美敦力 (MDT) 2022 Q4 法說會逐字稿

Good morning. I'm Ryan Weispfenning, Vice President and Head of Medtronic Investor Relations, and I appreciate that you're joining us today for Medtronic's Fiscal Year 2022 Fourth Quarter Earnings Video Webcast.

早上好。我是副總裁兼美敦力投資者關係主管 Ryan Weispfenning，感謝您今天參加美敦力 2022 財年第四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.

在我們進去聽我們準備好的評論之前，我將分享一些關於今天網絡直播的細節。加入我的還有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 and Karen will provide comments on the results of our fourth quarter and fiscal year 2022, which ended on April 29, 2022, and our outlook for fiscal year '23. After our prepared remarks, our portfolio executive VPs 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.

Geoff 和 Karen 將就截至 2022 年 4 月 29 日的第四季度和 2022 財年的業績以及我們對 23 財年的展望發表評論。在我們準備好講話後，我們的投資組合執行副總裁將加入我們，我們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理收入摘要。我們還發布了一份收益報告，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 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.

在今天的計劃中，我們做出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大不相同。有關可能導致實際結果不同的因素的其他信息包含在我們向 SEC 提交的定期報告和其他文件中，我們不承諾更新任何前瞻性陳述。

Unless we say otherwise, all comparisons are on a year-over-year basis, and revenue comparisons are made on an organic basis, which this quarter includes only adjustments for foreign currency as there were no acquisitions or divestitures made in the last 4 quarters that had a significant impact on total company or individual segment quarterly revenue growth.

除非我們另有說明，否則所有比較都是按年進行的，收入比較是有機的，本季度僅包括外幣調整，因為過去 4 個季度沒有進行收購或剝離對整個公司或個別部門的季度收入增長產生了重大影響。

References to sequential revenue changes compared to the third quarter of fiscal '22 and are made on an as-reported basis and all references to share gains or losses refer to revenue share in the first calendar quarter of 2022 compared to the first calendar quarter of 2021, unless otherwise stated.

與 '22 財年第三季度相比，提及的連續收入變化是在報告的基礎上進行的，所有對份額收益或損失的提及均指 2022 年第一季度與 2021 年第一季度相比的收入份額， 除非另有說明。

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.

所有非公認會計原則財務指標的對賬可以在我們的收益新聞稿或我們的網站investorrelations.medtronic.com 上找到。最後，我們的每股收益指引不包括任何費用或收益，這些費用或收益將被報告為本財年的非公認會計準則收益調整。

With that, let's head into the studio and get started.

有了這個，讓我們進入工作室並開始吧。

(presentation)

（介紹）

Hello, everyone, and thank you for joining us today. This morning, we reported our Q4 results. Now there were parts of the quarter that played out as anticipated, and there were also some unexpected challenges, more than I would have liked, which caused us to come up short of our expectations.

大家好，感謝您今天加入我們。今天早上，我們報告了第四季度的業績。現在本季度的某些部分按預期進行，也有一些意想不到的挑戰，超出了我的預期，這導致我們沒有達到我們的預期。

As we anticipated, procedure volumes in most of our markets reached pre-COVID levels by the end of the quarter. We also executed and delivered on recent product launches. However, we faced challenges related to supply chain in China that impacted some of our businesses and were the largest contributors to our shortfall.

正如我們預期的那樣，到本季度末，我們大多數市場的手術量都達到了 COVID 之前的水平。我們還執行並交付了最近的產品發布。然而，我們面臨與中國供應鏈相關的挑戰，這些挑戰影響了我們的一些業務，並且是造成我們短缺的最大原因。

Now I'll get into more detail on these challenges shortly, but you should take away that we understand the root causes and we are well down the path to addressing them. And to be prudent, however, we've assumed that these challenges will persist for the next quarter or 2 in the guidance that Karen is going to walk you through shortly. So let's focus on what happened this quarter.

現在，我將很快詳細介紹這些挑戰，但您應該明白我們了解根本原因，並且我們已經走上了解決這些挑戰的道路。然而，為了謹慎起見，我們假設這些挑戰將在下個季度或 2 個季度持續存在，Karen 將很快引導您完成。因此，讓我們關注本季度發生的事情。

The shortfall to our revenue guidance was primarily due to 2 factors: China, where the extended COVID lockdowns affected our results in the quarter particularly in April, and global supply chain challenges.

我們的收入指導不足主要是由於兩個因素：中國，延長的 COVID 封鎖影響了我們本季度的業績，尤其是 4 月份的業績，以及全球供應鏈挑戰。

Over the past few quarters, global supply chain challenges have impacted many of our businesses. And as they arise, our teams have worked quickly to resolve them, and prior to this quarter, we have largely mitigated their financial impact.

在過去幾個季度，全球供應鏈挑戰影響了我們的許多業務。當它們出現時，我們的團隊已迅速解決它們，並且在本季度之前，我們已在很大程度上減輕了它們的財務影響。

However, this quarter, one of our largest businesses, Surgical Innovations, was adversely affected by certain raw material shortages, and this resulted in large back orders and caused our SI revenue to come in well below our expectations. Several of our other businesses also face supply challenges in the quarter, but to a lesser extent.

然而，本季度，我們最大的業務之一 Surgical Innovations 受到某些原材料短缺的不利影響，這導致大量延期交貨並導致我們的 SI 收入遠低於我們的預期。我們的其他幾項業務在本季度也面臨供應挑戰，但程度較輕。

Now we're down the path of improving our supply chain capabilities, and we're leveraging the expertise that Greg Smith, our new Global Ops and Supply Chain leader brings from the retail, consumer products and automotive industries. Greg and his team are making progress addressing the areas where we can improve, including the management and resiliency of our critical suppliers and manufacturing network.

現在，我們正在提高我們的供應鏈能力，我們正在利用我們新的全球運營和供應鏈領導者 Greg Smith 從零售、消費品和汽車行業帶來的專業知識。 Greg 和他的團隊在解決我們可以改進的領域取得進展，包括我們關鍵供應商和製造網絡的管理和彈性。

The recent stress of these global supply chain issues has further illuminated the need for the enhancements. We have a new global structure in place that consolidates operations and supply chain functions, which were previously fragmented throughout the organization. Now this is a big move for us.

這些全球供應鏈問題的近期壓力進一步說明了增強的必要性。我們建立了一個新的全球結構，整合了以前分散在整個組織中的運營和供應鏈功能。現在，這對我們來說是一個重大舉措。

And there's still a lot of work to be done, but I am confident we will come out of this with a more resilient end-to-end global supply chain that we believe will be a competitive advantage in our industry.

還有很多工作要做，但我相信我們將通過更具彈性的端到端全球供應鏈走出困境，我們相信這將成為我們行業的競爭優勢。

While some of our Q4 challenges will persist in the near term, we expect strong improvement in the back half of our fiscal year, and we remain focused on delivering our long-term strategies. We have made significant changes over the past 2 years to position the company for accelerated and sustained innovation-driven growth.

雖然我們第四季度的一些挑戰將在短期內持續存在，但我們預計本財年後半段將出現強勁改善，我們將繼續專注於實施我們的長期戰略。在過去的 2 年中，我們做出了重大改變，使公司能夠加速和持續創新驅動的增長。

Our pipeline is robust and continues to advance with a number of upcoming catalysts and fast-growing MedTech markets. We're committed to creating strong returns for our shareholders, and we're making progress with our enhanced portfolio management and our capital allocation processes. We're investing in future growth drivers, while at the same time returning capital primarily through our meaningful and growing dividend, which we just increased again today by 8%.

我們的產品線穩健，並隨著一些即將到來的催化劑和快速增長的醫療技術市場而繼續發展。我們致力於為我們的股東創造豐厚的回報，並且我們在加強投資組合管理和資本分配流程方面取得了進展。我們正在投資於未來的增長動力，同時主要通過我們有意義且不斷增長的股息來返還資本，我們今天剛剛再次增加了 8%。

Regarding portfolio management, we are continuing to advance the robust process we began talking about earlier this year. And within that, and as a smaller initial step, we're pleased to announce that we've reached an agreement where we will contribute our Renal Care Solutions business into a new company, which we will jointly own with DaVita.

關於投資組合管理，我們將繼續推進我們今年早些時候開始討論的穩健流程。在此之中，作為一個較小的初始步驟，我們很高興地宣布，我們已經達成一項協議，我們將把我們的腎臟護理解決方案業務貢獻給一家新公司，我們將與 DaVita 共同擁有這家公司。

And in return, we'll receive up to $400 million in value from them and we expect this transaction will close in calendar 2023. The new company is going to develop a broad suite of novel kidney care solutions, including home-based products.

作為回報，我們將從他們那裡獲得高達 4 億美元的價值，我們預計這筆交易將在 2023 年完成。新公司將開發一套廣泛的新型腎臟護理解決方案，包括家庭產品。

I'm excited about this for a couple of reasons. First, this business is going to have the focus that it needs. Second, DaVita is a global leader in kidney care and will be a great partner to commercialize and scale this innovative technology. And finally, both Medtronic and DaVita will participate in the expected upside.

我對此感到興奮有幾個原因。首先，這項業務將擁有它需要的重點。其次，DaVita 是腎臟護理領域的全球領導者，將成為將該創新技術商業化和規模化的重要合作夥伴。最後，美敦力和 DaVita 都將參與預期的上漲。

Now turning to market share, product availability affected our performance in the quarter with our overall company share down about 0.5 point. On the bright side, even with our challenges, half of our businesses held or gained share. And as you know, market share is an important metric for us at Medtronic, as it is a driver of our annual variable compensation, along with revenue growth, profit and free cash flow. While I won't go through market share business by business in the interest of time, we'll be happy to take questions in Q&A.

現在轉向市場份額，產品可用性影響了我們在本季度的表現，我們的整體公司份額下降了約 0.5 個百分點。好的一面是，即使面臨挑戰，我們一半的業務仍持有或獲得份額。如您所知，市場份額是美敦力的一個重要指標，因為它是我們年度可變薪酬以及收入增長、利潤和自由現金流的驅動力。雖然為了時間的緣故，我不會逐個分析市場份額業務，但我們很樂意在問答中回答問題。

Now let's cover our product pipeline, where we're advancing several meaningful technologies that can create new markets, disrupt existing ones and accelerate the growth profile of Medtronic. We made great strides with our organic pipeline in fiscal '22, conducting over 300 clinical trials and receiving over 200 regulatory approvals in the U.S., Europe, Japan and China.

現在讓我們介紹一下我們的產品線，我們正在推進幾項有意義的技術，這些技術可以創造新市場、顛覆現有市場並加速美敦力的增長。我們在 22 財年的有機管道方面取得了長足的進步，在美國、歐洲、日本和中國進行了 300 多項臨床試驗並獲得了 200 多項監管批准。

Our recent product launches are starting to make an impact across our businesses. And as we look ahead, we have increasing visibility to upcoming catalysts in the back half of the calendar year that we expect will help accelerate our growth as we go through fiscal '23 and beyond.

我們最近推出的產品開始對我們的業務產生影響。隨著我們展望未來，我們對日曆年下半年即將到來的催化劑的可見性越來越高，我們預計這將有助於在我們度過 23 財年及以後的時間裡加速我們的增長。

Starting with our cardiovascular portfolio and cardiac Rhythm Management, recently we launched leadless pacemakers, including our Micra AV in Japan and Micra VR in China led to above-market growth again this quarter. We just received approval for Micra AV in China earlier this month. And we expect geographic expansion to continue to drive strong Micra growth.

從我們的心血管產品組合和心律管理開始，我們最近推出了無引線起搏器，包括我們在日本的 Micra AV 和中國的 Micra VR，在本季度再次實現了高於市場的增長。本月早些時候，我們剛剛在中國獲得了 Micra AV 的批准。我們預計地域擴張將繼續推動 Micra 的強勁增長。

In ICDs, we're preparing to disrupt the single-chamber market with our Aurora extravascular ICD. We continue to drive towards CE Mark approval for Aurora later this calendar year and U.S. approval next year. With Micra and EV ICD, we expect continued strength in CRM.

在 ICD 方面，我們正準備用我們的 Aurora 血管外 ICD 顛覆單腔市場。我們將繼續推動 Aurora 在本日曆年晚些時候獲得 CE 標誌批准，並在明年獲得美國批准。借助 Micra 和 EV ICD，我們預計 CRM 將繼續走強。

In Cardiac Ablation Solutions, we've been assembling a number of technologies to increase our impact in the $8 billion EP ablation market, building on our leadership in cryoablation. We're continuing the rollout of our DiamondTemp RF system and exclusive cryoablation first-line indication for paroxysmal AF.

在心臟消融解決方案中，我們一直在整合多項技術，以增強我們在價值 80 億美元的 EP 消融市場中的影響力，鞏固我們在冷凍消融領域的領先地位。我們將繼續推出我們的 DiamondTemp 射頻系統和陣發性 AF 的獨家冷凍消融一線適應症。

We're advancing our pulsed field [select] -- the anatomical pulsed field ablation system having fully enrolled our global pivotal trial. We're also expecting to fill competitive gaps in cardiac ablation with our recent announcements to add a differentiated mapping and navigation system and left heart access portfolio including a transseptal access system that can perform both mechanical and RF crossings.

我們正在推進我們的脈衝場 [select]——解剖脈衝場消融系統已完全註冊我們的全球關鍵試驗。我們還期望通過我們最近的公告來填補心臟消融領域的競爭空白，以增加差異化的映射和導航系統以及左心通路組合，包括可以執行機械和射頻交叉的經間隔通路系統。

In renal denervation, data from our SPYRAL HTN-ON MED pilot study were presented last month at ACC and simultaneously published in The Lancet. These data demonstrated durable and clinically significant blood pressure reductions through 3 years.

在腎臟去神經支配方面，我們的 SPYRAL HTN-ON MED 試點研究的數據於上個月在 ACC 上發表，同時發表在《柳葉刀》上。這些數據證明了 3 年的持久且臨床上顯著的血壓降低。

And last week, additional data were presented at EuroPCR which showed those receiving RDN spend significantly more time in target blood pressure range, adding to our robust body of evidence.

上週，在 EuroPCR 上展示了額外的數據，顯示接受 RDN 的人在目標血壓範圍內花費的時間明顯更多，這增加了我們強有力的證據。

In Q4, we also announced that we completed enrollment in the full cohort of patients in the ON MED study, which we expect to complete the 6-month follow-up in the second half of this calendar year. We'll then look to present the data and submit for FDA approval as ON MED is the final piece of our submission.

在第四季度，我們還宣布我們完成了 ON MED 研究中所有患者的入組，我們預計將在本日曆年下半年完成為期 6 個月的隨訪。然後，我們將展示數據並提交 FDA 批准，因為 ON MED 是我們提交的最後一部分。

In Structural Heart, differentiated durability data for our TAVR valves were presented as a late breaker at ACC last month. The data showed that our TAVR platform is the only one to outperform surgical valves and durability at 5 years as measured by SVD or structural valve deterioration. And less SVD was associated with better clinical outcomes, including mortality and heart failure hospitalization.

在 Structural Heart 中，我們的 TAVR 瓣膜的差異化耐用性數據在上個月的 ACC 大會上作為後期突破者展示。數據顯示，我們的 TAVR 平台是唯一一個在 5 年內通過 SVD 或結構性瓣膜劣化測量的性能優於手術瓣膜和耐用性的平台。更少的 SVD 與更好的臨床結果相關，包括死亡率和心力衰竭住院。

Additionally, durability data were presented from a separate U.K. registry, the first to look at TAVR data past 10 years. And it showed CoreValve had 1/3 the rate of structural valve deterioration compared to SAPIEN and SAPIEN XT.

此外，耐久性數據來自一個單獨的英國註冊機構，這是第一個查看過去 10 年 TAVR 數據的機構。並且它表明，與 SAPIEN 和 SAPIEN XT 相比，CoreValve 的結構閥劣化率只有 1/3。

And data at EuroPCR last week reinforced our excellent clinical outcomes with our cusp overlap implant technique, including 1-day hospital discharge, single-digit pacemaker rates and the absence of moderate or severe PVL.

上週 EuroPCR 的數據通過我們的牙尖重疊植入技術加強了我們出色的臨床結果，包括 1 天的出院、個位數的起搏器率以及沒有中度或重度 PVL。

In the quarter, we also continued to launch Evolut PRO+ in Europe and began the launch of Evolut PRO in China, our first entry into this large and underpenetrated market. In the U.S. we're planning to start the limited market release of our next-generation TAVR valve, Evolut FX here in our first fiscal quarter and move into full market release later in the fiscal year.

本季度，我們還繼續在歐洲推出 Evolut PRO+，並開始在中國推出 Evolut PRO，這是我們第一次進入這個龐大且尚未滲透的市場。在美國，我們計劃在第一財季開始我們的下一代 TAVR 閥門 Evolut FX 的有限市場發布，並在本財年晚些時候進入全面市場發布。

We're also looking to expand our TAVR indications. We had first enrollment earlier this month in our EXPAND TAVR II pivotal trial, evaluating our TAVR platform in patients with moderate symptomatic aortic stenosis. Overall, TAVR represents a large growth driver for Medtronic as we expect this roughly $5.5 billion market to exceed $7 billion within the next 3 years and reach $10 billion in the next 5 years.

我們也在尋求擴大我們的 TAVR 適應症。本月早些時候，我們在 EXPAND TAVR II 關鍵試驗中首次入組，評估我們的 TAVR 平台在中度症狀性主動脈瓣狹窄患者中的療效。總體而言，TAVR 代表了美敦力的巨大增長動力，因為我們預計這個大約 55 億美元的市場將在未來 3 年內超過 70 億美元，並在未來 5 年內達到 100 億美元。

Moving to our Med Surg portfolio and Surgical Robotics, we remain focused on the limited market release of our Hugo robot while we scale production. We completed Hugo installations in Denmark, France and Italy. We also continue to increase our installed base of Touch Surgery Enterprise, our AI-powered surgical video and analytics platform.

轉向我們的 Med Surg 產品組合和 Surgical Robotics，在我們擴大生產規模的同時，我們仍然專注於 Hugo 機器人的有限市場發布。我們在丹麥、法國和意大利完成了 Hugo 安裝。我們還繼續增加我們的人工智能手術視頻和分析平台 Touch Surgery Enterprise 的安裝基礎。

In our Patient Monitoring business, we just received FDA clearance earlier this month for our next-generation Nellcor OxySoft pulse ox sensor. Now this sensor includes a special silicon adhesive designed to protect fragile skin while enhancing adherence. Its low profile and brighter LEDs improve accuracy and responsiveness for the most challenging neonatal and adult critical care patients.

在我們的患者監測業務中，我們本月早些時候剛剛獲得了 FDA 對我們下一代 Nellcor OxySoft 脈搏血氧傳感器的批准。現在，該傳感器包含一種特殊的矽粘合劑，旨在保護脆弱的皮膚，同時增強附著力。它的低調和更亮的 LED 提高了最具挑戰性的新生兒和成人重症監護患者的準確性和響應能力。

Now turning to our Neuroscience portfolio and our Cranial and Spinal Technologies business. We're seeing strong adoption of our unit AI-enabled surgical planning platform with a mid-30 sequential growth in our U.S. user base. The ongoing launch of our Catalyft Expandable Titanium Interbody System and the rollout of our enabling technologies continues to differentiate us in spine. Customer demand for our capital equipment remains strong. And we had record quarters for our Mazor robotics system and StealthStation Navigation System.

現在轉向我們的神經科學產品組合以及我們的顱腦和脊柱技術業務。我們看到我們的單位人工智能手術計劃平台得到廣泛採用，我們的美國用戶群連續增長了 30 年左右。我們正在推出的 Catalyft 可擴展鈦金屬體間系統和我們的使能技術的推出繼續使我們在脊柱方面與眾不同。客戶對我們的資本設備的需求依然強勁。我們的 Mazor 機器人系統和 StealthStation 導航系統擁有創紀錄的季度。

In Neuromodulation, we're building our commercial teams and have started the initial launch of our Intellis and Vanta spinal cord stimulators to treat diabetic peripheral neuropathy. We believe DPN is one of the largest opportunities in Med Tech, and we expect the market to reach $300 million by FY '26 with an annual total addressable market of up to $2 billion.

在神經調節方面，我們正在建立我們的商業團隊，並已開始首次推出我們的 Intellis 和 Vanta 脊髓刺激器來治療糖尿病周圍神經病變。我們相信 DPN 是醫療技術領域最大的機會之一，我們預計到 26 財年市場將達到 3 億美元，每年的潛在市場總額高達 20 億美元。

And we're also excited about our Inceptiv ECAPs closed-loop spinal cord stimulator, which we submitted to the FDA late last calendar year. We expect Inceptiv's closed-loop therapy, which optimizes pain relief for patients to revolutionize the SCS market.

我們也對我們的 Inceptiv ECAPs 閉環脊髓刺激器感到興奮，我們在去年年底提交給 FDA。我們期待 Inceptiv 的閉環療法能夠優化患者的疼痛緩解，從而徹底改變 SCS 市場。

In brain modulation, our ongoing launch of the Percept PC neurostimulator and SenSight Directional Leads is driving new implant share in both Europe and the U.S. And this is the only system that can stimulate and sense brain signals.

在大腦調製方面，我們正在推出的 Percept PC 神經刺激器和 SenSight 定向引線正在推動歐洲和美國的新植入物份額。這是唯一可以刺激和感知大腦信號的系統。

In Pelvic Health, we received FDA approval of our next-gen InterStim recharge-free device, InterStim X, and that was happened in the fourth quarter. InterStim X features our proprietary fifth-generation battery chemistry that provides 10 to 15 years of battery life without the need to recharge.

在 Pelvic Health，我們的下一代 InterStim 免充電設備 InterStim X 獲得了 FDA 的批准，這發生在第四季度。 InterStim X 採用我們專有的第五代電池化學成分，無需充電即可提供 10 至 15 年的電池壽命。

And in ENT, we announced earlier this month that we completed the acquisition of Intersect ENT. And we're excited to add their attractive high-growth complementary products into our existing business. We believe we can grow Intersect's products in the double digits over the next several years as we expand use of both the PROPEL and SINUVA sinus implants globally.

在耳鼻喉科，我們本月早些時候宣布我們完成了對 Intersect 耳鼻喉科的收購。我們很高興將他們有吸引力的高增長互補產品添加到我們現有的業務中。我們相信，隨著我們在全球範圍內擴大 PROPEL 和 SINUVA 鼻竇植入物的使用，我們可以在未來幾年內以兩位數的速度增長 Intersect 的產品。

In Diabetes, our MiniMed 780G insulin pump, combined with our Guardian 4 Sensor continues to be extremely well received in markets where it's available. Now this system has a very positive user experience with no fingersticks and more time and range. This is due to its near real-time basal insulin and auto correction boluses every 5 minutes to address underestimated carbohydrate counts and occasional missed meal doses. Very strong data on 780G and Guardian 4 were presented at ATTD last month, showing improved time and range with less user interaction. Additional data sets on this differentiated system will be shared at ADA next month.

在糖尿病領域，我們的 MiniMed 780G 胰島素泵與我們的 Guardian 4 傳感器相結合，繼續在市場上廣受歡迎。現在這個系統有一個非常積極的用戶體驗，沒有手指，更多的時間和範圍。這是由於其近乎實時的基礎胰島素和每 5 分鐘一次的自動校正推注，以解決低估的碳水化合物數量和偶爾漏餐的問題。上個月在 ATTD 上展示了關於 780G 和 Guardian 4 的非常強大的數據，顯示時間和範圍有所改善，用戶交互更少。這個差異化系統的其他數據集將在下個月的 ADA 上共享。

And we also announced that Germany and France began reimbursement of our system in the quarter, which helped drive high-teens sequential international growth in diabetes. And in the U.S., we made substantial progress in meeting our observation and warning letter commitments, and continue to have regular communication with the FDA.

我們還宣布，德國和法國在本季度開始報銷我們的系統，這有助於推動青少年糖尿病的國際連續增長。在美國，我們在履行觀察和警告信承諾方面取得了實質性進展，並繼續與 FDA 保持定期溝通。

In our CGM pipeline, we expect to submit our next-generation sensor, Simplera, for CE Mark and FDA approval this summer. In addition, we're advancing multiple next-gen sensor and pump programs, including patch pumps. We're making considerable investments in our diabetes pipeline with line of sight to restoring strong growth in this business over the coming years.

在我們的 CGM 管道中，我們預計將在今年夏天提交我們的下一代傳感器 Simplera，以獲得 CE 標誌和 FDA 的批准。此外，我們正在推進多個下一代傳感器和泵程序，包括貼片泵。我們正在對我們的糖尿病管道進行大量投資，以期在未來幾年恢復該業務的強勁增長。

And with that, I'll turn it over to Karen to discuss our fourth quarter financial performance, and our new guidance for the next fiscal year, Karen?

有了這個，我將把它交給凱倫討論我們第四季度的財務業績，以及我們對下一財年的新指導，凱倫？

Thank you, Geoff. Our fourth quarter organic revenue increased 1.4% below our guidance and consensus. Compared to consensus, about 15% of the difference can be attributed to China, given recent COVID shutdowns and slowing distributor purchases in spine ahead of a potential national volume-based tender.

謝謝你，傑夫。我們第四季度的有機收入比我們的指導和共識增長了 1.4%。與共識相比，大約 15% 的差異可歸因於中國，因為最近 COVID 關閉以及在潛在的基於數量的全國招標之前，分銷商採購放緩。

About 10% of the difference is a result of changes in foreign exchange rates over the course of the quarter. And the remaining difference and the largest driver is due to supply chain issues that Geoff discussed.

大約 10% 的差異是本季度外匯匯率變化的結果。剩下的差異和最大的驅動因素是 Geoff 討論的供應鏈問題。

Despite revenue coming in roughly $350 million less than we expected, we reduced the impact that this would have had on our bottom line, resulting in EPS of $1.52, $0.04 below our guidance range.

儘管收入比我們預期的少了大約 3.5 億美元，但我們降低了這對我們的底線的影響，導致每股收益為 1.52 美元，比我們的指導範圍低 0.04 美元。

From a geographic perspective, our U.S. revenue declined 2%. Non-U.S. developed markets grew 4% and our emerging markets grew 7%. Within emerging markets, China declined 10%, given the impact of the COVID lockdowns. But we had very strong growth in many other emerging markets, including high teens growth in Eastern Europe, low 20s growth in Latin America, low 30s growth in the Middle East and Africa, and mid-30s growth in South Asia. In fact, excluding China, emerging markets grew in the low 20s.

從地理角度來看，我們在美國的收入下降了 2%。非美國發達市場增長 4%，新興市場增長 7%。在新興市場中，鑑於 COVID 封鎖的影響，中國下降了 10%。但我們在許多其他新興市場都有非常強勁的增長，包括東歐青少年的高速增長、拉丁美洲 20 多歲的低增長、中東和非洲 30 多歲的低增長以及南亞 30 多歲的增長。事實上，不包括中國，新興市場在 20 年代低點增長。

Turning to our margins, our fourth quarter adjusted gross margin improved by 30 basis points year-over-year, driven by product mix with lower sales of ventilators and higher sales of products like Micra. While we were impacted by inflation with increased freight expense, it's worth noting that the full impact from inflation on raw material and direct labor costs will be realized over the next couple of quarters as our inventory rolls off our balance sheet, negatively affecting our gross margin.

談到我們的利潤率，我們第四季度調整後的毛利率同比增長了 30 個基點，這主要是由於呼吸機銷量下降和 Micra 等產品銷量增加的產品組合。雖然我們受到通貨膨脹和運費增加的影響，但值得注意的是，隨著我們的庫存從資產負債表上滾下來，通貨膨脹對原材料和直接勞動力成本的全面影響將在未來幾個季度實現，從而對我們的毛利率產生負面影響.

Moving down to P&L, we also drove additional and continued improvement in our adjusted operating margin, which increased by 40 basis points, excluding the benefit from currency. We also ended the year with free cash flow at $6 billion, representing year-over-year growth of 22% and meeting our goal of 80% conversion from adjusted net income.

向下移動到損益表，我們還推動了調整後營業利潤率的進一步和持續改善，不包括貨幣收益，增加了 40 個基點。我們還以 60 億美元的自由現金流結束了這一年，同比增長 22%，實現了調整後淨收入 80% 轉換的目標。

Our balance sheet remained strong, and we continue to allocate our capital to investments that we expect will generate solid future growth and shareholder returns. We're investing heavily in R&D, with programs especially targeted for faster-growing Med Tech markets or where we have an opportunity to create new markets. We're also using our balance sheet to complement our innovation-driven growth strategy with tuck-in M&A, utilizing our very active capital committee process that was developed as part of our new operating model.

我們的資產負債表保持強勁，我們繼續將資本分配到我們預計將產生穩健的未來增長和股東回報的投資。我們在研發方面投入巨資，項目特別針對快速增長的醫療技術市場或我們有機會創造新市場的地方。我們還利用我們的資產負債表通過整合併購來補充我們的創新驅動增長戰略，利用我們非常活躍的資本委員會流程，該流程是我們新運營模式的一部分。

In fiscal '22, we announced 4 acquisitions totaling over $2.1 billion in total consideration. As Geoff mentioned, we closed our acquisition of Intersect ENT earlier this month, and also announced our intent to acquire a left heart access portfolio last month. At the same time, we're investing in promising early-stage ventures to keep our fingers on the pulse of new products and technologies, incubated by companies that one day could become future acquisitions.

在 22 財年，我們宣布了 4 次收購，總對價超過 21 億美元。正如 Geoff 所說，我們本月早些時候完成了對 Intersect ENT 的收購，並在上個月宣布了我們收購左心通路組合的意圖。與此同時，我們正在投資有前途的早期企業，以掌握新產品和技術的脈搏，這些新產品和技術由有朝一日可能成為未來收購的公司孵化。

We're also actively providing strong return to our shareholders, returning $5.5 billion in fiscal '22 through our dividend and net share repurchase. And this morning, we announced that we're increasing our dividend by 8%, reflecting the confidence we and our Board have in our financial strength and future earnings power.

我們還積極為股東提供強勁的回報，通過我們的股息和淨股票回購在 22 財年回報 55 億美元。今天早上，我們宣布將股息提高 8%，這反映了我們和董事會對我們的財務實力和未來盈利能力的信心。

We are an S&P Dividend Aristocrat, having increased our dividend for 45 years now, and our dividend is an important component of the total return we generate for our shareholders. This past year, we paid $3.4 billion in dividends and we're supplementing that through opportunistic share repurchase, particularly in periods where we see share price dislocation. In fact, we repurchased over 2.5 billion of our stock in fiscal '22, including 1.4 billion in the fourth quarter.

我們是標準普爾股息貴族，45 年來一直在增加股息，我們的股息是我們為股東創造的總回報的重要組成部分。過去一年，我們支付了 34 億美元的股息，我們正在通過機會性股票回購來補充這一點，特別是在我們看到股價錯位的時期。事實上，我們在 22 財年回購了超過 25 億股股票，其中包括第四季度的 14 億股。

Now turning to our guidance and starting with revenue, we continue to expect our recent launches and product pipeline to make a difference in many of our businesses, and Geoff covered many of them earlier. We expect organic revenue growth in fiscal '23 of 4% to 5%. While the impact of currency is fluid, if recent exchange rates hold, foreign currency would have a negative impact on full year revenue of $1 billion to $1.1 billion.

現在轉向我們的指導並從收入開始，我們繼續期望我們最近的發布和產品管道會對我們的許多業務產生影響，而 Geoff 早些時候涵蓋了其中的許多業務。我們預計 23 財年的有機收入增長為 4% 至 5%。雖然貨幣的影響是不穩定的，但如果最近的匯率保持不變，外幣將對 10 億至 11 億美元的全年收入產生負面影響。

By segment, we expect Cardiovascular to grow 5.5% to 6.5%; Medical Surgical to grow 3.5% to 4.5%; Neuroscience to grow 5% to 6%; and Diabetes to decline 6% to 7%, all on an organic basis. While we are hopeful that we can receive approval for 780G and Guardian 4 Sensor in the United States, we've elected not to include it in our guidance.

按細分市場，我們預計心血管將增長 5.5% 至 6.5%；內科增長 3.5% 至 4.5%；神經科學增長 5% 至 6%；糖尿病下降 6% 到 7%，這一切都是有機的。雖然我們希望能夠在美國獲得 780G 和 Guardian 4 Sensor 的批准，但我們選擇不將其包含在我們的指導中。

In the first quarter, we would have you model organic revenue to decline in the range of 4.5% to 5.5%, which conservatively assumes no near-term improvement in our supply chain and no major change to underlying fundamentals.

在第一季度，我們會讓您將有機收入建模為在 4.5% 至 5.5% 的範圍內下降，這保守地假設我們的供應鏈近期沒有改善，基本面也沒有重大變化。

Assuming recent exchange rates hold, the first quarter would have a currency headwind between $350 million and $400 million. By segment, we expect Cardiovascular to decline 1% to 2%; Medical Surgical to decline 7.5% to 8.5%; Neuroscience to be down 5% to 6%; and Diabetes down 8% to 10%, all on an organic basis.

假設最近的匯率保持不變，第一季度的貨幣逆風將在 3.5 億美元至 4 億美元之間。按細分市場，我們預計心血管疾病將下降 1% 至 2%；內科下降 7.5% 至 8.5%；神經科學將下降 5% 至 6%；和糖尿病下降 8% 到 10%，都是有機的。

Moving down the P&L, I provided early color for fiscal '23 on the last quarterly earnings call, where I talked about the expected impact of inflation, wages, acquisition dilution and foreign exchange headwinds. These still hold, but we've also seen environmental changes since late February.

向下移動損益表，我在上一個季度財報電話會議上為 23 財年提供了早期顏色，我在會上談到了通貨膨脹、工資、收購稀釋和外匯逆風的預期影響。這些仍然存在，但我們也看到了自 2 月下旬以來的環境變化。

Inflation and foreign exchange rates have become larger headwinds, and we're now factoring in continued supply chain challenges early in the year. Inflation and FX pressures also create near-term challenges on our margins, although we continue to look for opportunities to offset them.

通貨膨脹和匯率成為更大的阻力，我們現在正在考慮今年年初持續的供應鏈挑戰。通貨膨脹和外匯壓力也對我們的利潤率造成了近期挑戰，儘管我們繼續尋找機會來抵消它們。

At the same time, we continue to prioritize our long-term investments in organic R&D, with a focus on large opportunities in future growth markets, like renal denervation, robotics, diabetic peripheral neuropathy and transcatheter mitral valves.

與此同時，我們繼續優先考慮對有機研發的長期投資，重點關注未來增長市場的巨大機遇，如去腎神經、機器人、糖尿病周圍神經病變和經導管二尖瓣。

Taking this all into account on the bottom line, we expect non-GAAP diluted EPS in the range of $5.53 to $5.65 in fiscal '23, which includes an unfavorable impact of $0.20 to $0.25 from currency at recent rates, for the first quarter, we expect EPS of $1.10 to $1.14, including an FX headwind of about $0.05 at current rates.

考慮到這一切，我們預計 23 財年非 GAAP 攤薄後每股收益在 5.53 美元至 5.65 美元之間，其中包括以近期匯率計算的 0.20 美元至 0.25 美元的不利影響，對於第一季度，我們預計每股收益為 1.10 美元至 1.14 美元，包括按當前匯率計算的約 0.05 美元的外匯逆風。

Before I send it back to Geoff, I want to thank our employees around the globe who are working hard to overcome the macro challenges we face. Thanks for all you do to fulfill our mission every day. Back to you, Geoff.

在我將其發回給 Geoff 之前，我要感謝我們在全球範圍內努力克服我們面臨的宏觀挑戰的員工。感謝您每天為完成我們的使命所做的一切。回到你身邊，傑夫。

Thank you, Karen. While we spent a lot of time covering the fourth quarter, it's worth briefly reflecting on what we've accomplished in fiscal '22. It's certainly been a difficult environment, and our organization has enacted big changes in such a short period of time and under unique circumstances to better position the company.

謝謝你，凱倫。雖然我們花了很多時間介紹第四季度，但值得簡要回顧一下我們在 22 財年取得的成就。這當然是一個艱難的環境，我們的組織在如此短的時間內和在獨特的情況下進行了重大變革，以更好地定位公司。

It was our first full year in the new operating model, and with our enhanced Medtronic mindset of acting boldly, competing to win, moving with speed and decisiveness, fostering, belonging and delivering results the right way. We've also made strides to becoming a more diverse and inclusive organization.

這是我們在新運營模式下的第一個全年，我們增強了美敦力的思維方式，即大膽行動、競爭取勝、快速果斷地前進、培養、歸屬和以正確的方式交付成果。我們在成為一個更加多元化和包容性的組織方面也取得了長足的進步。

And I was very proud that Medtronic was recognized earlier this month as #10 on Diversity Inc.'s Top 50 U.S. Companies for Diversity. Even with that, we're committed to improving through innovative programs to attract, develop and retain top talent from all gender and ethnic backgrounds. Along those lines, we've made notable hires in fiscal '22, recruiting great talent from health care technology industry and beyond.

我很自豪美敦力本月早些時候在 Diversity Inc. 的美國多元化公司 50 強中排名第 10。即便如此，我們仍致力於通過創新計劃進行改進，以吸引、培養和留住來自所有性別和種族背景的頂尖人才。沿著這些思路，我們在 22 財年招聘了大量人才，從醫療保健技術行業及其他行業招聘了優秀人才。

While we've implemented a number of changes, this past year has been choppier than I would have liked with some of our growth drivers being pushed out and the impact from the pandemic, quality challenges and supply chain affecting our results. But we have a clear direction -- a clear direction where we're headed as we transform the company.

雖然我們已經實施了一些變革，但過去一年的波動比我想像的要大，我們的一些增長動力被排除在外，大流行、質量挑戰和供應鏈的影響影響了我們的業績。但我們有一個明確的方向——在我們改造公司時，我們的前進方向很明確。

Let's start with the top line. We remain laser-focused on accelerating the growth through robust capital allocation and portfolio management. You're seeing our efforts to enhance our future growth through greater investment in organic R&D, as well as portfolio moves.

讓我們從第一行開始。我們仍然專注於通過穩健的資本配置和投資組合管理來加速增長。您會看到我們通過加大對有機研發的投資以及投資組合變動來促進我們未來增長的努力。

We've already spoken of the organic growth catalysts in front of us, many coming later this fiscal year. We're also executing a healthy cadence of tuck-in acquisitions in faster-growing markets, and we're focused on reducing our footprint in lower growth and lower-margin businesses.

我們已經談到了擺在我們面前的有機增長催化劑，其中許多將在本財年晚些時候推出。我們還在快速增長的市場中以健康的節奏進行收購，我們專注於減少我們在低增長和低利潤業務中的足跡。

We continue to work on additional portfolio moves with the goal of creating a portfolio where we have distinct expertise, synergies across the company and ultimately, higher growth and higher margins. And to aid this effort, we've assembled a dedicated team that is 100% focused on our integrations and divestitures.

我們將繼續致力於更多的投資組合舉措，目標是創建一個我們在整個公司擁有獨特專業知識、協同效應的投資組合，並最終實現更高的增長和更高的利潤率。為了協助這項工作，我們組建了一個專門的團隊，100% 專注於我們的整合和資產剝離。

At the same time, we have the opportunity to improve our global supply chain and operations by centralizing these activities, allowing us to leverage our scale, invest in new technology and ensure we have world-class supply chain experts responsible for our global operations.

同時，我們有機會通過集中這些活動來改善我們的全球供應鍊和運營，使我們能夠利用我們的規模，投資於新技術，並確保我們擁有負責我們全球運營的世界級供應鏈專家。

And this isn't something new that we're just starting now. Although recent challenges have given us a greater sense of urgency, we've been on this journey for over a year. And while it will take time, I fully expect our efforts to drive lower cost and lead to consistent and reliable quality along with greater product availability, all on a sustainable basis.

這並不是我們剛剛開始的新事物。儘管最近的挑戰給了我們更大的緊迫感，但我們已經踏上了這一旅程一年多了。雖然這需要時間，但我完全希望我們能夠在可持續的基礎上努力降低成本並帶來一致和可靠的質量以及更高的產品可用性。

Now well beyond health care, our world is facing a lot of economic uncertainty with questions around inflation, global supply chain challenges and continued impacts from the pandemic and a potential recession. But our business, the business of health care and the delivery of essential life-saving technology is something that continues in good times and uncertain times like these. And demand for our products continues to increase with the aging and growing of our global population.

現在，除了醫療保健之外，我們的世界還面臨著許多經濟不確定性，包括通脹、全球供應鏈挑戰以及大流行和潛在衰退的持續影響。但我們的業務、醫療保健業務和提供必要的救生技術在這樣的繁榮時期和不確定時期都會繼續存在。隨著全球人口的老齡化和增長，對我們產品的需求不斷增加。

When you look at health care technology, Medtronic is uniquely situated, particularly in these uncertain times, given our diversified businesses with leading market positions in growth markets, a robust product pipeline, solid free cash flow, strong balance sheet, and a very attractive and growing dividend to add to our return to shareholders.

當您查看醫療保健技術時，美敦力處於獨特的位置，尤其是在這些不確定的時期，因為我們的多元化業務在增長市場中具有領先的市場地位、強大的產品線、穩健的自由現金流、強勁的資產負債表以及極具吸引力和增加股息以增加我們對股東的回報。

We have near-term challenges that we are overcoming, and the opportunities in health care technology and at Medtronic are immense. We are fully focused on continuing on our transformation journey and making our opportunities a reality as we alleviate pain, restore health and extend life for millions of people around the world.

我們正在克服近期的挑戰，醫療保健技術和美敦力的機會是巨大的。我們完全專注於繼續我們的轉型之旅，讓我們的機會成為現實，因為我們為全世界數百萬人減輕痛苦、恢復健康和延長生命。

Finally, I want to thank our exceptional Medtronic employees. I get to see the outcome of their efforts to fulfill our mission every day. It's inspiring. In addition, their willingness to lean into our new operating model and embrace our new culture have been key to the ongoing transformation of the company.

最後，我要感謝我們傑出的美敦力員工。我每天都能看到他們努力完成我們使命的成果。這很鼓舞人心。此外，他們願意融入我們的新運營模式並接受我們的新文化，這也是公司持續轉型的關鍵。

I also want to thank our partners in health care, the frontline workers who are at that final step in ensuring patients get our therapies and are dedicating their lives day in and day out. Their incredible efforts to continue care delivery and get us all through the pandemic will be noted as one of the great accomplishments in history.

我還要感謝我們在醫療保健領域的合作夥伴，感謝前線工作人員，他們在確保患者得到我們的治療的最後一步，並日復一日地奉獻自己的生命。他們為繼續提供護理並讓我們所有人度過大流行所做的令人難以置信的努力將被視為歷史上的偉大成就之一。

Now let's move to Q&A. We're going to try to get as many analysts as possible, so we ask that 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。我們將嘗試吸引盡可能多的分析師，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) Today's Q&A session is being recorded. For today's session, Geoff, Karen and Ryan are joined by Sean Salmon, EVP and President of the Cardiovascular portfolio and former Head of the Diabetes Operating Unit; Bob White, EVP and President of the Medical Surgical portfolio; and Brett Wall, EVP and President of the Neuroscience portfolio. (Operator Instructions) We'll take the first question from Vijay Kumar at Evercore ISI.

（操作說明）今天的問答環節正在錄製中。在今天的會議上，Geoff、Karen 和 Ryan 與執行副總裁兼心血管產品組合總裁、前糖尿病手術部門負責人 Sean Salmon 一起參加； Bob White，執行副總裁兼醫療外科產品組合總裁； Brett Wall，執行副總裁兼神經科學產品組合總裁。 （操作員說明）我們將回答 Evercore ISI 的 Vijay Kumar 的第一個問題。

Geoff and Karen, maybe I had a 2-part question. I'll ask both right away. When I look at the 4% to 5% organic guide for fiscal '23, perhaps it came in slightly better than expected. Can you talk about some specific assumptions around even -- you noted supply chain, there were some back orders. Is there some contribution from supply chain back orders? Any further disruption from supply chain? What are you assuming for diabetes, robotics?

傑夫和凱倫，也許我有一個兩部分的問題。我會馬上問兩個。當我查看 23 財年 4% 到 5% 的有機指南時，也許它比預期的要好一些。你能否談談一些具體的假設——你注意到供應鏈，有一些延期交貨。供應鏈延期交貨是否有貢獻？供應鍊是否會進一步中斷？你對糖尿病、機器人有什麼假設？

I think China VBP something that investors have asked. And Geoff, related to that, I think, if I take a step back, the Medtronic pieces of mid-singles top high singles earnings. Consistency has been something that people have questioned. We've had some moving parts over the years.

我認為中國 VBP 是投資者提出的問題。傑夫，與此相關，我認為，如果我退後一步，美敦力的中單曲收入最高。一致性一直是人們質疑的問題。這些年來，我們有一些活動的部分。

As you look at all the changes that have happened, -- maybe talk about what gives you the confidence that this consistency of mid-singles on the top and high singles on the EPS line should be something that investors should look forward to?

當你看到所有發生的變化時，——也許談談是什麼讓你相信，這種在每股收益線上的中單和高單的一致性應該是投資者應該期待的？

Sure. Well, let me -- thanks for the question Vijay, maybe I'll take the second part of that question, and then Karen can take the first part of the details behind the 4% to 5% for FY '23. But on the second part in terms of the confidence of getting back to -- getting to that constant mid-single-digit currency top line and high single-digit EPS growth or double-digit total return to shareholders. I do think we're putting the right things in place.

當然。好吧，讓我 - 謝謝 Vijay 的問題，也許我會回答這個問題的第二部分，然後 Karen 可以回答 23 財年 4% 到 5% 背後的第一部分細節。但在第二部分，就回歸的信心而言 - 達到恆定的中個位數的貨幣收入和高個位數的每股收益增長或兩位數的股東總回報。我確實認為我們正在做正確的事情。

So first of all, just over the next -- Karen can detail this, but over the next year, you'll see the acute back order issues that we faced in Q4. Those abate over the next quarter or so, and we can get into the details of that. In addition, we're definitely anniversarying a lot of things that hurt us in FY '22, like exiting the LVAD business, the Navion recall, some tough comps on our ventilator business during the height of the pandemic. So these things abate over -- these things go away over the course of the fiscal year and you're starting now, actually.

所以首先，就在下一個 - 凱倫可以詳細說明這一點，但在接下來的一年裡，你會看到我們在第四季度面臨的嚴重的延期交貨問題。這些在下個季度左右會有所減弱，我們可以深入了解其中的細節。此外，我們肯定會在 22 財年紀念很多傷害我們的事情，比如退出 LVAD 業務、Navion 召回、在大流行高峰期對我們的呼吸機業務進行一些艱難的補償。所以這些事情會消退——這些事情會在本財年的過程中消失，實際上你現在就開始了。

And then finally, we've got a lot of growth catalysts. We've talked a lot about the pipeline and I can go through that. There's a long list. I went through a lot of it in the commentary, but it's much broader than like the Hugo or our soft tissue robot, in RD. And those are big ones, but there's a whole lot of other ones as well.

最後，我們有很多增長催化劑。我們已經談了很多關於管道的事情，我可以通過它。有一個很長的清單。我在評論中經歷了很多，但它比 RD 中的 Hugo 或我們的軟組織機器人要廣泛得多。這些都是大的，但還有很多其他的。

And then -- so that -- those things kick in, in the second half of this year and then get even bigger in FY '24. And then finally, we've got some portfolio moves that over the next year or so, I think we'll -- that will add to this. So that's how we get from where we are to back to that, the numbers that you quoted.

然後 - 所以 - 這些事情在今年下半年開始，然後在 24 財年變得更大。最後，我們在接下來的一年左右進行了一些投資組合變動，我認為我們會 - 這將增加這一點。所以這就是我們如何從我們所在的地方回到那個，你引用的數字。

And then the second part of your question gets to kind of the confidence and the consistency. And I'd say there are 2 things. One is having this robust pipeline spread across all of our businesses. And we've been working hard over the last couple of years to double down on our innovation, putting more into R&D, the new operating model that we have the 20 operating units, we have a clear visibility into their end markets, their competition, people are getting evaluated on their pipeline.

然後你問題的第二部分涉及信心和一致性。我想說有兩件事。一是讓這條強大的管道遍布我們所有的業務。在過去的幾年裡，我們一直在努力加倍創新，投入更多的研發，我們擁有 20 個運營單位的新運營模式，我們清楚地了解他們的終端市場，他們的競爭，人們正在對其管道進行評估。

And we're putting more into R&D and as well as some meaningful tuck-in acquisitions, like we just mentioned Intersect ENT closing and in the Cardiac Ablation Solutions space or the AFib space, the Affera acquisition. These are meaningful adds. So I get -- that gives us diversity and more growth on the top line.

我們在研發和一些有意義的收購中投入更多，就像我們剛剛提到的 Intersect ENT 關閉和在心臟消融解決方案空間或 AFib 空間中的 Affera 收購。這些是有意義的補充。所以我明白了——這給了我們多樣性和收入的更多增長。

But the piece that we really have been focusing on over the last year and is important for our future in terms of consistency is the global operations and supply chain changes that we made. These are -- coming into this role, myself and the team identified this as an opportunity for us, brought in Greg Smith, as we mentioned in the commentary over a year ago and really already centralized our supply chain.

但是，我們在過去一年中真正關注的並且在一致性方面對我們未來很重要的是我們所做的全球運營和供應鏈變化。這些是 - 擔任這個角色，我和團隊認為這對我們來說是一個機會，引入了格雷格史密斯，正如我們在一年前的評論中提到的那樣，並且真的已經集中了我們的供應鏈。

Our global ops and supply chain was really set up for a different era, a pass there. And we had to make those changes. And unfortunately, they haven't fully taken hold yet, they need more time to mature. I would have liked to have this -- those moves done earlier. It definitely would have helped in Q4 because the supply chain issues came out fast and hard and especially in the back half of the quarter more supplier decommits than we've ever seen.

我們的全球運營和供應鏈確實是為一個不同的時代而建立的，那裡是一個通行證。我們必須做出這些改變。不幸的是，他們還沒有完全站穩腳跟，他們需要更多的時間來成熟。我本來希望早點完成這些動作。這肯定會在第四季度有所幫助，因為供應鏈問題很快就出現了，尤其是在本季度後半段，供應商離職的數量比我們所見過的要多。

But the good news is that we're not just getting started on this transformation of supply chain. I'd hate to be starting it now in the middle of this environment. We're well down the path and to building in that resiliency. We've made these moves and we're confident that these changes will give us that resiliency that we need and that dependability.

但好消息是，我們不只是開始進行這種供應鏈轉型。我不想現在在這種環境中開始它。我們已經走上了這條道路並建立了這種彈性。我們已經採取了這些舉措，我們相信這些變化會給我們帶來我們需要的彈性和可靠性。

So the combination of the innovation, plus some portfolio moves and just a more resilient global ops and supply chain. That's how we're confident that we get to the long-range forecast that we talked about of consistent mid-single digits, that 5% plus, including the plus and the high single-digit EPS when you add in the dividend gives you a double-digit return.

因此，創新的結合，加上一些投資組合的變動，以及更具彈性的全球運營和供應鏈。這就是我們有信心實現長期預測的方式，我們談到了一致的中個位數，即 5% 以上，包括當您添加股息時的正數和高個位數每股收益，給您一個兩位數的回報。

But in terms of -- I hope I answered that question. Karen can add to it. But in terms of the FY '23 guide and the details below that, I'll turn that over to Karen.

但就-- 我希望我回答了這個問題。凱倫可以添加它。但就 23 財年指南和下面的詳細信息而言，我將把它交給凱倫。

Yes, thanks, Vijay, for the question, and I'd love to take this in pieces because I want to walk you through Q1 and then also talk about the full year because we expect improvement each quarter as we move through the year. So just starting with Q1, given our recent challenges, we've elected to take a conservative approach with our Q1 guide.

是的，謝謝 Vijay 提出的問題，我很樂意將其分解，因為我想帶您了解第一季度，然後再談談全年，因為我們預計隨著一年的發展，每個季度都會有所改善。因此，從第一季度開始，鑑於我們最近面臨的挑戰，我們選擇在我們的第一季度指南中採取保守的方法。

We're assuming underlying fundamentals are pretty similar to last quarter to Q4, and we've built in some conservatism in the supply chain. If you look at the year-over-year view, it's influenced by COVID. And so to remove that noise, I think it's really good to look at it on a COVID comp-adjusted basis. And when you do that, our guide really just implies a slight deceleration from Q4 to Q1. That's not out of line with what we've seen historically. And again, I would just emphasize that we've included conservatism due to the supply chain.

我們假設基本面與上一季度到第四季度非常相似，並且我們在供應鏈中建立了一些保守主義。如果您查看同比視圖，它會受到 COVID 的影響。因此，為了消除這種噪音，我認為在 COVID 補償調整的基礎上查看它真的很好。當你這樣做時，我們的指南實際上只是暗示從第四季度到第一季度略有減速。這與我們在歷史上看到的情況並不矛盾。再一次，我只想強調，由於供應鏈，我們已經包括了保守主義。

Some puts and takes that we've got in Q1, in addition to the supply chain impact that we factored in, we've also assumed some incremental pressure in Spine in China ahead of a potential national volume-based purchasing tender. And Geoff already mentioned on the plus side, we anniversary some of our headwinds like the Navion recall and the LVAD shutdown.

我們在第一季度得到了一些看跌期權，除了我們考慮到的供應鏈影響外，我們還在潛在的全國性採購招標之前承擔了中國 Spine 的一些增量壓力。 Geoff 已經提到了積極的一面，我們紀念我們的一些不利因素，比如 Navion 召回和 LVAD 關閉。

If I move beyond Q1 and then into the full year guide of the 4.5%, I mentioned we do expect improvement as we progress through the quarters with our back half much better than our first half. But I'd also talk about the puts and takes that we've got on the full year. We talked about the fact that we continue to actively work with the FDA on the diabetes warning letter.

如果我超越第一季度，然後進入 4.5% 的全年指南，我提到我們確實預計會有所改善，因為我們在各個季度取得進展，我們的後半部分比上半年要好得多。但我也會談談我們全年的看跌期權。我們談到了我們繼續在糖尿病警告信上與 FDA 積極合作的事實。

But for conservatism, we've elected not to assume the approval of the 780G in this guidance. And also, it's manageable, but we've got volume-based pricing in China that we believe will have a bigger impact in this fiscal year, primarily in Spine.

但出於保守主義的考慮，我們選擇不假定本指南中的 780G 已獲得批准。而且，它是可控的，但我們在中國有基於數量的定價，我們相信這將在本財年產生更大的影響，主要是在 Spine。

And at the same time, Geoff talked about it, and we have a number of positives as we think about FY '23. First, we've got headwinds that are going to go away, the LVAD business, the Navion recall, the reduced ventilator sales that Geoff mentioned. And then we also had some volume-based pricing on drug-eluting stents in China that will anniversary. And combined, all of those headwinds had a 200 basis point impact in FY '22.

與此同時，傑夫談到了它，當我們考慮 23 財年時，我們有許多積極的一面。首先，我們遇到的不利因素將會消失，LVAD 業務、Navion 召回以及 Geoff 提到的呼吸機銷量下降。然後我們還在中國對藥物洗脫支架進行了一些基於數量的定價，這將是周年紀念日。加起來，所有這些不利因素在 22 財年產生了 200 個基點的影響。

Second, we expect these supply chain challenges to improve as starting in Q2 and obviously continuing to improve from there.

其次，我們預計這些供應鏈挑戰將在第二季度開始改善，並且顯然會繼續改善。

And then thirdly, our year-over-year comps get easier, particularly in the back half. And then lastly, we've got a number of really important product launches throughout the year. And just to name a few of them, we've got Evolut FX, we've got ECAPs, we've got Diabetic Painful (sic) [Peripheral] Neuropathy. And again, I'm just naming a few. So I hope that's helpful and shows what our guidance implies as we move throughout the year.

第三，我們的年復賽變得更容易，尤其是在後半部分。最後，我們全年推出了許多非常重要的產品。僅舉幾例，我們有 Evolut FX，我們有 ECAP，我們有糖尿病疼痛（原文如此）[外周]神經病變。再說一次，我只是舉幾個例子。因此，我希望這會有所幫助，並展示我們的指導在我們全年行動中的含義。

Thanks Vijay. Next question, Brad.

謝謝維杰。下一個問題，布拉德。

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。

I'll ask a 2-part one as well. I guess, first on the elective procedure recovery. Curious how May is shaping up versus April kind of around the world, both in the U.S. and China as well. And then the second part was going back to kind of some of the supply chain issues. The impact this quarter is a little bit worse than some of your peers. I don't know if things got a lot worse in April, or there was something specific with surgical innovations. I just want to make sure we have the confidence that, that's going to start to improve here in the next quarter or 2.

我也會問一個兩部分的。我猜，先對選修程序恢復。好奇五月與四月在世界各地的情況如何，無論是在美國還是在中國。然後第二部分回到了一些供應鏈問題。本季度的影響比您的一些同行要差一些。我不知道四月份情況是否變得更糟，或者手術創新有什麼特別之處。我只是想確保我們有信心，這將在下一季度或第二季度開始改善。

Sure. I'll take the second one first. The supply chain issues, yes, they did -- look, they did -- no one's more disappointed about our Q4 miss than I am, and we got -- we believe we understand the root cause of that miss.

當然。我先拿第二個。供應鏈問題，是的，他們確實 - 看，他們確實 - 沒有人比我對第四季度的失誤更失望，而且我們得到了 - 我們相信我們理解這次失誤的根本原因。

And it really started hitting us in the second half of Q4. And I'd say that 75% of the miss is due to -- of the $340 million, $350 million miss is due to supply chain. 15 -- and I'll get into that in a second, maybe about 15% is due to the China lockdown and then maybe another 10% is FX getting worse, and Karen can talk about that.

它真的在第四季度的下半年開始打擊我們。我想說，75% 的失誤是由於——在 3.4 億美元中，3.5 億美元的失誤是由於供應鏈造成的。 15 - 我稍後會談到，也許大約 15% 是由於中國的封鎖，然後可能還有 10% 是外匯變得更糟，Karen 可以談論這個。

But in the miss, the supply chain miss, it hit us across a number of businesses, but it was definitely the most pronounced in our Surgical Innovations business, and it was 3 things. It was semiconductors, which is affecting everybody, that affected a number of businesses, but particularly in our SI business. It also was resins, a particular resin that we use in our energy business in SI has been a major source of problem for us.

但是在錯過，供應鏈錯過中，它影響了我們的許多業務，但它絕對是我們的外科創新業務中最明顯的，它是三件事。影響每個人的正是半導體，它影響了許多業務，尤其是我們的 SI 業務。它也是樹脂，我們在 SI 的能源業務中使用的一種特殊樹脂一直是我們的主要問題來源。

And then packaging, our trade packaging there was a catastrophic explosion in our supply chain. And so those last 2 ones, the packaging and the resins were the biggest issues, the biggest supplier decommits, and I'd say the biggest surprise, and most of that was in SI. We see this getting better over the next -- the SI one is -- overall for the company, we see the supply chain issues getting -- abating over the next quarter or 2. The SI issues probably it will take more than a quarter or so, put it on the first half of the year to get through those issues. We factored all that into our guidance.

然後是包裝，我們的貿易包裝在我們的供應鏈中發生了災難性的爆炸。所以最後兩個，包裝和樹脂是最大的問題，最大的供應商退役，我想說最大的驚喜，其中大部分是在 SI。我們看到這在下一個季度會變得更好 - SI 是 - 總體而言，對於公司而言，我們看到供應鏈問題在下一季度或 2 季度內得到緩解。SI 問題可能需要超過一個季度或所以，把它放在今年上半年來解決這些問題。我們將所有這些因素都納入了我們的指導。

I mentioned China. We have -- remember, we have April. This really hit us in April. We have April in our Q4, and that represented roughly about $60 million of the shortfall combination of the COVID lockdown. And Karen mentioned some of the volume-based procurement.

我提到了中國。我們有——記住，我們有四月。這在四月真的打擊了我們。我們在第四季度有 4 月，這大約佔 COVID 鎖定的缺口組合中的約 6000 萬美元。凱倫提到了一些基於數量的採購。

So other than China, our emerging markets, as Karen mentioned in the commentary, grew 20%. China was actually down 10% or more and the rest of emerging markets grew 20%. And so these -- like I said, these acute issues, I mentioned in the commentary and one of my answers were well down the path of remaking our global ops and supply chain to provide that resiliency that we just haven't had.

因此，正如凱倫在評論中提到的，除了中國，我們的新興市場增長了 20%。中國實際上下降了 10% 或更多，而其他新興市場則增長了 20%。所以這些——就像我說的，這些尖銳的問題，我在評論中提到，我的答案之一是在重塑我們的全球運營和供應鏈以提供我們剛剛沒有的彈性的道路上。

And we started that over a year ago, centralizing the function and bringing in some -- building a very strong leadership team under Greg, bringing in new people from different industries, investing in all kinds of whether it be tools and technology and operating mechanisms for this.

一年多前我們就開始了，集中職能並引進一些——在 Greg 領導下建立一個非常強大的領導團隊，引進來自不同行業的新人，投資於各種工具、技術和運營機制這個。

And I know I'm confident we're going down the right path there. And I'm glad that we started when we did. I wish we would have started even earlier. But -- so the long-term building those fundamentals will take some time. But the acute issues that hit our numbers will go away or get better over the next quarter or 2.

我知道我有信心我們正朝著正確的方向前進。我很高興我們開始時就開始了。我希望我們能更早開始。但是 - 所以長期建立這些基本面將需要一些時間。但影響我們數據的嚴重問題將在下一季度或第二季度消失或好轉。

I'll turn it over to Karen to answer the first part of the question.

我將把它交給凱倫來回答問題的第一部分。

Yes, Travis, thank you. So just in terms of the month of May, it's still early. And we're obviously focused on managing through some supply issues that we've got in some of our businesses. So the numbers are a little cloudy, but when we look at our operating units that are not impacted by supply issues, just through the first 3 weeks of May, we're trending largely in line with where we were first quarter last year. And I would note that elective procedures for the most part were back to pre-COVID levels for us last quarter.

是的，特拉維斯，謝謝。所以就5月份而言，現在還為時過早。我們顯然專注於解決我們在某些業務中遇到的一些供應問題。所以數字有點模糊，但當我們查看不受供應問題影響的運營單位時，就在 5 月的前 3 週，我們的趨勢與去年第一季度的情況基本一致。而且我會注意到，上個季度我們的選修程序大部分都回到了 COVID 之前的水平。

Thanks Travis. Take the next question, Brad.

謝謝特拉維斯。回答下一個問題，布拉德。

The next question comes from Larry Biegelsen with Wells Fargo Securities.

下一個問題來自富國銀行證券公司的拉里·比格爾森。

Just Geoff, on the kidney company news today, should we expect more like this? Or could they be more significant? Just kind of remind us of what the overarching goals are. And Bob, maybe on Hugo, just help us understand what the expectations are for fiscal '23, the status of the supply constraints and the preop setup error, and when you expect to start the U.S. pivotal trial.

只是 Geoff，在今天的腎臟公司新聞中，我們應該期待更多這樣的事情嗎？或者它們會更重要嗎？只是提醒我們總體目標是什麼。 Bob，也許在 Hugo 上，只是幫助我們了解對 23 財年的期望、供應限制的狀態和 preop 設置錯誤，以及您預計何時開始美國的關鍵試驗。

On the Renal Care Solutions joint venture with DaVita, this is what I'd characterize as a smaller initial step in terms of our portfolio management work. That work continues, and we do anticipate that there could be more portfolio moves over the course of FY '22. I'm not going to comment on the size of those. But I'd characterize this is a smaller initial step. It's been under consideration for a while.

在與 DaVita 的 Renal Care Solutions 合資企業中，我認為這是我們投資組合管理工作的一個較小的初始步驟。這項工作仍在繼續，我們確實預計在 22 財年期間可能會有更多的投資組合變動。我不會評論它們的大小。但我認為這是一個較小的初始步驟。已經考慮了一段時間了。

And like I said in the commentary, I am excited about this. This technology that we've been working on for years, I think DaVita, this joint venture, will bring more focus to that finishing up the development. And then I think, obviously, DaVita is a leader in kidney care and will be a great partner as we commercialize and scale this innovative technology. They bring a lot to the table there. And I think we bring a lot to the table on the technology side and looking forward to it.

正如我在評論中所說，我對此感到興奮。我們多年來一直在研究的這項技術，我認為這家合資企業 DaVita 將把更多的精力放在完成開發上。然後我認為，很明顯，DaVita 是腎臟護理領域的領導者，並且在我們將這項創新技術商業化和擴展時將成為一個很好的合作夥伴。他們帶來了很多東西。我認為我們在技術方面帶來了很多東西並期待它。

But as we move forward, I don't know that I'm not -- the other portfolio moves would be JVs or anything like that. For this one -- this one just made the most sense. And we think there's a lot of upside in this technology and the way we structured this deal. Both DaVita and Medtronic will share in that upside. So looking forward to that.

但隨著我們向前發展，我不知道我不是——其他投資組合舉措將是合資企業或類似的東西。對於這個——這個是最有意義的。我們認為這項技術以及我們構建這筆交易的方式有很多好處。 DaVita 和美敦力都將分享這一優勢。所以很期待。

In terms of the goals of the portfolio work, they remain unchanged. Our North Star is durable growth, durable growth without taking a step back on margins and free cash flow. We just want a higher level of growth. And so we want to remake the portfolio for a higher (inaudible) and more consistency and growth.

就組合工作的目標而言，它們保持不變。我們的北極星是持久的增長，持久的增長，不會在利潤率和自由現金流上退後一步。我們只想要更高水平的增長。因此，我們希望重新設計投資組合，以實現更高（聽不清）和更多的一致性和增長。

So that's the goal. And I think the other -- the secondary goal would be just to simplify the company a bit. So that's -- those are the goals. That's where we're headed and more to come.

所以這就是目標。我認為另一個 - 次要目標只是稍微簡化公司。所以這就是 - 這些是目標。這就是我們要去的地方，還有更多。

Thanks, Geoff. And Larry, good to hear from you. Thanks for the question. Let me provide you a good update on Hugo. So we're still in limited market release. We're making good progress on the supply chain issues. We're currently in 8 countries. We've had a number of installs this past quarter in France and Italy and Denmark. We did receive regulatory approval in Brazil in Saudi Arabia, and you'll recall this followed Canada and Australia.

謝謝，傑夫。還有拉里，很高興收到你的來信。謝謝你的問題。讓我為您提供有關 Hugo 的最新消息。所以我們仍然處於有限的市場發布中。我們在供應鏈問題上取得了良好進展。我們目前在 8 個國家/地區。上個季度，我們在法國、意大利和丹麥進行了多次安裝。我們確實在巴西和沙特阿拉伯獲得了監管部門的批准，你會記得這緊隨加拿大和澳大利亞之後。

We've begun general surgery cases in Panama, in Chile, in India, and now have done procedures across urology, gynecology, and general surgery including our first bariatric case which was a nice milestone.

我們已經在巴拿馬、智利和印度開始了普通外科手術病例，現在已經完成了泌尿科、婦科和普通外科手術，包括我們的第一個減肥病例，這是一個很好的里程碑。

The second part of your question was relating to the IDE. We expect to begin the IDE relatively soon. We're working closely to train the site personnel and gain IRB approval. So we'll certainly keep posted on that. But hopefully, that helps on a good thorough update for where we stand on Hugo.

您問題的第二部分與 IDE 有關。我們希望相對較快地開始 IDE。我們正在密切合作培訓現場人員並獲得 IRB 批准。所以我們肯定會繼續發布。但希望這有助於我們對 Hugo 的立場進行徹底的更新。

Thanks Larry. Next question please, Brad.

謝謝拉里。下一個問題，布拉德。

The next question comes in Shagun Singh at RBC Capital Markets.

下一個問題來自加拿大皇家銀行資本市場的 Shagun Singh。

I was just wondering if you can give us an update on your portfolio management initiatives. What are you assuming for Hugo sales in your FY '23 guidance? And can you elaborate on the magnitude of China VBP impacted FY '23?

我只是想知道您是否可以向我們提供有關您的投資組合管理計劃的最新信息。您在 23 財年的指導中對 Hugo 的銷售有何假設？您能否詳細說明中國 VBP 對 23 財年的影響程度？

And lastly, if you can just comment on the capital environment. We've heard some puts and takes. Q1 has been a little soft. Just what your outlook is for the full year.

最後，如果您可以評論一下資本環境。我們已經聽到了一些看跌期權。 Q1 有點軟。正是您對全年的展望。

Okay, all right. We've got some good music there for a second. But I'll start, maybe there was a couple of others on the list there, so maybe Karen can help me out. But I'll start on the Hugo one. We haven't quoted Hugo numbers for FY '23, but I'll just say we expect a strong ramp because the order book is really strong.

好吧，好吧。我們在那裡有一些好聽的音樂。但我會開始，也許名單上還有其他幾個人，所以也許凱倫可以幫助我。但我將從雨果開始。我們沒有引用 23 財年的雨果數據，但我只想說我們預計會有強勁的增長，因為訂單非常強勁。

You heard Bob just give an update about all the countries we've got approvals in and the different type of procedures that we're now doing, various type of procedures, including general surgery procedures. So we're moving up the food chain there. So we really gained a lot of confidence that we have something in Hugo, and we see a nice ramp in FY '23. But we haven't quoted exact numbers.

你聽說鮑勃剛剛介紹了我們獲得批准的所有國家和我們現在正在做的不同類型的程序，各種類型的程序，包括普通外科程序。所以我們正在向那裡的食物鏈上游移動。因此，我們真的對我們在 Hugo 中有所幫助獲得了很大的信心，並且我們在 23 財年看到了一個不錯的增長。但我們沒有引用確切的數字。

In terms of the capital environment, capital for us in Q4 was a bright spot. And a lot of our capital that we sell are tied, directly tied to specific revenue-producing procedures, profitable procedures. I think that helps. And we had record numbers in the Neuroscience space, in our Spine business. We have record number of sales of our StealthStation Navigation O-arm and Mazor. That capital equipment is at record highs for us.

在資本環境方面，第四季度的資本對我們來說是一個亮點。我們出售的很多資本都與特定的創收程序、盈利程序直接相關。我認為這有幫助。在我們的脊柱業務中，我們在神經科學領域擁有創紀錄的數字。我們的 StealthStation 導航 O 型臂和 Mazor 的銷售量創歷史新高。資本設備對我們來說處於歷史最高水平。

And we're really excited as we place those or we sell those -- that capital equipment, that's just further building out our ecosystem, which is our differentiating strength in the Spine business and portrays optimism for the future of that business.

當我們放置或出售這些設備時，我們真的很興奮——資本設備，這只是進一步建立我們的生態系統，這是我們在脊柱業務中的差異化優勢，並描繪了對該業務未來的樂觀態度。

I'll turn it over to Karen for the other parts of the question.

我將把它交給凱倫處理問題的其他部分。

Thanks, Geoff. The other 2, you had a question on portfolio management, which I know Geoff shared when he answered Larry's question. So I'll cover China VBP. With VBP, we've been dealing with a variety of regional and national tenders already.

謝謝，傑夫。另外兩個，你有一個關於投資組合管理的問題，我知道 Geoff 在回答 Larry 的問題時分享了這個問題。因此，我將介紹中國 VBP。通過 VBP，我們已經處理了各種區域和國家招標。

And just from a national expected we expect the government to continue to focus on the top 10 medical device products by public insurance spending. So we've been through stents already, and some of our other industry players have gone through large joints. And we see 2 more potential tenders on that list where we've got exposure, spine and surgical stapling.

僅從全國預期來看，我們預計政府將繼續關注公共保險支出排名前 10 位的醫療器械產品。所以我們已經經歷了支架，我們的一些其他行業參與者也經歷了大關節。我們在該名單上看到了另外 2 個潛在的投標，我們有暴露、脊柱和外科縫合。

And I talked about the fact that we expect Spine to impact us this fiscal year and to likely happen in the second quarter. But ahead of tenders, distributors do pull back on their purchases. So we built that into our first quarter guide as well.

我談到了我們預計 Spine 將在本財年影響我們並可能在第二季度發生的事實。但在招標之前，分銷商確實會撤回採購。因此，我們也將其納入了第一季度指南。

Just to remind you, though, our gross exposure for both spine and stapling in China is somewhere between 1% to 1.5% of our total company revenue. So it is small. And based on what we experienced with the coronary tender, we do believe there could be offsets to the ultimate net impact number because we have pull-through of other product lines, and we'll be working on those.

不過，提醒您一下，我們在中國脊柱和訂書機的總敞口占公司總收入的 1% 到 1.5% 之間。所以它很小。根據我們對冠狀動脈招標的經驗，我們確實相信最終的淨影響數字可能會被抵消，因為我們已經完成了其他產品線，我們將致力於這些。

Thanks Shagun. Let's go to the next question, please Brad.

謝謝沙貢。讓我們轉到下一個問題，請布拉德。

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

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

I wanted to ask on the diabetes U.S. pump business. I know there's a lot of moving parts. But just with the further deceleration in fiscal 4Q, I was hoping you could share some insights in terms of why you think that's occurring. Is the warning letter in place kind of painting endocrine prescription patterns or patient sentiment? Are you seeing incremental renewal pressure? Just wanted to get a better sense and then how you see that U.S. pump business trending over the course of the year.

我想問一下美國糖尿病泵業務。我知道有很多活動部件。但是，隨著第四財季的進一步減速，我希望您能就您認為這種情況發生的原因分享一些見解。警告信到位是畫內分泌處方模式還是病人情緒？您是否看到增量更新壓力？只是想更好地了解一下美國泵業在這一年中的趨勢。

And then any other incremental details you can share just on interactions with the FDA? And I know you pulled that out of your guidance for fiscal '23 any 780G regarding for approvals. But what gives you hope that you could still see those approvals occur in this fiscal year?

然後你可以分享與 FDA 互動的任何其他增量細節嗎？而且我知道您已將其從 23 財年任何 780G 的批准指南中撤出。但是，是什麼讓您希望在本財年仍能看到這些批准？

All right. Thanks, Josh, for the questions. I'm going to turn it over to Sean here in a second, although he has officially moved on from that role to focus exclusively on our Cardiology portfolio. We have him on the call answering the Diabetes questions this quarter.

好的。謝謝喬希的問題。稍後我將把它交給 Sean，儘管他已正式從該職位轉為專注於我們的心髒病學產品組合。我們讓他在本季度回答糖尿病問題。

And I'll just say a few words about Cue Dallara. She joined the company here a couple of weeks ago and has taken over our Diabetes Business Unit, and we couldn't be really excited about having Cue. She's already diving right in, she's already at ATTD, and she'll be in some other upcoming diabetes meetings that you'll get to see her. And she'll be on our next earnings call to field these questions, and she's getting settled in now and is moving her family out to our Northridge, California site and really excited you'll get a chance to hear from her shortly.

我只想說幾句話關於 Cue Dallara。幾週前，她在這裡加入了公司，並接管了我們的糖尿病業務部門，我們對擁有 Cue 感到非常興奮。她已經開始投入，她已經在 ATTD，她將參加其他一些即將舉行的糖尿病會議，你會看到她。她將在我們的下一次財報電話會議上回答這些問題，她現在已經安頓下來，正在將她的家人搬到我們位於加利福尼亞州北嶺的網站，並且非常高興您很快就會有機會收到她的來信。

In the meantime, I'm going to field this question to Sean. So Sean, can you answer the question that Josh posed?

與此同時，我將向肖恩提出這個問題。那麼肖恩，你能回答喬希提出的問題嗎？

Yes, sure, Josh, thanks for the question. So the dynamics on the revenue side of things are really all about the competitiveness in the United States. We grew sequentially quarter-on-quarter in EMEA by 20%, high 20s. And that's really based on the strong demand for that combination of 780 and the Guardian 4 sensor, which is now in 40 different countries.

是的，當然，喬希，謝謝你的提問。因此，收入方面的動態實際上都與美國的競爭力有關。我們在歐洲、中東和非洲地區的季度環比增長了 20%，達到 20 年代的最高水平。這實際上是基於對 780 和 Guardian 4 傳感器組合的強勁需求，該傳感器現在在 40 個不同的國家/地區。

So everywhere we go, it's really picked up a lot of steam. This past quarter, that was driven by favorable reimbursement. We had no reimbursement in either France or Germany. We picked up that reimbursement and that really helped us drive that continued growth.

因此，無論我們走到哪裡，它都確實獲得了很多動力。上個季度，這是由有利的報銷推動的。我們在法國或德國都沒有報銷。我們獲得了報銷，這確實幫助我們推動了持續增長。

So within the U.S., the dynamic is obviously people waiting for the new technology to come before prescribing it for new patients or some patients not wanting to wait for it and moving on to competitive therapies.

因此，在美國，動態顯然是人們在為新患者或一些不想等待它並轉向競爭性療法的患者開處方之前等待新技術的出現。

With regard to the warning letter progression, it's really -- as Karen said, we did conservatively lead that out of the guidance, I think that's prudent. But the most important thing we have to do is to improve and sustainably improve the quality system, which was outlined in those items that were in the 43 and the subsequent warning letter.

關於警告信的進展，真的 - 正如凱倫所說，我們確實保守地將其引導到指導之外，我認為這是謹慎的。但我們要做的最重要的事情是改進和持續改進質量體系，這在 43 和隨後的警告信中的那些項目中進行了概述。

And we've made excellent progress against those commitments. We're more than 80% the way through fulfilling all those commitments. And it's also important to note that the 780 and Guardian 4 Sensor are under active review with the FDA right now. And we don't want to get ahead of the FDA on timing or predictions, and that's really the reason for the conservatism, but it'll suffice to say, there's a huge interest from patients. The technology continues to prove itself in real-world applications.

我們在兌現這些承諾方面取得了出色的進展。我們已經完成了所有這些承諾的 80% 以上。同樣重要的是要注意，780 和 Guardian 4 傳感器目前正在接受 FDA 的積極審查。而且我們不想在時間或預測方面領先於 FDA，這確實是保守主義的原因，但可以說，患者有很大的興趣。該技術繼續在實際應用中證明自己。

And you just see the numbers going up for both revenue, as well as the data we shared, the recent ATTD meeting, the coming up ADA. It's really a robust solution, a unique solution, where we're getting kids to time and range that has never been seen before. And that's during the day, overnight.

而且您只會看到收入的數字以及我們共享的數據，最近的 ATTD 會議，即將到來的 ADA。這確實是一個強大的解決方案，一個獨特的解決方案，我們讓孩子們獲得前所未有的時間和範圍。那是白天，一夜之間。

And of course, it's worked for adults too at the highest time and range yet reported. So we're very confident that when we get the solution out, we'll turn the boat around. But I think for conservatism because we can't predict it. That's what's in the guidance.

當然，它在迄今為止報告的最高時間和範圍內也適用於成年人。所以我們非常有信心，當我們找到解決方案時，我們會扭轉局面。但我認為保守主義是因為我們無法預測。這就是指南中的內容。

Thanks Josh. Next question please, Brad.

謝謝喬希。下一個問題，布拉德。

The next question comes from Joanne Wuensch at Citi.

下一個問題來自花旗的 Joanne Wuensch。

So when I take a look at your guidance, you've got what, in your words are or is a pretty conservative first quarter, and then it ramps pretty aggressively throughout the remainder of the year. I know you don't like to give quarterly guidance, but just to sort of level set us so that we're not resetting the quarters as we go along, talk us through how you ramp and what improves.

因此，當我查看您的指導時，您會發現，用您的話來說，第一季度是一個相當保守的季度，然後在今年餘下的時間裡它會非常積極地增長。我知道你不喜歡提供季度指導，但只是為了讓我們保持水平，這樣我們就不會在進行過程中重新設置季度，告訴我們你如何提升以及改進的地方。

And if you can just sort of give the classic like X percent in the first quarter, Y in the second quarter, et cetera, that would be really helpful. Just to sort of build out from here.

如果你能在第一季度給出 X% 的經典值，在第二季度給出 Y 值等等，那將非常有幫助。只是為了從這裡開始。

Yes. Thanks, Joanne, for the question. I'm going to not give specific guidance for the other quarters, but I will let you know that we've got these things that anniversary through the quarter. So ventilator sales was up and down in the quarter. And I know Ryan can take you in the after call about those changes that happened in ventilator sales.

是的。謝謝喬安妮的問題。我不會為其他季度提供具體指導，但我會讓你知道我們在整個季度的周年紀念日都有這些東西。因此，本季度的呼吸機銷量有漲有跌。而且我知道 Ryan 可以在電話後帶您了解呼吸機銷售中發生的這些變化。

And then obviously, we expect our biggest supply challenges this quarter and starting to improve in second quarter. So think about a ramp of revenue growth just getting better and better every quarter. And by the time you get to the back half, our year-over-year comps obviously get easier. And particularly in the fourth quarter, particularly in: Med Surg, given the fourth quarter that we had.

然後顯然，我們預計本季度最大的供應挑戰，並在第二季度開始改善。因此，請考慮一下每個季度的收入增長會越來越好。而當你到達後半部分時，我們的年度比賽顯然會變得更容易。尤其是在第四季度，尤其是在：Med Surg，鑑於我們擁有的第四季度。

So think of strongest growth, obviously, in the fourth quarter as you ramp. And that is in line with how we think about our product launches too going through the year. We've got some product launches that are helping us earlier in the year, and then more that will ramp as we go through the year. So I know that Ryan can easily take you through some more of the detail, too.

因此，顯然，隨著您的增長，第四季度的增長最為強勁。這也符合我們對全年產品發布的看法。今年早些時候，我們推出了一些對我們有幫助的產品，然後隨著我們一年的過去，更多的產品將會增加。所以我知道 Ryan 也可以輕鬆地帶您了解更多細節。

Appreciate that. And then for my second question, Renal Denervation, you've completed the enrollment of the last piece of the puzzle. It sounds like data won't be presented in the fall, but we may get data in the spring. Are you thinking FDA approval mid next year, calendar year?

感謝。然後對於我的第二個問題，去腎神經，你已經完成了最後一塊拼圖的註冊。聽起來數據不會在秋季呈現，但我們可能會在春季獲得數據。您是否在考慮明年年中 FDA 批准，日曆年？

Sean, you want to take that one?

肖恩，你想拿那個嗎？

Yes, Joanne, we will file that last piece of the PMA, which is that last bit of data when we have it. And that would dictate the timing for the review clock to start. So it's important to note that we've done a modular PMA. So every other part of this device characterization, all the manufacturing modules has already been reviewed and closed. So it's really this last piece of it that would go into the review.

是的，喬安妮，我們將歸檔 PMA 的最後一部分，也就是我們擁有的最後一點數據。這將決定審查時鐘開始的時間。因此，重要的是要注意我們已經完成了模塊化 PMA。因此，該設備表徵的所有其他部分，所有製造模塊都已經過審查和關閉。所以這真的是最後一部分將進入審查。

Thank you Joanne. We have time for one more question, Brad.

謝謝喬安妮。布拉德，我們還有時間再問一個問題。

Our final question comes from Pito Chickering, Deutsche Bank. Pito, please go ahead. Pito, are you on mute?

我們的最後一個問題來自德意志銀行的 Pito Chickering。皮托，請繼續。皮托，你靜音了嗎？

Yes. Can you guys hear me now?

是的。你們現在能聽到我的聲音嗎？

Yes. We can.

是的。我們可以。

This question is sort of pretty hard to answer, but I'll ask it anyway. We heard U.S. hospitals are beginning to defer procedures due to lack of contrast dye supplies for Interventional Cardiology. Any chance you can let us know what you're seeing and hearing, what you're assuming is in your first quarter guidance? And what, if any, impact there is from outside the U.S. due to the shortages from GE?

這個問題有點難回答，但我還是會問的。我們聽說美國醫院由於缺乏用於介入心髒病學的對比染料供應而開始推遲手術。您是否有機會讓我們知道您的所見所聞，您所假設的是您的第一季度指導？由於通用電氣的短缺，美國以外的地區會產生什麼影響（如果有的話）？

Yes, thanks, Pito, for that question. So contrast dye we believe it's a transient issue. It's mostly contained to the U.S. It is something that we're closely watching because it can impact our Cardiovascular and Neurosciences' portfolios. But we do expect it to resolve within the quarter just based on what we're hearing.

是的，謝謝，皮托，這個問題。所以對比染料我們認為這是一個暫時的問題。它主要包含在美國。這是我們正在密切關注的事情，因為它會影響我們的心血管和神經科學的投資組合。但我們確實希望它會根據我們所聽到的情況在本季度內得到解決。

Many health systems in the United States have already instituted conservation measures. And we're working with them to see how we can help support them through thoughtful allocation. But at this stage, we've built our view of it into the guidance for the first quarter, and we do believe it's a transient issue getting better after the first quarter.

美國的許多衛生系統已經制定了保護措施。我們正在與他們合作，看看我們如何通過深思熟慮的分配來幫助支持他們。但在這個階段，我們已經將我們的觀點納入第一季度的指導，我們確實相信這是一個暫時的問題，在第一季度之後會好轉。

A quick follow-up on the transaction with DaVita today. What was the organic growth rate of Renal Care Solutions, and kind of what is the strategic value you guys are seeing adding to your portfolio?

今天快速跟進與 DaVita 的交易。 Renal Care Solutions 的有機增長率是多少，你們看到的戰略價值是什麼？

Well, I'll answer it. Thanks for the question, Pito. I'll answer the second part of it, the strategic value. I mean look, I think we both -- the transaction revolves around a big piece of the value creation will be us bringing in some innovative home dialysis technologies to the market that the inherent in that technology is some something that we picked up from other businesses in Medtronic and the IP around it and the know-how.

嗯，我會回答的。謝謝你的問題，皮托。我將回答它的第二部分，戰略價值。我的意思是看，我認為我們雙方 - 交易圍繞價值創造的很大一部分將是我們將一些創新的家庭透析技術推向市場，該技術的內在是我們從其他業務中獲得的一些東西在美敦力及其周圍的知識產權和技術訣竅中。

And we're building that into this home dialysis technologies. There will be a couple of different products. It drives up access, it lowers costs and there's a better patient experience. And we bring that to the table. But just even just in the United States context, the dialysis market is pretty unique. And the go-to-market channel is not something that we have any kind of synergies with.

我們正在將其構建到這種家庭透析技術中。會有幾個不同的產品。它提高了訪問量，降低了成本，並提供了更好的患者體驗。我們把它帶到桌面上。但即使僅在美國范圍內，透析市場也非常獨特。進入市場的渠道與我們沒有任何協同作用。

And so DaVita brings one, that channel that access to these customers, and they have a lot of -- obviously, they're a leader in kidney care, so they bring a lot of clinical expertise as well. So I think it really is regarding the home dialysis technology. It is 1 plus 1 definitely equals more than 2 here. And we're excited about it. We think it's going to have a big impact. And the way like I said before, the way we structured it we get to share in the upside with DaVita. In terms of the other question the organic...

所以 DaVita 帶來了一個可以接觸這些客戶的渠道，他們有很多——顯然，他們是腎臟護理領域的領導者，所以他們也帶來了很多臨床專業知識。所以我認為這確實與家庭透析技術有關。 1 加 1 在這里肯定大於 2。我們對此感到興奮。我們認為它會產生很大的影響。就像我之前說的那樣，我們構建它的方式，我們可以與 DaVita 分享好處。就另一個問題而言，有機...

It's about the growth in renal care, Pito, and it was low single digits for us last fiscal year. it is a lower growth, lower margin business for us.

這是關於腎臟護理的增長，Pito，上一財年對我們來說是個位數的低。對我們來說，這是一項低增長、低利潤的業務。

Thanks, Pito. Geoff, please go ahead with your closing remarks.

謝謝，皮托。傑夫，請繼續你的結束語。

Sure, thanks, Ryan. Okay. Well, thanks for the questions, everyone. And as usual, we appreciate your support and your continued interest in Medtronic. And look, I realize there's a lot to sort through here, including the macro issues of supply chain in China that surprised us this quarter. But as we've talked about, we've conservatively factored these into our guidance going forward.

當然，謝謝，瑞恩。好的。嗯，謝謝大家的提問。和往常一樣，我們感謝您的支持以及您對美敦力的持續關注。看，我意識到這裡有很多東西需要整理，包括本季度讓我們感到驚訝的中國供應鏈的宏觀問題。但正如我們所談到的，我們保守地將這些因素納入了我們未來的指導。

But I think more importantly, I hope you see that there's a clear direction, a clear direction of travel for the company, where we're headed. And it gets back to some of the questions earlier, like Vijay posed in terms of us getting to that mid-single digit, that 5% plus and the double-digit shareholder returns on a consistent basis.

但我認為更重要的是，我希望你看到公司有一個明確的方向，一個明確的前進方向，我們要去哪裡。它回到了早些時候的一些問題，比如 Vijay 提出的我們達到中個位數、5% 以上以及兩位數的股東回報率始終如一。

The things that we're doing, the new operating model that's driving the more innovation-driven growth, the capital allocation and portfolio management to reposition our portfolio for higher growth. And finally, the global operations and supply chain changes that we were working on to provide that resiliency and provide that consistency that we need -- these are the right things to do.

我們正在做的事情，推動更多創新驅動增長的新運營模式，資本配置和投資組合管理，以重新定位我們的投資組合以實現更高的增長。最後，我們正在努力改變全球運營和供應鏈，以提供我們需要的彈性和一致性——這些都是正確的事情。

I'm confident -- I mean the macro environment has made it choppier to execute on these things, but we're heading in the right direction. We're making the right moves. And just again, this will -- this will benefit the company and get us where we need to go.

我有信心——我的意思是宏觀環境使得執行這些事情變得更加困難，但我們正朝著正確的方向前進。我們正在採取正確的行動。再說一次，這將使公司受益，並使我們到達需要去的地方。

So we're looking forward to update you on the progress in our Q1 earnings program, which we anticipate owning on August 23. And so with that, thanks again for tuning in today, and please stay healthy and safe, and have a great rest of your day.

因此，我們期待著向您介紹我們的第一季度收益計劃的最新進展，我們預計將於 8 月 23 日擁有該計劃。因此，再次感謝您今天收看，請保持健康和安全，好好休息你的一天。