的對帳表可在我們的收益新聞稿或我們的網站 investorrelations.medtronic.com 上找到。

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

最後，我們的每股盈餘預期不包含任何將作為非公認會計準則調整計入本財年收益的費用或收益。好了，讓我們走進攝影棚，聆聽本季的精彩內容。

(presentation)

（推介會）

Hello, everyone, and thank you for joining us today as we discuss our Q2 results and outlook. Our Q2 organic constant currency revenue growth of 2.2% came in about 1 point below expectations due to a slower-than-expected recovery in both procedure volumes in certain markets and in our supply chain. In terms of reported revenue, the continued strength of the dollar over the course of the quarter drove over half the difference to expectations.

大家好，感謝大家今天與我們討論第二季業績及展望。我們第二季的有機固定匯率營收成長率為2.2%，低於預期約1個百分點，原因是部分市場和供應鏈的手術量復甦均慢於預期。就報告收入而言，美元在本季持續走強，導致收入與預期之間的差距超過一半。

Now despite the top line results, we were able to control expenses and deliver EPS at the high end of our guidance range. We also issued guidance for the back half of our fiscal year this morning. We expect continued acceleration in organic revenue growth in the second half, although less than previously anticipated, and this partially flows through to EPS. Now this is something that I don't take lightly, delivering on our expectations is important to building and maintaining trust and credibility with you.

儘管營收表現不佳，但我們仍控制了開支，並將每股盈餘保持在預期範圍的高端。今天上午，我們也發布了下半年財報指引。我們預計下半年有機收入成長將繼續加速，儘管低於先前的預期，但這部分將轉化為每股盈餘。我對此非常重視，而實現我們的預期對於與各位建立和維護信任和信譽至關重要。

Karen will walk you through the details, but some of our markets and some of our supply constraints recovered more slowly than we expected in the quarter, and that, along with incremental China volume-based procurements, led us to reduce our expectations. While the current operating environment remains challenging, we had strong growth in several businesses in geographies, where our strategy, our operating model and execution are yielding solid results.

Karen 將為您詳細介紹，但本季部分市場和供應限制的恢復速度低於預期，再加上中國市場批量採購的增加，導致我們下調了預期。儘管當前的營運環境依然充滿挑戰，但我們在多個地區的業務實現了強勁成長，我們的策略、營運模式和執行力在這些地區取得了穩健的成果。

We have near-term product catalysts in our pipeline. We are decisively allocating capital internally and selectively making focused acquisitions. We're making improvements to the operational health of the company, and we're streamlining the company's structure and taking cost out. All of this gives us confidence that we're on the path to creating durable growth and shareholder value.

我們擁有一系列短期產品催化劑。我們正在果斷地內部配置資本，並選擇性地進行有針對性的收購。我們正在改善公司的營運狀況，精簡公司架構並降低成本。所有這些都讓我們充滿信心，相信我們正走在創造持久成長和股東價值的道路上。

Now diving deeper into our Q2 results. For reported revenue, as I said earlier, currency drove over half the miss to consensus. Organically, the miss was primarily split evenly between 2 challenges. One, procedure volumes in some markets have been slower to return to normal levels. And two, some of our supply challenges have persisted longer than we anticipated.

現在深入探討我們第二季的業績。就報告收入而言，正如我之前所說，匯率因素導致超過一半的業績未達預期。從有機角度來看，業績未達預期主要歸因於兩大挑戰。第一，部分市場的手術量恢復正常水準的速度較慢。第二，部分供應挑戰的持續時間比我們預期的要長。

With regard to procedural volumes, in addition to an incremental China VBP, we are still seeing lower volumes in elective coronary PCI, GI procedures, TAVR, spinal cord stim and some less emergent surgical procedures. The slower-than-anticipated recovery in procedural volumes primarily occurred in developed markets as health care systems continue to work through staffing and other challenges.

就手術量而言，除了中國VBP的增加外，我們仍然看到擇期冠狀動脈PCI、胃腸道手術、經導管主動脈瓣置換術（TAVR）、脊髓刺激以及一些非緊急外科手術的手術量下降。手術量復甦慢於預期主要發生在已開發市場，因為醫療保健系統仍在努力應對人員配備和其他挑戰。

Now with regard to supply, we've made meaningful recovery and many of the most acute issues are now behind us, including the acute packaging issues, which we highlighted last quarter. But some of the improvements did come later than we expected in Q2, and as a result, we missed cases in businesses like surgical innovations and it has delayed our expected momentum.

就供應而言，我們已經取得了顯著的復甦，許多最棘手的問題都已解決，包括我們上個季度強調過的嚴重的包裝問題。但第二季的一些改善確實比我們預期的要晚，因此我們錯過了外科創新等業務的案例，這推遲了我們預期的成長勢頭。

Now focusing beyond challenges impacting our markets and product availability, we have a number of businesses where our strategy and execution are yielding results. Recall that we moved to the new operating model 2 years ago, we created highly focused, accountable and empowered operating units that can move with greater speed and decisiveness. And today, we're clearly seeing the benefit of this model across many of our businesses.

現今，我們不僅關注影響市場和產品供應的挑戰，還在許多業務領域，透過策略和執行，取得了豐碩的成果。兩年前，我們啟用了新的營運模式，創造了高度專注、責任明確、賦能的營運部門，使其能夠以更快的速度和更果斷的行動。如今，我們在許多業務領域都清楚地看到了這種模式的益處。

Starting with cranial and spinal technologies. CST grew 5%, and this is despite a large negative impact from China VBP. In fact, our U.S. Core Spine business grew 15%. Additionally, this quarter, we launched our spine technology ecosystem, which we call Aible at the NASS conference. From planning to our best-in-class implants, to navigation and robotic assistance, to interoperative imaging and surgical tools up to and including patient follow-up, Aible brings spinal surgery together in one seamless and connected platform.

首先從顱腦和脊椎技術開始。儘管中國VBP帶來了巨大的負面影響，CST仍成長了5%。事實上，我們的美國核心脊椎業務成長了15%。此外，本季我們在NASS大會上推出了名為Aible的脊椎技術生態系統。從手術規劃到我們一流的植入物，再到導航和機器人輔助，再到術中影像和手術工具，甚至患者隨訪，Aible將脊椎外科手術整合到一個無縫互聯的平台上。

And another highlight was our Structural Heart business, where our TAVR business grew 15% globally, including 17% in the United States. The launch of our Evolut FX valve drove 18% sequential revenue growth in our U.S. TAVR business, despite being at full market launch for only the last month of the quarter. So we expect Evolut FX to drive momentum for us over the coming quarters.

另一個亮點是我們的結構性心臟業務，我們的TAVR業務在全球成長了15%，其中在美國成長了17%。儘管Evolut FX瓣膜在本季最後一個月才全面上市，但它的推出推動了我們美國TAVR業務營收季增18%。因此，我們預計Evolut FX將在未來幾季為我們帶來強勁成長動能。

Our Cardiac Rhythm Management business continues to execute and win share with 4% growth in this quarter. Within CRM, our pacing business grew 6%, well above the market, with 18% growth of our micro family of leadless pacemakers. And we're looking forward to the commercial introduction of our AURORA EV-ICD in the back half of this fiscal year.

我們的心律管理業務本季持續表現強勁，市佔率成長4%。在心律管理業務方面，我們的心律調節器業務成長了6%，遠高於市場平均水平，其中微型無導線起搏器系列成長了18%。我們期待AURORA EV-ICD在本財年下半年實現商業化。

So while we have businesses where the changes we've made over the past couple of years are clearly having a positive impact, we're also focused on ensuring these efforts translate into improved performance in all of our businesses. It's worth highlighting a few businesses where we are making strong progress to drive future growth over the near to midterm and some of that already have immediate momentum.

因此，雖然我們過去幾年對部分業務的改革顯然產生了積極影響，但我們也致力於確保這些努力能夠轉化為所有業務的業績提升。值得一提的是，一些業務正在取得強勁進展，預計在近期至中期推動未來成長，其中一些業務已經展現出強勁勢頭。

Let's take cardiac ablation solutions, a business that we expect to be a strong future growth driver. Pulsed field ablation represents a large market opportunity and we're looking forward to seeing our PULSED AF pivotal trial results in the first half of the next calendar year, putting us on the path to be one of the first companies with the PFA catheter in the U.S. market, which we think is underappreciated. This is a meaningful growth opportunity for Medtronic in the next 18 to 24 months.

以心臟消融解決方案為例，我們預期該業務將成為未來強勁的成長動力。脈衝場消融代表著巨大的市場機遇，我們期待在明年上半年看到 PULSED AF 關鍵試驗的結果，這將使我們有望成為美國市場上首批擁有 PFA 導管的公司之一，我們認為該領域目前被低估了。這對美敦力未來 18 到 24 個月來說是一個意義重大的成長機會。

And as you know, we closed our acquisition of Affera in August and Affera's differentiated mapping and navigation system gives us the breadth and differentiation that we need to win share in cardiac ablation. And we expect to complete enrollment this quarter in the pivotal. This fully integrated system will be the first of its kind to offer a unique catheter that can perform high-density mapping and deliver both pulse field and radiofrequency ablation in a single device.

如您所知，我們於8月完成了對Affera的收購，Affera差異化的測繪和導航系統為我們贏得了心臟消融領域市場份額所需的廣度和差異化優勢。我們預計本季完成關鍵臨床試驗的入組。這款完全整合的系統將是同類產品中首個提供獨特導管的系統，該導管可執行高密度測繪，並在單一裝置中同時提供脈衝場和射頻消融。

Now in diabetes, we remain focused on resolving our warning letter. We've now completed 100% of our warning letter commitments and have informed the FDA that we're 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. And outside the U.S., we continue to receive positive customer feedback on the performance of the 780G, which is now available in over 60 countries.

目前，在糖尿病領域，我們正專注於處理警告信。我們已完成100%的警告信承諾，並已通知FDA我們已準備好接受重新檢查。我們仍在積極向FDA審查搭載Guardian 4感測器的MiniMed 780G系統。在美國以外，我們持續收到客戶對780G效能的正面回饋，該系統現已在60多個國家/地區上市。

In Q2, 780G drove mid-teens growth for our Diabetes business in international markets. And across Diabetes, we're investing heavily in the development of multiple next-generation insulin delivery and sensor technologies, and we remain focused on restoring strong growth to this important franchise over the coming years.

第二季度，780G 推動了我們糖尿病業務在國際市場上實現中等幅度的成長。在整個糖尿病領域，我們正在大力投資開發多種下一代胰島素輸送和感測器技術，並將繼續致力於在未來幾年恢復這項重要業務的強勁成長。

Turning to our Hugo surgical robot. Now I'm sure we're going to get into this in Q&A, but we saw a lot of positive momentum this quarter as we scale manufacturing production, expand regulatory approvals and ramp installations. In addition, we just received FDA IDE approval last week on our product enhancements. Now this allows us to start our U.S. urology clinical trial by the end of the calendar year and is a catalyst for continued progress with our international sales.

談談我們的Hugo手術機器人。我相信我們會在問答環節深入討論這個問題，但隨著我們擴大生產規模、獲得監管部門批准並加速安裝，本季度我們看到了許多積極的發展勢頭。此外，我們上週剛獲得了FDA IDE對我們產品改進的批准。這使我們能夠在年底前啟動美國泌尿外科臨床試驗，並將成為我們國際銷售持續成長的催化劑。

Now before I talk about our capital allocation and portfolio management, let me share my thoughts on the Ardian opportunity. Despite the impact we believe COVID and medication changes had on the ambulatory endpoint in ON MED, the totality of the data is compelling. The large drop in office blood pressure in the Ardian arm was impressive, and it was consistent with what we've seen in our other trials. Importantly, the current standard of care for reducing blood pressure, it just isn't working, which was evident in the long-term SPRINT trial results published just last month in JAMA Cardiology.

在談論我們的資本配置和投資組合管理之前，我想先分享一下我對 Ardian 投資機會的看法。儘管我們認為新冠疫情和藥物變化對 ON MED 的門診終點產生了影響，但整體數據仍然令人信服。 Ardian 組的診室血壓大幅下降令人印象深刻，這與我們在其他試驗中觀察到的結果一致。重要的是，目前的降血壓標準療法根本不起作用，上個月發表在《JAMA Cardiology》雜誌上的長期 SPRINT 試驗結果證明了這一點。

Patients don't seem to stay on multidrug therapy for long periods of time and eventually just stop taking their medications. And that's the advantage of Ardian, it's always on. We've demonstrated that our Ardian procedure, it's safe, it's effective, and it's durable. Physicians are excited and Ardian is preferred by patients. Now we've submitted our PMA to the FDA, and we're looking forward to working with governments and payers in the U.S. and around the world who are searching for improvements to control high blood pressure and avoid the costly and devastating consequences of this disease.

患者似乎不會長期服用多種藥物，最終停藥。這就是 Ardian 的優勢，它始終有效。我們已經證明了我們的 Ardian 療法安全、有效且持久。醫生們對此感到興奮，Ardian 也深受病患的青睞。現在，我們已經向 FDA 提交了上市前批准 (PMA)，我們期待與美國及世界各地的政府和醫療機構合作，共同尋求控制高血壓的改進方法，避免這種疾病帶來昂貴且災難性的後果。

In addition to advancing our pipeline, we're focused on decisively allocating capital and streamlining the company to deliver durable growth. We're freeing up resources to invest more in R&D, feeding our fast-growing businesses in areas where we can see the strongest returns. Cardiac ablation solutions and Diabetes are two clear examples of this.

除了推進產品線建設外，我們還專注於果斷配置資本並精簡公司架構，以實現持久成長。我們正在釋放資源，加大研發投入，為快速成長、回報最高的業務領域提供支援。心臟消融解決方案和糖尿病就是兩個明顯的例子。

We're also making moves with our portfolio to focus our company and our capital on opportunities that are better aligned with our long-term growth acceleration strategies. Over the past two quarters, we've announced our intent to separate three businesses, that we believe will thrive outside the company. With our Renal Care Solutions business, we're progressing on the separation, forming a new kidney health technology company together with DaVita.

我們也正在調整投資組合，將公司和資本集中在更符合我們長期成長加速策略的機會。過去兩個季度，我們宣布了剝離三項業務的計劃，我們相信這些業務將在公司外部蓬勃發展。對於我們的腎臟護理解決方案業務，我們正在推進剝離工作，並與DaVita共同組建一家新的腎臟健康技術公司。

We continue to expect this transaction to close in calendar 2023. And last month, we announced our intention to separate our combined patient monitoring and respiratory interventions business. We remain focused on active portfolio management, evaluating both potential additions and subtractions to further accelerate our growth and create value for our shareholders.

我們預計此次交易將於2023年完成。上個月，我們宣布了拆分合併的病患監護和呼吸幹預業務的計畫。我們將繼續專注於積極的投資組合管理，評估潛在的增減，以進一步加速成長並為股東創造價值。

Now with that, I'll turn it over to Karen to discuss our second quarter financial performance and our guidance. Karen?

現在，我將把時間交給 Karen 來討論我們第二季度的財務表現和指導。 Karen？

Thank you, Geoff. Our second quarter organic revenue increased 2.2%, up significantly from Q1, but below our guidance range, given the challenges Geoff mentioned. Yet with a focus on expenses, our adjusted EPS of $1.30 landed at the upper end of our guidance range. Currency had a significantly unfavorable impact of 5.8% on our reported revenue growth.

謝謝，Geoff。我們第二季的有機收入成長了2.2%，較第一季大幅成長，但考慮到Geoff提到的挑戰，低於我們的預期範圍。然而，由於關注支出，我們的調整後每股收益為1.30美元，處於預期範圍的上限。匯率因素對我們報告的收入成長產生了5.8%的顯著不利影響。

Our FX hedges mitigated that impact on the bottom line with EPS down only $0.01 or 80 basis points from currency. Looking at our results from a geographic perspective, our U.S. revenue grew 1%. Our non-U.S. developed increased 3%, and emerging markets grew 4%. Our emerging markets growth continued to be affected by China, which declined 9%, given the impact of a national tender in our spine business and several provincial tenders in certain other businesses.

我們的外匯對沖減輕了對利潤的影響，每股盈餘僅下降0.01美元，即80個基點（基於貨幣）。從地域角度來看，我們的業績表現如下：美國市場收入成長1%。美國以外的已開發市場成長3%，新興市場成長4%。新興市場的成長持續受到中國市場的影響，受脊椎業務全國性招標以及其他一些業務省級招標的影響，中國市場收入下降了9%。

However, we continue to see strong double-digit growth in our other markets, including mid-20s growth in Eastern Europe and mid-teens growth in Latin America. In fact, excluding China, our emerging markets grew 15%.

然而，我們在其他市場持續保持強勁的兩位數成長，其中東歐市場實現了25%左右的成長速度，拉丁美洲市場實現了15%左右的成長速度。事實上，除中國外，我們的新興市場成長了15%。

Turning to our margins. Our adjusted gross margin of 67.6% declined 120 basis points from inflationary pressures in materials, direct labor, freight and utilities.

談到我們的利潤率。由於材料、直接人工、運費和公用事業方面的通膨壓力，我們的調整後毛利率為 67.6%，下降了 120 個基點。

We expect these inflationary pressures to continue and to impact the back half of this fiscal year, more than what we experienced in the first half. Our adjusted operating margin of 26.6% declined 40 basis points, including a 120 basis point benefit from our currency hedging program. Compared to the first quarter, our operating margin improved 270 basis points, given accelerated revenue growth.

我們預期這些通膨壓力將持續存在，並對本財年下半年造成更大影響，且影響程度將超過上半年。我們調整後的營業利潤率為26.6%，下降了40個基點，其中包括貨幣對沖計畫帶來的120個基點的收益。與第一季相比，由於營收成長加速，我們的營業利潤率提高了270個基點。

We expect sequential improvement throughout the fiscal year. We continue to maintain a strong balance sheet. I would note that the vast majority of our debt is fixed at low rates as we move into a higher rate environment.

我們預計整個財年業績將持續改善。我們的資產負債表將持續保持強勁。我想指出的是，隨著我們進入高利率環境，我們的絕大多數債務仍以低利率固定。

Regarding our capital allocation, we continue to balance investing for the future with returning capital to shareholders, and we remain committed to our dividend and to returning a minimum of 50% of our free cash flow to our shareholders.

關於我們的資本配置，我們繼續平衡未來投資與向股東返還資本，我們仍然致力於派發股息並向股東返還至少 50% 的自由現金流。

Now turning to our guidance. Today, we set our second half revenue guidance at 3.5% to 4% organic, which excludes currency movement and revenue from our Intersect ENT acquisition. If recent exchange rates hold, foreign currency would now have a negative impact on our back half revenue of $930 million to $1.03 billion.

現在談談我們的業績預期。今天，我們將下半年營收預期設定為3.5%至4%的自然成長，不包括匯率變動和Intersect ENT收購帶來的營收。如果近期匯率不變，外幣匯率將對我們下半年9.3億至10.3億美元的營收產生負面影響。

Our back half guidance translates into a reduction of our annual guidance, driven by a slower pace of market and supply recovery. On market, we are expecting incremental provincial tenders in China, particularly in stapling and cardiac ablation. And Geoff referenced earlier that some procedure volumes in the second quarter didn't recover as quickly as we were expecting. So at this point, we are assuming no incremental improvement in the back half.

由於市場和供應復甦步伐放緩，我們下半年的業績指引將轉化為年度指引的下調。在市場上，我們預計中國各省的招標數量將增加，尤其是在吻合器和心臟消融領域。 Geoff 先前提到，第二季部分手術量的恢復速度不如我們預期。因此，目前我們預計下半年不會有明顯改善。

On supply, while we have had a meaningful recovery, it came later than anticipated, particularly in SI and cardiac diagnostics. And that simply delays our pace of recovery ahead.

在供應方面，雖然我們取得了顯著的復甦，但復甦來得比預期要晚，尤其是在SI和心臟診斷領域。這只會延緩我們未來的復甦步伐。

By segment in the back half, the majority of the reduction is in our medical surgical portfolio, which we now expect to be flat to up 0.5%. We expect cardiovascular to grow 5.25% to 5.75%, neuroscience to grow 6% to 6.5% and diabetes to decline in the low single digits, all on an organic basis.

就下半年各細分領域而言，大部分減幅來自我們的外科醫療產品組合，我們目前預計該組合將持平至成長0.5%。我們預期心血管產品組合將成長5.25%至5.75%，神經科學產品組合將成長6%至6.5%，糖尿病產品組合將出現低個位數的下降，且所有產品都將實現內生成長。

Our total company revenue guidance does assume continued revenue growth acceleration, which we saw in each month of the second quarter. We expect the third quarter growth rate to be better than the second and the fourth quarter better than the third. We will have easing comparisons in ventilators, improving supply in certain businesses like cardiac diagnostics and SI and the benefit from product launches, like Evolut FX and EV ICD.

我們對公司總收入的預期確實假設收入成長持續加速，正如我們在第二季每個月所見。我們預期第三季的成長率將優於第二季度，第四季將優於第三季。呼吸器的市場比較將趨於平穩，心臟診斷和SI等特定業務的供應將改善，Evolut FX和EV ICD等產品上市也將帶來利多。

In the third quarter, we expect organic revenue growth in the range of 2.5% to 3%, an acceleration from the second quarter. And assuming recent exchange rates hold, the third quarter would have a currency headwind between $460 million and $510 million.

我們預計第三季有機收入成長率將在2.5%至3%之間，較第二季有所加快。假設近期匯率維持不變，第三季將面臨4.6億美元至5.1億美元的匯率逆差。

By segment and on an organic basis, we expect Medical Surgical to be down 2% to 2.5%, an improvement from the second quarter, given lesser event headwinds and the impact of the flu season. Cardiovascular to grow 4.75% to 5.25% on the continued rollout of Evolut FX and LINQ II. Neuroscience to grow 5.75% to 6.25%, improving from the prior quarter with less VBP impact in spine and diabetes to decline in the low single digits.

以細分市場和內生成長來看，我們預期外科手術業務將下降 2% 至 2.5%，較第二季有所改善，這得益於疫情期間不利因素和流感季的影響有所減弱。心血管業務將隨著 Evolut FX 和 LINQ II 的持續推出而成長 4.75% 至 5.25%。神經科學業務將成長 5.75% 至 6.25%，較上一季度有所改善，其中脊椎和糖尿病領域 VBP 的影響較小，降幅將達到低個位數。

On the bottom line, we are driving significant expense reduction throughout the company to help offset the lower revenue and continued inflation impact and now expect fiscal '23 non-GAAP diluted EPS in the range of $5.25 to $5.30. That range includes an unfavorable impact of currency of approximately $0.18 at recent rates.

就獲利而言，我們正在推動全公司大幅削減開支，以抵消收入下降和持續的通膨影響。目前，我們預計23財年非公認會計準則稀釋每股收益將介於5.25美元至5.30美元之間。此區間包含以近期匯率計算約0.18美元的不利匯率影響。

For the third quarter, we expect non-GAAP diluted EPS to be in the range of $1.25 to $1.27, including an FX headwind of about $0.05 at recent rates. Amidst the macro environmental headwinds we face from inflation, China VBP, softer procedure volumes in certain markets and currency, we are laser-focused on driving operational and expense efficiencies. We are also committed to invest appropriately for the long term, allocating capital to our most promising growth drivers and executing tuck-in acquisitions, design to reach more patients and create value for our shareholders.

我們預期第三季非公認會計準則稀釋每股盈餘將在1.25美元至1.27美元之間，其中包括以近期匯率計算約0.05美元的匯率不利因素。面對通貨膨脹、中國VBP、某些市場診療量下降以及匯率波動等宏觀環境不利因素，我們專注於提升營運效率和費用效率。我們也致力於進行合理的長期投資，將資金配置到我們最有前景的成長動力上，並執行補充性收購，旨在惠及更多患者，並為股東創造價值。

As we approach Thanksgiving, I want to share my gratitude to our employees who have been committed, particularly during these challenging times to deliver on our mission, to alleviate pain, restore health and extend life for millions of people around the world.

在感恩節即將來臨之際，我想向我們的員工表達我的謝意，他們一直致力於完成我們的使命，特別是在這些充滿挑戰的時期，為全世界數百萬人減輕痛苦、恢復健康和延長壽命。

Back to you, Geoff.

回到你這裡，傑夫。

Thank you, Karen. Now before we open the lines for questions, I want you to know that our growth rate and our consistency are not where we want them to be. That's why I shared with you our aggressive agenda to transform this company 2 years ago when I became CEO. We embarked on a plan of implementing a new operating model, eliminating the bureaucracy of our groups and forming more nimble operating units, while at the same time, learning to leverage our scale.

謝謝，凱倫。在開始提問之前，我想讓大家知道，我們的成長率和穩定性遠未達到我們預期。正因如此，兩年前我上任執行長時，就與大家分享了我們積極轉型公司的計畫。我們著手實施新的營運模式，消除各部門的官僚作風，組成更靈活的營運部門，同時學習如何利用我們的規模優勢。

We set in motion a new performance-driven culture, and we changed our incentive plans to reward new behaviors and performance. We brought in new leaders to inject new ways of thinking in the organization, and we implemented new capital allocation and portfolio management processes. Now these changes take time, and we face setbacks along the way that have slowed us down. Some are environmental like COVID recovery rates, raw material shortfalls and Chinese procurement policy, while other setbacks are of our own doing, like our quality and operational challenges and the pace of improvement we anticipated.

我們建立了以績效為導向的全新文化，並調整了激勵計劃，以獎勵新的行為和績效。我們引入了新的領導者，為組織注入了新的思維方式，並實施了新的資本配置和投資組合管理流程。這些改變需要時間，我們也面臨一些阻礙我們前進的障礙。其中一些是環境因素，例如新冠疫情後的恢復速度、原材料短缺和中國採購政策；而另一些則是我們自身造成的，例如品質和營運挑戰以及我們預期的改進速度。

Look, I know we have more work to do here, but we understand the root causes that led to the years of underperformance from this company. And our aggressive transformation agenda is designed to fix these issues. I know we will get this right, choosing the right markets, being more efficient and productive with our resources, empowering businesses and increasing accountability, improving our quality, our manufacturing and our supply chain and turning our size and scale into an advantage.

我知道我們還有很多工作要做，但我們了解導致公司多年業績不佳的根本原因。我們積極的轉型計劃旨在解決這些問題。我相信我們一定能做好，選擇正確的市場，提高資源利用效率和生產力，賦能企業，加強問責，提升品質、製造和供應鏈，並將我們的規模轉化為優勢。

And I know we are on the right path. The progress we've made so far gives me that confidence. We have experienced leaders, a compelling pipeline and positions of strength in some of the most attractive MedTech markets, which address significant unmet needs for patients.

我知道我們正走在正確的道路上。我們迄今為止的進展讓我充滿信心。我們擁有經驗豐富的領導者、強大的產品線，並在一些最具吸引力的醫療科技市場中佔據優勢地位，滿足了患者尚未滿足的重大需求。

We will execute on our plan to deliver durable growth that we began 2 years ago. And as we do, we will create tremendous value for all of our stakeholders.

我們將執行兩年前啟動的持久成長計畫。同時，我們將為所有利害關係人創造巨大的價值。

So now let's move to Q&A. We're going to try to get to as many analysts as possible, so 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.

現在我們進入問答環節。我們會盡可能多地聯繫分析師，因此請您只提問一個問題，並且僅在必要時進行相關的後續提問。如果您還有其他問題，可以在電話會議結束後聯繫 Ryan 和投資者關係團隊。

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

布拉德，您能否給予提問的說明？

(Operator Instructions) 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) We'll take the first question from Robbie Marcus, JPMorgan. Robbie, please go ahead.

（操作員指示）今天的會議將由Geoff、Karen和Ryan主持，此外還有糖尿病營運部門執行副總裁兼總裁Que Dallara、心血管產品組合執行副總裁兼總裁Sean Salmon、神經科學產品組合執行副總裁兼總裁Brett Wall以及外科產品組合執行副總裁兼總裁Bob White。 （操作員指示）我們將回答摩根大通Robbie Marcus的第一個問題。 Robbie，請問問題。

Great. Maybe I'll ask in 2 part or upfront. The miss in the top line in the quarter, the guide down was pretty significant for the second half of the year. You point to slowing procedure growth or not a recovery they're hoping for yet it's different from what we're hearing from most of your peers in terms of stabilizing volume growth.

太好了。也許我會分兩部分問，或者提前問。本季營收未達預期，下半年的業績預期下調幅度相當大。您指出，業務成長放緩，或者復甦並非他們所希望的，但這與我們從大多數同行那裡聽到的穩定銷售成長的說法不同。

So I was hoping you could spend more time. Walk us through what Medtronic is seeing and maybe why it's a little different relative to peers in terms of the recovery and the stabilization in volumes -- and then as we think out to next year and fiscal '24, can you give some thoughts on the last call about FX and how we should be thinking about growth for next year. Any updates to that growth? And does it change with the updated second half guidance range?

所以我希望您能多花點時間。請您介紹美敦力目前的情況，以及為什麼它在銷售復甦和穩定方面與同行略有不同。然後，展望明年和2024財年，您能否談談上次電話會議中關於外匯以及我們應該如何看待明年的成長？關於成長方面有什麼更新嗎？它會隨著下半年業績指引的更新而改變嗎？

Okay. Thanks, Robbie. Okay. I saw three parts there. I'm going to ask Karen to chime in to help me here on this one, but provide some details. But on the miss, like we said in the commentary, the primary issue is the pace of the recovery and there's the two buckets. There's the pace of our supply recovery, which we did make quite a bit of progress there and they got over the most acute issues that were plaguing us, but happened a little -- it happened late in the quarter and pushed out our momentum, which gets to the second part of your question, which is the effects the guide down.

好的。謝謝，羅比。好的。我看到了三個部分。我想請凱倫幫我補充一下，但請提供一些細節。至於未達標的問題，正如我們在評論中所說，主要問題是復甦的速度，而且有兩個方面。一個是供應復甦的速度，我們在這方面確實取得了相當大的進展，他們克服了困擾我們的最棘手的問題，但也發生了一些小問題——它發生在季度末，削弱了我們的增長勢頭，這就涉及到你問題的第二部分，即指導下調的影響。

The other bucket is part of your second question as well as on the markets. Many of our businesses are back, the majority of them are back to the pre-COVID level of their markets. But there are some that are not. And I'll let Karen walk through those and we were -- we just overstated what that market recovery would be, and we'll walk you through those and how those impact the second quarter -- the second half. Karen, do you want to...

另一個方面是您第二個問題的一部分，也與市場有關。我們的許多業務已經恢復，其中大多數都恢復到了疫情前的市場水準。但也有一些業務沒有恢復。我請凱倫講解一下這些情況，我們之前誇大了市場復甦的規模，現在我們將向您講解這些情況以及它們對第二季度——也就是下半年——的影響。凱倫，您想…

Yes. Thanks, Geoff, and thanks, Robbie. So let me talk about it more broadly than your question to, Robbie because I know you asked a specific question on procedure growth. So I'll talk about that and a little bit more broadly. So just on those two buckets. First, on our markets. Some of our markets have not returned to normal growth levels and this does account for about -- for over half of the reduction in our second half guide.

是的。謝謝傑夫，也謝謝羅比。羅比，我想比你問的更廣泛地談談這個問題，因為我知道你問的是一個關於手術量增長的具體問題。所以我會更廣泛地談談這個問題。就這兩個方面來說。首先，關於我們的市場。我們的一些市場尚未恢復到正常的成長水平，這確實佔了我們下半年預測中一半以上的減幅。

You talked about competitors. You've heard from some of our competitors about a slow recovery in the neuro market and the TAVR market. And we're also seeing a slow recovery in basic coronary PCIs and some general surgery procedures that we mentioned in the commentary. And because these markets have not accelerated as quickly as we had anticipated, we've decided to assume volumes in the back half remain at Q2 levels.

您談到了競爭對手。您從我們的一些競爭對手那裡聽說了神經市場和經導管主動脈瓣置換術 (TAVR) 市場的緩慢復甦。我們也看到基礎冠狀動脈介入治療 (PCI) 和我們在評論中提到的一些一般手術的復甦緩慢。由於這些市場的成長速度不如我們預期，我們決定假設下半年的銷售量將維持在第二季的水平。

If those volumes improve in those markets, that would be upside. We also talked about related to markets that we're expecting additional provincial tenders in China. And those were ones that we believed would occur next fiscal year and are occurring sooner, particularly in stapling and cardiac ablation.

如果這些市場的銷量有所改善，那將是利好。我們也談到了與市場相關的問題，我們預計中國將有更多省級招標。我們認為這些招標將在下個財年出現，而且很快就會出現，尤其是在吻合器和心臟消融領域。

And then on the second bucket of supply that Geoff mentioned, we, obviously, did see meaningful improvement over the second quarter. But some of that happened late in the quarter, as we said, and that pushes out our assumptions for share recapture. For example, and particularly in SI, while we were short on supply, our competitor benefited. They stepped in to fill the shelves with our customers. We're under long-term contracts with those customers, so we will gain our share back. There's just a lag while the shelf inventory comes down.

關於Geoff提到的第二類供應，我們在第二季確實看到了顯著的改善。但正如我們所說，其中一些改善發生在季度末，這超出了我們對重新奪回市場份額的預期。例如，尤其是在SI領域，當我們供應短缺時，我們的競爭對手卻從中受益。他們介入，把我們客戶的庫存填滿了貨架。我們與這些客戶簽訂了長期合約，所以我們會重新獲得市場份額。只是貨架庫存下降會有一個延遲。

So hopefully, that gives you some context on our guide this morning. But just to summarize, in addition to our assumptions on market growth, we assume incremental contribution from products that we've recently launched and supply that has recently improved.

希望以上內容能讓您對我們今天早上的指南有所了解。總結一下，除了我們對市場成長的假設之外，我們還假設我們最近推出的產品和最近改善的供應將帶來增量貢獻。

On your question on FY'24, it's still early. We have 2 quarters to go, and we're at the beginning of our planning process. So we're not going to give FY'24 guidance on this call. But I will say a few things, including currency because that was your question. First, on the top line, you can see that we expect to exit the year with mid-single-digit growth, and that's a great place to start the following year.

關於您關於2024財年的問題，現在還為時過早。我們還有兩個季度要結束，我們的規劃流程才剛開始。因此，我們不會在本次會議中給予2024財年的業績指引。但我可以談幾點，包括匯率，因為這是您的問題。首先，從營收數據來看，我們預計今年底將實現中等個位數的成長，這對於開啟新的一年來說是一個很好的起點。

Second, down the P&L, we're still in a challenging operating environment with inflation, interest rates and currency, as you mentioned. And on currency, we now estimate that to be a $0.36 headwind on the bottom line in FY'24. And that's, obviously, worse than the $0.18 that I mentioned for FY'23.

其次，從損益表來看，正如您所提到的，我們的營運環境仍然充滿挑戰，包括通貨膨脹、利率和匯率。就匯率而言，我們目前估計，這將對2024財年的利潤帶來0.36美元的不利影響。這顯然比我之前提到的2023財年的0.18美元還要糟糕。

And third, we're purposely driving significant expense reduction given these headwinds and given our focus on continuing to drive long-term investments for the company. So we've got several puts and takes for next fiscal year, and we plan on giving you more on FY'24 as we move through the back half.

第三，鑑於這些不利因素，以及我們專注於繼續推動公司的長期投資，我們有意大幅削減開支。因此，我們對下一財年有幾點預期，並計劃在2024財年下半年公佈更多計劃。

The next question comes from Travis Steed at Bank of America.

下一個問題來自美國銀行的 Travis Steed。

A little bit more color on FY'24 as it relates to China VBP. I don't know if there's any way to think about how much of the China VBP stuff hits in FY'23 versus FY'24, given some of the new ones like EP and even neuro? And then I did want a little bit more color on TAVR as well given the strong U.S. result there. Curious if you could kind of comment a little bit on the TAVR market and also share -- I don't know if you can say how much share you think you took this quarter in U.S. TAVR?

關於2024財年與中國VBP相關的細節，我想再詳細一點。考慮到一些新的領域，例如EP（電生理）甚至神經外科，我不知道有什麼方法可以計算出2023財年與2024財年相比，中國VBP的銷售量成長了多少？另外，考慮到美國TAVR的強勁表現，我也想再詳細一點關於TAVR的情況。您能否對TAVR市場發表一些評論並分享一下——您認為本季您在美國TAVR市場佔據了多少份額？

Yes. So thanks for the question, Travis. On the -- why don't we start with the TAVR one because we -- the market didn't grow quite as much as we had hoped, but it still was a strong growth driver for us, and we did do well from a share perspective. And we have Sean maybe comment on that, and then we'll come back and help Karen talk about the VBP part of the question. Sean?

是的。謝謝你的提問，Travis。關於－我們為什麼不從TAVR開始呢？因為——市場成長不如我們預期，但它仍然是我們強勁的成長動力，而且從市場佔有率的角度來看，我們確實表現良好。我們請Sean對此發表一下看法，然後我們再回來幫助Karen討論VBP部分的問題。 Sean？

Yes. Travis, we think we took about a 0.5 point of share for that for the full quarter, and it was really driven by the late -- the last month of the quarter where we picked up some of that momentum in October with the launch of the Evolut FX we're in about 400 accounts of that so far. So we've got some room to run there for the back half of the year, but that is very strong.

是的。 Travis，我們認為我們整個季度的市佔率大約成長了0.5個百分點，這主要是因為本季最後一個月，也就是10月份，我們推出了Evolut FX，這給我們帶來了一些成長動力。到目前為止，Evolut FX已經擁有約400個帳戶。所以，下半年我們還有一些成長空間，但目前來看，成長動能非常強勁。

I think the underlying market is still in the kind of high singles area. And I think that, that's really, as you know, just conspired against by the resource intensity that's required. You get this whole chain of events where you have to have a patient go through imaging prior to their eventual procedure, and there's a lot of handoffs along the way.

我認為潛在的市場仍然處於高單次交易量區域。而且，正如你所知，我認為這與所需的資源密集度相悖。你會遇到一系列事件，例如在最終手術前必須讓患者進行影像檢查，而整個過程中會有很多交接環節。

So those dynamics are continuing to play out around the world, but probably more in Europe and France and Germany than we see in other countries. And then we had a little bit of slowness on our own throughout -- through Japan. Japan had a flare of COVID the summer, which was difficult.

所以這些動態正在世界各地持續上演，但在歐洲、法國和德國可能比其他國家更嚴重。然後，我們自身也出現了一些放緩——在日本也是如此。今年夏天，日本新冠疫情爆發，這很艱難。

And we also had a problem where there was a sheet that we use for the procedure that we don't make that became unavailable because of supply challenges, and that led to some share loss in Japan. But overall, the TAVR momentum is really strong for us with FX launching, and we're excited about back half to get to a full release of that product into all the accounts.

我們也遇到了一個問題，由於供應問題，我們用於該手術的手術單無法供應，而我們並沒有生產該手術單，這導致我們在日本的市場份額有所損失。但總體而言，隨著FX的推出，TAVR的勢頭非常強勁，我們對下半年將產品全面推廣到所有客戶感到興奮。

And on your China VBP question, Travis, about 15% to 20% of our back half guide down is due to the incremental China VBP being pulled forward from next year from our perspective from what we had assumed. China declined 9% in the second quarter. And that was because of an impact of VBP in spine.

關於您關於中國VBP的問題，Travis，我們在下半年預測下調了約15%到20%，這是因為中國VBP的增量從明年開始提前，這與我們的預期不同。中國第二季的VBP下降了9%，這是因為脊椎VBP的影響。

For the rest of this fiscal year, we don't expect China to be a material growth driver for us. And in fact, for the full year, we're expecting low single-digit declines in China. That said, as we look forward into FY'24, we'll continue to have some VBP, but I think the vast majority will be behind us, and China should be a contributor of growth again next fiscal year.

在本財年剩餘時間裡，我們預期中國市場不會成為我們業務的實質成長動力。事實上，我們預期全年中國市場將出現低個位數的下滑。即便如此，展望24財年，我們仍會有一些VBP，但我認為絕大多數VBP都會過去，中國市場應該會在下一財年再次成為成長的貢獻者。

Just a little bit more color on the VBP. I mean we had visibility to these national tenders, and we factored that in earlier in the year. But what we didn't have real good visibility to some of these provincial tenders that came out here in the last couple of months. And that's part of the change in the guidance. And to Karen's point, look, longer term, we still think China is a growth market, but it's not right now, and we factored that into our guidance.

關於VBP，我再補充一點細節。我的意思是，我們之前關注過這些全國性的招標，今年早些時候我們也把這些因素考慮進去了。但最近幾個月發布的一些省級招標，我們並沒有真正了解。這也是指引調整的一部分原因。正如Karen所說，從長遠來看，我們仍然認為中國是一個成長型市場，但目前並非如此，我們也把這一點納入了指引。

The next question comes from Vijay Kumar at Evercore ISI.

下一個問題來自 Evercore ISI 的 Vijay Kumar。

My first question was on the back half guidance. When you look at 2Q, second quarter organic slightly north of 2% and the back half guidance of 3.5% to 4%. How do you risk is that 3.5% to 4%? Can you give us a bridge of what gets easier? I think you had some easier wind comps, et cetera. And I think related to that, is this -- why is Medtronic confident that this is not a firm your share loss in surgical innovations?

我的第一個問題是關於下半年的業績指引。您看一下第二季的自然成長率略高於2%，而下半年的績效指引是3.5%到4%。您認為3.5%到4%之間的風險有多大？能具體解釋一下哪些情況會比較容易嗎？我認為您有一些比較容易的風濕病相關數據等等。我想與此相關的是——為什麼美敦力確信這不會讓您在外科創新領域損失份額？

Okay. Thanks for the question, Vijay. Let me take the -- well, I'll take the share loss question first and then I'll get to the back half and maybe I have Karen talk to that one as well. But in SI or surgical innovations, this -- first of all, this is a contracted business with health systems and mainly us and our main competitor in that space.

好的。謝謝你的提問，Vijay。我先回答份額損失的問題，然後再談後半部分，或許Karen也應該談談這個問題。但在SI或外科創新方面，首先，這是一項與醫療系統簽訂的合約業務，主要是我們和我們在該領域的主要競爭對手。

And in the past, there have been circumstances when the shoe is on the other foot when our competitor had a recall -- and have had recalls. And we did the same thing where we got -- picked up some incremental revenue and some share because the two big competitors are make up the majority of what the hospitals are buying in the surgery space, but these hospitals do honor these contracts. There's a lot that goes into them and that revenue went back after the supply situation was resolved.

過去，當我們的競爭對手召回產品時，情況就完全不同了——而且確實發生過召回。我們也採取了同樣的做法，獲得了一些增量收入和市場份額，因為這兩大競爭對手佔據了醫院在手術領域採購的大部分份額，但這些醫院確實遵守了合約。這其中涉及很多方面，供應問題解決後，收入又恢復了。

And so that -- we've seen that over the years on multiple times. So these are contracted -- like I said, contracted business for us. And based on our dialogue, with the health systems, we're confident this is going to come back as our supply, which we mentioned. We did get past the most acute part of our supply issues in the Surgical Innovations business, was this packaging issue. It did come later in the quarter and slower momentum, but we do have momentum now, and you should see that business recover.

所以——我們多年來多次看到這種情況。所以這些都是合約——就像我說的，對我們來說是合約業務。根據我們與醫療系統的對話，我們相信，隨著我們之前提到的供應，供應將會恢復。我們確實解決了外科創新業務中最嚴重的供應問題，也就是包裝問題。這個問題確實在本季後期出現，成長勢頭也放緩了，但現在我們確實有了成長勢頭，你應該會看到業務復甦。

On the back half, I'll ask Karen to...

在後半部分，我會請凱倫…

Yes. Thanks, Vijay. When we look at our back half ramp, we have new products. We've got TAVR with Evolut FX that Sean has mentioned, was only in the market for a month in Q2. So we expect continued growth from that. We've got Hugo starting to ramp. We've got our Harmony valve returning to the market. We've also got our diabetic painful neuropathy opportunity that will be driving more in the back half. And we've got supply returning.

是的，謝謝，Vijay。我們後半段的產能提升，有新產品。 Sean 提到的 Evolut FX 經導管主動脈瓣置換術 (TAVR)，第二季才上市一個月。所以我們預計該產品會持續成長。 Hugo 瓣膜也開始加速成長。 Harmony 瓣膜也回到市場。此外，糖尿病疼痛性神經病變治療方案也將在後半段帶來更多成長。我們的供應也在恢復。

We've got supply returning for our LINQ II product in our cardiac diagnostics and also better supply in SI and ICDs. And we've got reduced headwinds. Our sale events and aortic graphs are normalizing. So all of those things really lead to the back half ramp. Hopefully, that's helpful.

我們心臟診斷產品LINQ II的供應正在恢復，心臟節律器（SI）和植入式心臟復律去顫器（ICD）的供應也得到了改善。而且，我們面臨的阻力也減少了。我們的銷售活動和主動脈圖正在恢復正常。所有這些因素都有助於我們實現後半段的成長。希望這些對您有所幫助。

Yes. So I mean, beyond the supply returning, the back half, as Karen walked through a lot of it, is really powered by very tangible things beyond supply, product-related they're tangible and compelling.

是的。所以我的意思是，除了供應回歸之外，正如Karen所詳述的，後半部分實際上是由供應之外非常有形的東西推動的，與產品相關的，它們是有形的，而且引人注目。

And then maybe one related. I think in the past, Medtronic is thought about itself as a mid-single to your top line company in light of the these (inaudible), is that mid-single-digit LRP still intact? Does Medtronic lead to your supplement this growth with...

還有一個相關的問題。我認為，過去美敦力被認為是貴公司營收的中位數公司，考慮到這些（聽不清楚），中個位數的LRP（最低零售價）是否仍然維持？美敦力是否通過…引領了貴公司的這種成長？

I didn't hear the very last part of it, does Medtronic -- but the answer to your question is yes. I mean, the mid-single-digit growth, we'll exit the year at mid-single digit. You see throughout this year, you're seeing the acceleration from the first quarter, which was the depth of our supply issues. We're really in a tough spot.

我沒有聽到最後部分，美敦力呢？但你的問題的答案是肯定的。我的意思是，中等個位數的成長，我們今年年底的業績也會是中等個位數。今年全年，你會看到從第一季開始的加速，當時正是我們供應問題最嚴重的時候。我們真的處境艱難。

We were down minus 4%. Then this past quarter, on an organic basis, up 2% and then Karen walked you through the back half guide. But we exited the year at mid-single digits, and we believe that's durable. Like I said, based on these product launches that are here now, so no -- immediate drivers.

我們之前下降了4%。上個季度，我們有機成長了2%，然後Karen向大家介紹了下半年的業績。但今年我們以中等個位數的成長速度結束了這一年，我們相信這種成長是可持續的。就像我說的，基於目前這些產品的發布，所以沒有直接的驅動因素。

And then we -- Karen brought up a list of things that are already kind of tangible in the back half, but there's a number of other things that are still coming. The AURORA EV-ICD, PFA and an Afib and inceptive with ECAPs and our SCS business and then there's the whole diabetes discussion with those products coming on in the U.S. in the next year. And the Hugo ramp will go on for a while. So there's a number of things that keep us going. And so that's why we feel good about the mid-single digit.

然後，Karen 列出了一些在下半年已經實現的實質進展，但還有一些其他項目仍在推進中。 AURORA EV-ICD、PFA 和心房顫動 (AFIB)，以及 ECAP 和 SCS 業務，還有關於糖尿病的討論，這些產品將於明年在美國上市。 Hugo 的產能提升還會持續一段時間。所以，有很多項目支撐著我們繼續前進。這也是我們對中等個位數成長感到滿意的原因。

The next question comes from Larry Biegelsen at Wells Fargo.

下一個問題來自富國銀行的拉里·比格爾森。

Maybe on diabetes for Que. So Que just a multipart question here. Did you ask for a variance on 780G? And if so, what was the response or when will you know? And if you don't get a variance, do you need reinspection for 780G clearance? And how long do you expect that to take? And just lastly on 780G, do you expect it to have the same impact in the U.S. as you've seen outside the U.S.?

或許是關於糖尿病的Que。所以Que是一個多部分的問題。您是否要求對780G進行變更？如果是，回覆是什麼？或者您什麼時候會知道？如果沒有獲得變更，是否需要重新檢查才能獲得780G的許可？您預計這需要多長時間？最後，關於780G，您預期它在美國的影響會和在美國以外地區一樣嗎？

Thanks, Larry. So on your first question, no, we did not ask for a variance. We've been focused on lifting the warning letter. I'm pleased to say that we are 100% complete on the warning letter commitments, and we have welcomed the FDA back in to assess our current status. So I think that's forward progress, and that's the clearest path because, obviously, it's not just 780, but it is a whole pipeline of innovation that we care about from a growth perspective.

謝謝，拉里。關於你的第一個問題，沒有，我們沒有要求變更。我們一直專注於解除警告信。我很高興地說，我們已經100%完成了警告信承諾，並且我們歡迎FDA再次評估我們目前的狀況。所以我認為這是向前的進展，也是最清晰的道路，因為顯然，這不僅僅是780，而是從成長的角度來看，我們關心的整個創新管道。

So there's progress there. It's very hard to say, timing on that. I think that's up to the agency. We know they're working very hard on that. So we anticipate progress there as well. On your question around 780G progress in international markets, we're very pleased with the double-digit performance there. We do expect to see something similar in the U.S. market once approved.

所以這方面確實取得了進展。現在很難說具體時間。我認為這取決於FDA。我們知道他們正在努力推進這項工作。所以我們預計這方面也會有進展。關於您提到的780G在國際市場的進展，我們對市場兩位數的成長感到非常滿意。我們確實預計，一旦獲得批准，美國市場也會有類似的表現。

We are actually doing -- we've been really happy with how 770G has performed in the U.S. market. It's helping to stabilize attrition here. And as you know, our customers have a free upgrade option with 770 once approved in the U.S. market.

我們確實在做這件事——我們對770G在美國市場的表現非常滿意。它有助於穩定客戶流失率。而且如你所知，一旦770在美國市場獲得批准，我們的客戶就可以免費升級到770。

And sorry, Larry, I missed your third -- your second part of the question.

抱歉，拉里，我錯過了你問題的第三部分——第二部分。

Que, that's helpful. I guess, why didn't you ask for variant in the U.S., it seems like a kind of no risk option here? So why not ask for it.

嗯，這很有幫助。我想，為什麼不在美國申請變體？在美國這似乎是一種沒有風險的選擇。所以為什麼不申請呢？

Primarily because as we've stated, we've been focused on really the long-term lifting up the warning letters is critically important. It's not just about 780G, but it's still about the pipeline. You know we submitted Simplera for CE Mark this year. We just submitted 780G with Simplera IDE last week.

主要是因為正如我們之前所說，我們一直專注於長期提升警告信的重要性。這不僅關乎780G，更關乎整個產品線。您知道，我們今年提交了Simplera的CE標誌認證申請。上週，我們剛提交了帶有Simplera IDE的780G認證申請。

So there's a long line of innovation that we are interested in. And we were also very pleased with the progress we're making on correcting the warning letter commitment. So with those things progressing at the pace, we did not feel it was necessary to seek a variance.

我們對一系列創新都感興趣。我們也對糾正警告信承諾方面取得的進展感到非常滿意。鑑於這些工作的進展速度，我們認為沒有必要尋求變更。

The next question comes from Matt O'Brien at Piper Sandler.

下一個問題來自 Piper Sandler 的 Matt O'Brien。

(technical difficulty).

（技術難度）。

Okay. There seems to be a problem Matt with your audio.

好的。 Matt，你的音訊好像有點問題。

Maybe we'll take the next question, Brad, and then we'll try to come back to Matt.

也許我們會回答下一個問題，布拉德，然後我們會嘗試回到馬特。

The next question comes from Josh Jennings at Cowen & Company.

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

Can you guys hear me okay?

你們聽得到我說話嗎？

Yes, we can hear you, Josh.

是的，我們能聽到你的聲音，喬希。

Okay. Great. So I just want to make sure. Just one maybe for Geoff and maybe Sean as well, just on the renal denervation program and understand, I think it's well understood that the totality of evidence can get the approval. I believe that your team has had preliminary discussions with payers and you might be helpful just in terms of under better understanding your optimism that not just approval could be in hand in the next 6 to 12 months, but payer decisions will ultimately be positive.

好的。太好了。所以我只是想確認一下。關於腎臟去神經支配項目，Geoff 和 Sean 可能各問一個問題。我想大家應該都明白，只有充分的證據才能獲得批准。我相信您的團隊已經與付款方進行了初步討論，您或許能幫助我們更好地理解您的樂觀態度，您認為不僅在未來 6 到 12 個月內就能獲得批准，而且付款方最終也會做出積極的決定。

And then the follow-up is just on supply and just want to make sure I'm clear on the dynamics here. And just the recovery and regaining momentum is what's left, but is the supply chain -- are those headwinds gone? And just should we be expecting -- I know you've got your team has executed on the streamlining or consolidation of operations and supply chain functions, and we start to see a benefit from those efforts in fiscal '24?

接下來是關於供應的問題，我想確保我清楚了解當前的動態。剩下的就是復甦和重獲動力，但供應鏈的阻力消失了嗎？我們是否應該期待—我知道您的團隊已經實施了營運和供應鏈職能的精簡或整合，並且我們開始在24財年看到這些努力帶來的效益？

Maybe I'll start with the supply situation. Are the supply chain issues gone, not completely, but the biggest pain, or if you will, is behind us, especially in surgical innovations with the packaging, as I mentioned, issue. What lingers a bit would be, like we've talked about before, some semiconductor, I'd say, constraints.

我先從供應情況說起。供應鏈問題解決了嗎？雖然還沒有完全解決，但最大的痛點，或者說，已經過去了，尤其是在外科手術創新方面，就像我之前提到的那樣，封裝問題。還有一點揮之不去，就像我們之前討論過的，我想說，一些半導體方面的限制。

But the changes that we've made to our supply organization with the new leadership under Greg, the new structure, bringing in new people to help us with capabilities where we thought we weren't -- where we needed to be, implementing new systems and new processes. And these changes, I believe, are durable. I mean they are -- so we're going to get -- we're getting through this.

但在格雷格領導下，我們對供應組織進行了改革，採用了新的架構，引進了新人才，幫助我們提升了我們之前認為我們尚未具備的能力，以及我們需要具備的能力，實施了新的系統和流程。我相信這些改變是持久的。我的意思是，這些改變是持久的——所以我們會——我們會渡過難關。

The worst is behind us. We factored in or update into the guidance, but there are some. I mean, like some issues that are outstanding like the semiconductors, but all that's factored in, and we feel good about going forward, not just FY'24, but beyond that. Regarding Ardian, look, I'll ask Sean to chime in here.

最糟糕的時期已經過去。我們已經將一些問題納入或更新了業績指引，但還有一些問題。我的意思是，有些問題仍然懸而未決，例如半導體，但所有這些都已納入考量，我們對未來充滿信心，不僅是24財年，而且是更長遠的未來。關於Ardian，我請Sean談談。

But look, the -- as you look at the data, we believe it's very compelling. And you see that the sham arm in the trial increased their medication and the Ardian arm reduced. And the difference is 10x. I mean it's a significant difference. And when you -- when physicians look at it, they understand this and are excited about it and why we're optimistic with payers is because health systems and governments are really focused on.

但是，看看數據，我們認為這非常令人信服。你會發現，試驗中的假手術組增加了藥物劑量，而Ardian組減少了。兩者相差10倍。我的意思是，這是一個顯著的差異。醫生們看到這些數據時，他們理解這一點，並對此感到興奮。我們之所以對付款人持樂觀態度，是因為衛生系統和政府都非常關注這個問題。

And payers are focused on hypertension, which -- and like the current standard, as I mentioned in the commentary, just isn't working and more data came out to substantiate that in September a physician -- to substantiate what people already know. And so now there's a new option. And I think payers are going to be compelled to take it seriously, especially with the public health epidemic that we're facing here.

保險公司關注的是高血壓，而正如我在評論中提到的，目前的標準根本行不通，9月份有更多數據證實了這一點，一位醫生證實了人們已知的情況。所以現在有了新的選擇。我認為保險公司將不得不認真對待這個問題，尤其是在我們正面臨的公共衛生危機之下。

Sean, do you want to chime in and add some more color to this?

肖恩，你想加入進來並為此增添一些色彩嗎？

Yes, you said it well, Geoff. And Josh, you're right. The totality of the data is really the strength of this program compared to just about any other new therapy I can think of, there's really not a lot of comparisons for just how much good data we have here, it's over 3,000 patients in the real world data on top of the sham-controlled randomized studies. And importantly, we did a patient preference study, which is getting more and more considered by payers because they know that patients have a say in what they want to go do.

是的，傑夫，你說得很好。喬希，你說得對。與我能想到的任何其他新療法相比，這個計畫真正的優勢在於其全面的數據。我們擁有的優質數據真的很少能與這些療法進行比較，除了假手術對照隨機研究外，我們還收集了超過3000名患者的真實世界數據。更重要的是，我們進行了一項患者偏好研究，這項研究越來越受到保險公司的重視，因為他們知道患者在選擇治療方案方面擁有發言權。

And there's a large majority of patients that prefer having a procedure versus adding just even one more drug. And of course, we can get their blood pressure down without the addition of drugs, which is a huge benefit. I'll remind you also that Ardian was a breakthrough device had that designation. In the world of MST ruling that would have met automatic coverage. We don't know yet what the (inaudible) pathway is going to look like.

絕大多數患者更願意接受手術，而不是只加用一種藥物。當然，我們不用加藥就能降低他們的血壓，這是一個巨大的優點。我還要提醒大家，Ardian 是一款突破性的設備，擁有這項頭銜。在 MST 裁決的框架下，它應該可以自動獲得承保。我們還不知道（聽不清楚）治療途徑會是什麼樣子。

We'll find out more about that in the fall time frame, I suppose, or in the spring time frame, but we do think that the novelty of this therapy, the desire of patients, and of course, the public health benefit that this can provide is going to be compelling to both public and private payers around the world.

我想，我們會在秋季或春季找到更多相關信息，但我們確實認為，這種療法的新穎性、患者的願望，當然還有它能帶來的公共衛生效益，將對世界各地的公共和私人付款人產生吸引力。

The next question will come from Matt O'Brien at Piper Sandler. Matt, are you there?

下一個問題來自 Piper Sandler 的 Matt O'Brien。 Matt，你在嗎？

How about now?

現在怎麼樣？

Yes, we can hear you now.

是的，我們現在可以聽到你的聲音。

Sorry about that. I guess, just to follow up a little bit on Josh's question, and I know how enthusiastic you still are about Ardian. But I think the ambulatory number is one that is a little bit more robust in the office-based number. So why would clinicians and payers be so interested in doing these cases or we're paying for them given the ambulatory feedback that we've seen? And are you guys still thinking about the market is $500 million by '26, $3 billion by the end of the decade?

抱歉。我想，只是想稍微跟進一下喬希的問題，我知道你對 Ardian 仍然充滿熱情。但我認為門診病例的數量比門診病例的數量要多一些。那麼，考慮到我們看到的門診回饋，為什麼臨床醫生和付款人對這類病例如此感興趣，或者說我們為什麼要為它們付費呢？你們還在想，到2026年，市場規模會達到5億美元，到2020年底會達到30億美元嗎？

Sean, do you want to get into the specifics on the ambulatory versus the office?

肖恩，你想了解門診和診間的具體差異嗎？

Yes. Matt, I think if you just recall how that study was done, the patients were witnessed taking their blood pressure medicine in the morning. And whether they were taking that for the full 6 months or not, they just took it that day, you saw the change in blood pressure that was during the daytime not what we've seen before in these prior trials.

是的。馬特，我想如果你回想一下那項研究是如何進行的，研究人員會觀察患者在早上服用降血壓藥的情況。無論他們是否服用了整整6個月，只要他們在當天服用，你就能觀察到白天血壓的變化，而這與我們先前在這些試驗中觀察到的情況不同。

But at night time, there was still a reduction ambulatory. So I think the simple story here is that patients weren't taking their medications, except on game day and their blood pressure dropped. Now we don't know that for sure, we didn't test blood in urine every day. We just test it on game day and we know that there were more medications in the patients that were in the control arm than in the treated arm.

但到了晚上，門診量仍然減少。所以我認為這裡的原因很簡單，病人除了比賽當天血壓下降外，沒有服用藥物。現在我們還不能確定，因為我們沒有每天檢測尿血。我們只在比賽當天檢測，我們知道對照組病人服用的藥物比治療組病人多。

And as Geoff said, the changes increasing medication, decreasing medication, taking even medications for blood pressure that weren't even prescribed maybe from their medicine cabinet, maybe from their spouse or partners medicine cabinet. There's a lot of changes in medicine, which we know were present different than the prior studies. We actually have that proof now that we can measure the drug metabolites.

正如傑夫所說，這些變化包括增加用藥量、減少用藥量，甚至服用一些並非處方的降血壓藥，這些藥物可能來自他們的藥櫃，也可能來自配偶或伴侶的藥櫃。醫學領域發生了許多變化，我們知道這些變化與先前的研究結果不同。我們現在實際上有證據表明，我們可以測量藥物代謝物。

So cleaner, if you will, measure is that morning blood pressure, we took the office blood pressure. And that blood pressure is the one that's used for all the epidemiology studies that show what the reduction in blood pressure means for the avoidance of events and reduction of cost. And it's also the primary endpoint that's gotten just about every -- I think maybe every pharmaceutical approved for the treatment of high blood pressure.

所以，更清楚的測量方法是早晨的血壓，我們測量的是診間血壓。所有流行病學研究都使用這個血壓來顯示血壓降低對於避免事件發生和降低成本的意義。這也是幾乎所有——我想可能是所有獲準用於治療高血壓的藥物——都採用的主要終點指標。

So it is the robust standard. In fact, ambulatory is not even reimbursed in this country. So it's not used routinely in clinical practice. So it is a robust measurement that was consistently performed throughout this trial and across the other trials that we've done.

所以這是一個穩健的標準。事實上，在我們國家，門診費用甚至不在報銷範圍內。所以它在臨床實踐中並不常規使用。因此，這是一個穩健的測量方法，並且在整個試驗以及我們進行的其他試驗中都一致地執行。

So I'm confident in that part. In terms of the market size, we're very confident in this therapy. There's 1 billion people blood pressure problems around the world, even if very small amount gets you to the kind of market growth that we think is going to be meaningful for the company. So we're very confident in this therapy and that is approval and ultimate uptake.

所以我對此很有信心。就市場規模而言，我們對這種療法非常有信心。全球有10億人患有血壓問題，即使只是很小一部分，也能帶來我們認為對公司有意義的市場成長。所以我們對這種療法非常有信心，而且它很快就會獲得批准，最終被廣泛接受。

Okay. That makes sense. I appreciate that. And then it's not a related follow-up, but turning over to cardiac rhythm for a second. Just -- I'd love to hear about the competitive dynamics that are going on with Micra because you've got a competitor there now? And then what the expectation is with EV ICD, given the long-standing presence of another one of your competitors in that market. What should we be expecting between those two as we progress over the next 12 months?

好的。這很有道理，我很感激。接下來，我們不再討論相關的後續問題，而是先談談心律。我很想了解 Micra 的競爭動態，因為你們現在在那裡已經有競爭對手了。考慮到你們的另一個競爭對手長期佔據該市場，你們對 EV ICD 的預期是什麼？隨著未來 12 個月的發展，我們應該對這兩款產品的未來發展有何期待？

Yes. So for Micra, we continue to grow, and you saw 18% globally, 40% of that was from international sales. And really Japan and China, in particular, really drove that great and continued success. And we'll see continued penetration in international markets and in the U.S. and a shift between single chamber to the AV device, which can pick up a larger proportion of patients, it's about 30% of the market there.

是的。 Micra 的銷售額持續成長，全球銷售額成長了 18%，其中 40% 來自國際市場。尤其在日本和中國，Micra 的持續成功功不可沒。我們將看到 Micra 在國際市場和美國市場持續滲透，並從單腔設備轉向 AV 設備，後者可以覆蓋更大比例的患者，目前約占美國市場的 30%。

And in the next 12 months, we're going to refresh both the VR and the AV devices in the coming year around the world. So while we have some competition in the United States, we fared pretty well. I think the ease of use of our micro device in the long-term data that we have as well as just the familiarity with our system has made it pretty durable.

在接下來的12個月裡，我們將在全球更新VR和AV設備。因此，雖然我們在美國面臨一些競爭，但我們表現得相當不錯。我認為，我們的微型設備易於使用，並且擁有長期數據，加上用戶對我們系統的熟悉，使得它相當耐用。

On AURORA EV-ICD, as you know, we've got CE Mark coming up. That's a little bit of a different technique. You've got to put a lead underneath the breast bone, which takes some training to learn and we'll be very meticulous in the way we roll that out. But make no mistake that is a product that really offers a huge benefit, getting leads out of the heart, having half the size in the can and twice the battery life compared to the other device that realm and being able to voice shock by pacing people out of their fatal arrhythmia as opposed to having to have a painful shock. Those are all really, really welcome improvements, and we're excited to roll that technology out first in Europe and then the United States, next year.

AURORA EV-ICD，如您所知，我們即將獲得CE標誌。這是一種略有不同的技術。您必須將導線置於胸骨下方，這需要一些訓練才能掌握，我們會非常細緻地推廣。但毫無疑問，這款產品確實帶來了巨大的好處：無需將導線置於心臟之外，體積只有同類產品的一半，電池壽命卻是同類產品的兩倍，而且它能夠通過語音電擊來緩解致命的心律失常，而無需患者接受痛苦的電擊。這些都是非常受歡迎的改進，我們很高興明年將首先在歐洲推廣這項技術，然後在美國推廣。

Chronic Rhythm business has done well and we expect it to continue to do well with products like Micra and EV ICD, but also pioneering conduction system pacing, and we've got a nice pipeline there and really a strong leadership team and strong position.

Chronic Rhythm 業務表現良好，我們預計它將繼續憑藉 Micra 和 EV ICD 等產品保持良好勢頭，同時開拓傳導系統起搏，我們在該領域擁有良好的管道、強大的領導團隊和強勢地位。

The next question comes from Matt Taylor at Jefferies.

下一個問題來自 Jefferies 的 Matt Taylor。

Sorry, guys. Can you hear me okay?

抱歉，各位。你們聽見我說話嗎？

Yes, we can, Matt.

是的，我們可以，馬特。

Okay. Sorry. So I wanted to just explore you talked about the slower recovery of some of these elective and developed markets. And obviously, there's staffing, you said other challenges.

好的。抱歉。我想探討您提到的一些非全日制和已開發市場的復甦速度較慢的問題。當然，您也提到了人員配備等其他挑戰。

I guess maybe you could just give us some insight into two things. One is, could you talk a little bit more about procedure trends through the quarter? Did you see any improvement? And then what gives you the confidence or what intelligence do you have to point to whether this is really staffing or I think investors are worried about lack of pent-up demand. Could you just address that?

我想您能不能跟我們談兩件事。第一，您能否再多談談本季的流程趨勢？您看到任何改善了嗎？第二，是什麼讓您有信心，或是您有什麼情報可以指出這究竟是人員配備問題，還是我認為投資者擔心的是被壓抑的需求不足？能簡單談談嗎？

Sure. I'll ask Karen to comment on the procedure trends through the quarter and then we can talk to the staffing issue.

當然。我會請凱倫對本季的流程趨勢進行評論，然後我們再討論人員配備問題。

Yes. So I would say, through the quarter, we did see, particularly in the markets that we had mentioned not as robust recovery, but some recovery. But as we ended the quarter with less robust recovery, we're just assuming that in those areas, those procedures stay where they were in the back half.

是的。所以我想說，整個季度，我們確實看到了復甦，尤其是在我們之前提到的那些市場，復甦雖然不算強勁，但也算有所回升。但由於本季末的復甦勢頭不那麼強勁，我們只能假設這些領域的流程與下半年的水平持平。

We'll see if that's a good assumption or not. As we look at the first few weeks of our current quarter of the third quarter, we are seeing improvement from the second quarter. So that's pointing to some good things, but we'll see.

我們拭目以待，看看這個假設是否合理。回顧第三季的前幾週，我們看到情況較第二季有所改善。所以，這預示著一些好消息，但我們拭目以待。

Yes. So just to highlight what Karen is saying there. I mean, we were disappointed that we missed the call on this one for the Q2. And so now in our guidance, we've assumed a prolonged recovery here, especially for those segments that we called out, not all the segments.

是的。我只是想強調Karen剛才說的話。我的意思是，我們很遺憾錯過了第二季的業績預測。所以現在在我們的預測中，我們假設復甦將持續很長時間，尤其是那些我們預測的細分市場，而不是所有細分市場。

Like we said, many of the segments are back to pre-COVID, but there are a handful of those electives and developed markets that we've called out and Karen walked you through the assumption for the back half of the year. In terms of the staffing, I hear that dynamic in some of the cardiology space is more than others. And maybe I'll have Sean comment on that.

正如我們所說，許多細分市場已經恢復到新冠疫情之前的水平，但其中也有一些我們之前提到的選修課和發達市場，Karen 也向大家介紹了下半年的預測。就人員配置而言，我聽說某些心臟病學領域的動態比其他領域更為活躍。或許我可以請 Sean 對此發表一下看法。

Yes, I'd say a couple of things on that, Geoff. First of all, there's -- you take a therapy like TAVR, where there's multiple handoffs. You have to have pre-imaging, you have to get the patient worked up, they get their procedure done. And then there are sometimes even post imaging this done. So a lot of handoffs and the patients tend to be elderly.

是的，Geoff，我想就此說幾點。首先，像TAVR這樣的治療，需要多次交接。你必須進行術前影像檢查，必須讓患者興奮起來，然後才能完成手術。有時甚至還需要術後影像檢查。所以，需要進行多次交接，而且患者往往是老年人。

So there's -- you want to sure you schedule that in a way that's okay that they can get it all done in an efficient way. We don't want them exposed to the health care environment for a long time. And I think that's challenging. It's also true that you can't wait forever. You've got -- with severe aortic stenosis, there's about an 80% mortality rate for 2 years from your diagnosis of that. So it's more lethal than cancer, for example, most cancers. So it's not something you can put off forever, but it is resource intensive.

所以，你要確保安排得當，讓他們能有效率地完成所有工作。我們不希望他們長時間暴露在醫療環境中。我認為這很有挑戰性。而且，你也不能永遠等下去。嚴重的主動脈瓣狹窄，從確診到兩年內，死亡率約為80%。所以它比癌症，例如大多數癌症，更致命。所以這不是一件可以永遠拖延的事情，但它會耗費大量資源。

And I think the other thing we're seeing with staffing just in general is, there's a prioritization for patients that you can get in and out relatively quickly so they can make downstream staffing available. So whether it's ICU recovery or you've got even transport to (inaudible) move.

我認為我們在人員配置方面普遍觀察到的另一個現像是，優先安排那些能夠相對快速進出的患者，以便為後續人員配備預留時間。無論是ICU康復，還是轉運（聽不清楚）。

And I think there's some arbitrage in some countries even on the margin that they make on those procedures. Cardiac surgery have grown like a 5.5% for us. So very robust. There's a lot of margin that comes out of cardiac surgery patients. They tend not to be as deferrable as, say, like a PCI patient, for example.

我認為，即使在某些國家，這些手術的利潤率也存在一定的套利空間。我們的心臟手術成長了5.5%，非常強勁。心臟手術患者可以獲得豐厚的利潤。他們通常不像PCI患者那樣可以延期。

So we hear it in pockets. I mentioned before, France and Germany seem to be some places that are really struggling with staffing in Europe, and we see it just in pockets around the United States and other places. So it is a dynamic situation, and we think it has gotten better, certainly a lot of places, but not everywhere yet.

所以我們聽到了一些地方的情況。我之前提到過，法國和德國似乎是歐洲在人員配備方面真正陷入困境的幾個國家，我們也在美國和其他地方的一些地方看到了這種情況。所以這是一個動態的情況，我們認為情況已經好轉，當然很多地方都是如此，但並非所有地方都如此。

The next question comes from Pito Chickering, Deutsche Bank.

下一個問題來自德意志銀行的 Pito Chickering。

I know that you don't have a ton of exposure here, but there has been a healthy debate around hospital demand for capital equipment this year. Can you give us any color on what you're seeing from behavior changes in hospitals for capital ordering in 2Q and what you guys assume in the back half of the year?

我知道您在這方面的經驗並不豐富，但今年圍繞醫院資本設備需求的討論一直很熱烈。您能否介紹一下您觀察到的第二季醫院資本設備訂購行為的變化，以及您對下半年資本設備需求的預測？

Our capital, first of all, isn't a huge piece yet of our revenue. But it is -- it tends to be tied to profitable procedures, and we actually had a strong capital performance in last quarter. And especially in our cranial and spinal technologies business, CST, our capital there, we had a number of our -- whether it be navigation, intra-operative imaging, I had record capital quarters for us.

首先，我們的資本目前還不是我們收入的很大一部分。但它往往與獲利業務息息相關，而我們上個季度的資本表現實際上非常強勁。尤其是在我們的顱腦和脊椎技術業務（CST）中，我們的資本——無論是導航還是術中成像，都創下了季度資本紀錄。

So we're -- we definitely see a bit of -- it takes a little longer to close a deal, but the demand as you're working with the hospital and how they're going to pay or finance this, but we're having strong demand in those areas. And then, of course, we mentioned Hugo. Hugo is still new for us, but we are very happy with the placements we've been able to make on Hugo here. Of course, those are outside the U.S. but very pleased with that.

所以，我們確實看到了一些——達成交易需要更長的時間，但與醫院合作的需求以及他們將如何支付或融資，我們在這些地區的需求強勁。當然，我們提到了Hugo。 Hugo對我們來說還很新，但我們對在這裡透過Hugo進行的安排非常滿意。當然，這些安排是在美國境外，但我們對此非常滿意。

We've got time for one more question, please, Brad.

我們還有時間再問一個問題，布拉德。

Our final question comes from Joanne Wuensch, Citi.

我們的最後一個問題來自花旗的 Joanne Wuensch。

Early happy Thanksgiving. This led straight into my Hugo question. Could you give us a little bit of an update on how you feel about the market potential for the product, the timing of U.S. approval? And at one stage, several years ago, you were talking about the potential contribution. Is there a way to start thinking about that again?

感恩節快樂！這直接引出了我關於雨果獎的問題。您能否簡單介紹一下您對該產品市場潛力以及美國批准時間的看法？幾年前，您曾談到該產品的潛在貢獻。現在有什麼方法可以重新考慮這個問題嗎？

Sure. Well, thanks for the question, Joanne. Yes, like I said, we have good news on Hugo. We're kicking off the U.S. IDE with our first case is scheduled for December based on getting these instruments enhancements approved. And like I just said to Pito, we are pleased with the system placements. And in terms of the other color commentary on that, I'll ask Bob White to chime in.

當然。好吧，謝謝你的提問，喬安妮。是的，就像我說的，我們在Hugo上有個好消息。我們將啟動美國IDE，我們的第一起案件計劃於12月審理，前提是這些儀器的增強功能獲得批准。就像我剛才對皮託說的，我們對系統佈局很滿意。至於其他方面，我會請鮑伯懷特來補充。

Yes. Thanks, Geoff, and thanks, Joanne. Couple of thoughts here. First, on the overall market for Hugo, we continue to be really excited about it. Remember, there's -- around the world still 95% arousable cases are not done. That could be done robotically [assistedly]. So we believe this is a true market expansion opportunity. So we're still really excited about the continued term of the market and excited to be the #2 player in this space.

是的。謝謝傑夫，也謝謝喬安妮。我有幾個想法。首先，關於Hugo的整體市場，我們仍然非常興奮。要知道，全球仍有95%的可喚醒性交案例尚未完成。這些可以透過機器人輔助完成。所以，我們相信這是一個真正的市場擴張機會。我們仍然對市場的持續發展感到非常興奮，也很高興能成為這個領域的第二大參與者。

With respect to the timing of U.S. approval, as Geoff mentioned, we expect to begin our U.S. IDE by the end of this calendar year. So that's exciting. Actual approval in the U.S., of course, depends upon the agency and the process there. So I really can't comment on that. And overall, with respect to the contribution, as you mentioned, I think it's early to call that, but given our system is now installed around the world in markets in APAC, EMEA, LATAM, we just received regulatory approvals and indication expansions in Japan, which is the third largest robotics market in the world.

關於美國批准的時間，正如 Geoff 所提到的，我們預計將在今年年底前開始在美國進行 IDE 審批。這令人興奮。當然，美國的實際批准取決於當地的監管機構和流程。所以我對此無法評論。總的來說，正如您所說，關於貢獻，我認為現在下結論還為時過早，但考慮到我們的系統目前已在全球市場安裝，包括亞太地區、歐洲、中東和非洲地區以及拉丁美洲，我們剛剛獲得了日本的監管部門批准和適應症擴展，日本是全球第三大機器人市場。

We have general surgery approval in the EU, Canada and Australia, which opens up the hernia market for us. And we've started to see really strong presence and some really key congresses in Europe where live stream cases, et cetera. So a little early to call it contribution, Joanne, but we're starting to see the momentum in the acceleration that we talked about.

我們在歐盟、加拿大和澳洲都獲得了普通外科手術的批准，這為我們打開了疝氣市場。而且，我們在歐洲也開始展現出非常強勁的影響力，在一些重要的大會上，我們也進行了病例直播等等。所以，喬安妮，現在說這是貢獻還為時過早，但我們已經開始看到我們之前提到的加速發展勢頭。

Geoff, please go ahead with your closing remarks.

傑夫，請繼續你的結束語。

Okay. Thanks, Ryan. Well, first of all, thank you, everybody, for the questions. And we do really appreciate your support and continued interest in Medtronic. And we look forward to updating you on our progress on our Q3 earnings broadcast, which we anticipate holding on February 21.

好的。謝謝，Ryan。首先，謝謝大家的提問。我們非常感謝大家對美敦力的支持與持續關注。我們期待在2月21日舉行的第三季財報發布會上更新我們的進展。

So with that, thanks again for tuning in today. Please stay healthy and safe. I understand there's a lot of people traveling this holiday. And for those of you in the U.S., I'd like to wish you and your families a very happy Thanksgiving.

再次感謝您今天的收看。請保持健康和安全。我知道這個假期有很多人出遊。對於在美國的各位，我祝福你們和你們的家人感恩節快樂。