Inquired about Q4 share performance in the TAVR business, specifically U.S. vs. international, and assumptions for FY27, given recent Evolut data.

Geoff Martha stated the TAVR business has stabilized over the last 8-10 weeks, with the slowdown primarily a U.S. dynamic tied to low-risk data and the use of older technology/procedure tactics limited to large size valves. Thierry Pieton added that Q4 growth of 6.6% was achieved despite TAVR headwinds, and the stabilization is modeled into future guidance. “the business has stabilized, right? Over the last 8 to 10 weeks, it's been stable.”

Asked how MedSurg's 5% growth (Surgical 3%) factors into accelerating FY27 guidance, when Hugo will positively impact surgery growth, and when Hugo will contribute to margin/EPS versus being an R&D investment.

Geoff Martha highlighted MedSurg's broad strength (ACM 11%, Endo 9%) and Hugo's Q4 contribution. He noted positive feedback on Hugo's launch, submission for new indications (General Surgery, Gyn, LigaSure RAS), and strong procedure growth/utilization. He also emphasized the differentiator of the Touch Surgery platform (1,400+ ORs, 30% sequential installs). “We announced this morning the submission to the new indications, General Surgery, and LigaSure RAS, so we've got those submitted.”

Inquired about the potential for a gross margin step-up in H2 FY27, assuming tariffs lap and MiniMed separates, and if there are other constraints.

Thierry Pieton confirmed that tariff carryover impacts H1, but will lap in H2. He expects continued pricing lift and COGS efficiency. He noted that MiniMed separation would lift gross margin. While CAS mix is a near-term headwind, its improving margin helps. Overall, FY27 gross margin is expected to be flat to slightly up ex-tariffs, with better H2 performance, leading to operating margin accretion from growth and SG&A leverage. “we'll have about $65 million of carryover coming from tariffs in the first quarter and the second quarter. To your point, we'll lap that in the second half.”

MDT

Medtronic (MDT) Q4 FY26 earnings call: guidance and Q&A

Earnings call· Apr 2026 (Q4 FY26)· Health Care· Jun 3, 2026

Source: earnings call transcript

Executive summary

Medtronic plc Q4 FY26 — Strongest Top Line Growth in a Decade Driven by CAS and Hugo Momentum

Medtronic delivered its strongest top-line performance in a decade, driven by robust organic growth across key segments like Cardiac Ablation Solutions and the emerging impact of its Hugo robotic system. While navigating tariff headwinds and a transitional product mix, the company is strategically investing in high-growth areas and innovation, positioning itself for continued durable growth in the upcoming fiscal year.

Highlights

Q4 revenue up 9.9% reported and 6.6% organically, marking the strongest top line performance in 10 years.
Cardiac Ablation Solutions (CAS) delivered 78% worldwide growth, gaining 8 points of U.S. share, with PFA growing 145% globally.
Symplicity Spyral annualizing at $100 million, with weekly procedure volumes doubling since NCD.
Hugo surgical robotic system's worldwide procedure volume growth is 2-3x the market, with utilization increasing.
MiniMed Diabetes business delivered 15% reported growth (8.1% organic), driven by international execution and U.S. CGM momentum.

Concerns

Tariffs impacted the business by $74 million (80 basis points) in Q4, with an anticipated $250 million impact in FY27.
Structural Heart performance was flat in Q4, with U.S. softness due to low-risk data, though weekly procedure volumes have stabilized.
Mix was unfavorable by 60 basis points in Q4, largely reflecting the diabetes business and higher mix of lower-margin capital in CAS.
FY27 guidance includes 2% dilution from M&A, 1 point higher than previously shared due to earlier deal timing.
FY27 guidance factors in a roughly 1 point headwind from increased fuel and transportation costs due to the Middle East conflict.

Guidance & targets

Category	Target	Timeline	Confidence
FY27 Organic Revenue Growth	6.75% to 7.25% high materiality	FY27	High
Q1 FY27 Organic Revenue Growth	11.5% to 12% medium materiality	Q1 · FY27	High
FY27 Foreign Exchange Impact (Revenue)	neutral to roughly $100 million headwind medium materiality	FY27	High
Q1 FY27 Foreign Exchange Impact (Revenue)	neutral to $50 million tailwind low materiality	Q1 · FY27	High
FY27 Operating Margin (excluding tariffs)	roughly in line with the previous year medium materiality	FY27	High
FY27 Tariff Impact to COGS	$250 million high materiality	FY27	High
FY27 Gross Margin (including tariffs)	decrease by roughly 20 basis points medium materiality	FY27	High
FY27 Operating Margin	up 60 basis points high materiality	FY27	High
FY27 Adjusted EPS	$5.90 to $6.00 high materiality	FY27	High
Q1 FY27 EPS	$1.38 to $1.40 medium materiality	Q1 · FY27	High

Segment performance

Segment	Revenue	YoY	QoQ	Margin
Cardiovascular Led by 14% growth in the U.S. and 7% in international markets.	—	10%	—	—
Cardiac Ablation Solutions (CAS) Strong momentum, annualizing over $2 billion in revenue and on track to reach $2 billion trailing in Q1 FY27. U.S. growth: 124%	—	78%	—	—
Cardiac Rhythm Management (CRM) Growth in both U.S. and international markets.	—	5%	—	—
Defibrillation Strong momentum in OmniaSecure defibrillation lead following indication expansion. ICD growth: high teensEV ICD growth: mid-60s	—	mid-single-digit	—	—
Cardiac Pacing Therapies Micro growth: mid-teensSelect Secure 3830 lead for CSP growth: high teens	—	mid-single-digit	—	—
Structural Heart Strong international performance, U.S. softer due to low-risk data. Weekly U.S. procedure volumes stabilized over last 8 weeks.	—	flat	—	—
Coronary Decline offset by strength in renal denervation.	—	declined	—	—
Peripheral Vascular Health	—	low single-digit	—	—
Cardiac Surgery	—	mid-single digit	—	—
Neuroscience Category leader across all segments, investing to advance pipeline innovation. International growth: 6%	—	3%	—	—
Cranial and Spinal Technologies (CST) Growth in both U.S. and international markets.	—	3%	—	—
Core Spine Gained share on continued module X expansion and distributor conversions.	—	6%	—	—
Neurosurgery Supported by the launch of Stealth AXiS. Navigation growth: low double-digit	—	—	improved sequentially	—
Specialty Therapies	—	3%	—	—
Neurovascular Driven by healthy adoption in Euro garden RTs. Hemorrhagic growth: 11%	—	6%	—	—
ENT International growth: high single-digit	—	mid-single-digit	—	—
Pelvic Health Solid growth in Altaviva offset by broader market softness in sacral nerve modulation.	—	flat	—	—
Neuromodulation Strategic focus and investment, including expansion in BVNA.	—	low single digit	—	—
Medical Surgical Pleased with the finish to close the year. U.S. growth: 8%	—	5%	—	—
Surgical Split evenly between U.S. and international markets, driven by Advanced Energy, Wound Management, and Hugo.	—	3%	—	—
Advanced Energy	—	high single-digit	—	—
Wound Management	—	high single-digit	—	—
Endoscopy Driven by strong adoption of Endoflip in U.S. and Western Europe and market share gain in Nexpowder in the U.S.	—	high single-digit	—	—
Acute Care and Monitoring (ACM) Outsized strength, anticipated to normalize in FY27. U.S. growth: high teens	—	up	—	—
Nalcor Post Oximetry	—	mid-teens	—	—
Respiratory and Airways	—	high single-digit	—	—
Perioperative	—	mid-single digit	—	—
Diabetes Driven by strong international execution and continued momentum in U.S. CGM and new patient starts. Organic growth: 8.1%	—	15% reported	—	—

MDT operating KPIs by quarter

MDT operating KPIs stated on its earnings calls, by fiscal quarter
KPI	Jan 2026 Q3 FY26	This call Apr 2026 Q4 FY26	Jul 2026 Q1 FY27	Change vs prior quarter
Installed base Touch Surgery	1,000+ This quarter, Touch Surgery installations increased over 20% sequentially and have now surpassed 1,000 systems globally. Source: earnings call transcript	1,400+ And our Touch Surgery Digital Ecosystem, well, it continues to represent a clear advantage with over 1,400 installations, up 30% plus sequentially. Source: earnings call transcript	1,500+ Today, Touch Surgery is used in more than 1,500 operating rooms globally, supporting AI-powered insights, collaboration and workflows. Source: earnings call transcript	—

Operating figures the company stated on at least two of the calls shown, checked against each call's transcript. Click a figure to read the sentence. A dash means it was not stated that quarter.

Product announcements

Product	Type	Timeline
Hugo Robotic System	milestone	late April 2026
Pro Grip Advanced	launch	—
MiniMed Flex	launch	Summer 2026

Deals & partnerships

MiniMed divestiture

Completed the MiniMed IPO, establishing it as a stand-alone publicly traded company.

Cath Works acquisition

Closed on the Cath Works transaction. Their FFRangio system uses AI and advanced computational science to improve decision-making in the cath lab. Positive 1-year data from the all RISE trial validates FFRangio as a noninvasive technology for the $1 billion FFR segment.

Scientia acquisition

Announced plans to acquire Scientia, which will meaningfully expand Medtronic's neurovascular platform with differentiated guidewire technologies for stroke.

SPR Therapeutics acquisition

Announced plans to acquire SPR Therapeutics, which will build out Medtronic's portfolio of chronic pain management therapies.

Beluga Medical investment

Investment will advance development of next-generation ICE catheters that will further advance Medtronic's EP toolkit.

CardioACC investment

Investment will advance development of next-generation ICE catheters that will further advance Medtronic's EP toolkit.

Pulnovo venture

Investment in emerging technologies, including Pulnovo, a first-of-its-kind minimally invasive system designed to address pulmonary artery renovation.

Merit Medical partnership

Entered into a distribution agreement with Merit Medical for ViaVerte, an FDA-cleared solution for chronic tibolgenic back pain.

Risks & headwinds

Tariff Impact Q4 FY26 and FY27

$74 million (80 bps) in Q4 FY26; anticipated $250 million in FY27 ($65 million increase vs prior year), including $75 million in Q1 FY27.

Mitigation:No government refund incorporated in guidance; monitoring environment.

Structural Heart Softness Q4 FY26

Flat performance in Q4 FY26, particularly in the U.S.

Mitigation:Weekly U.S. procedure volumes have stabilized over the last 8 weeks; heavy investment in the business.

Business Mix Unfavorability Q4 FY26

60 bps negative impact on Q4 gross margin.

Mitigation:Largely reflecting the diabetes business and higher mix of lower-margin capital in CAS; pressure from diabetes mix will disappear upon separation.

M&A Dilution FY27

2% dilution factored into FY27 guidance, 1 point higher than previously shared.

Mitigation:Due to earlier timing of several deals.

Increased Fuel and Transportation Costs FY27

Roughly 1 point headwind.

Mitigation:Due to the conflict in the Middle East.

Bariatrics Pressure Q4 FY26

Continued pressure.

Q&A highlights

Asked about the underlying 5.5-6% organic growth for FY27, excluding the extra week, and how Medtronic plans to achieve this acceleration given concerns about CAS slowing down, inquiring about offsetting segments.

Geoff Martha clarified that CAS's impact on growth would be similar to FY26, expecting mid-to-high teens market growth and Medtronic to grow north of 2x that rate, with the business annualizing at $2 billion. Thierry Pieton detailed expected contributions from Cardiovascular (strong momentum in CAS, CRM, Ardian, stable Structural Heart), Neuroscience (acceleration across segments with Stealth AXiS, Neurovascular, Altaviva), and MedSurg (strong Q4 momentum normalizing).

“we're not talking about CAS slowing down its impact on our growth. I just laid out what I think it will grow, but the impact is strong.”

asked by Vijay Kumar · answered by Geoffrey Martha

2 min read 7 chapters

Detailed narrative

Cardiac Ablation Solutions (CAS) Leadership

Medtronic's CAS segment delivered exceptional Q4 growth of 78% worldwide, with PFA growing 145% globally. The company gained 8 points of U.S. share and expanded its U.S. installed base by 40% sequentially. New innovations like PRISM 2 mapping software and the Sphere-360 catheter (CE-marked, U.S. trial enrolling) are enhancing the EP ecosystem, alongside strategic investments in ICE catheter technology.

Hypertension Management with Symplicity Spyral

The Symplicity Spyral system for renal denervation is gaining significant traction, annualizing at $100 million in revenue and doubling weekly procedure volumes since the NCD. Long-term data presented at CRT reinforced sustained systolic blood pressure reductions, highlighting its potential to redefine hypertension management for 18 million uncontrolled patients in the U.S.

Hugo Robotic Surgical System Momentum

The Hugo robotic system is demonstrating strong early impact, with worldwide procedure volume growth 2-3x the market rate and increasing utilization. Medtronic recently submitted for FDA 510(k) clearance for general surgery and gynecologic indications, as well as for its LigaSure RAS vessel sealer, expanding its capabilities. The Touch Surgery Digital Ecosystem now has over 1,400 installations, up 30% sequentially.

Altaviva and Pelvic Health Growth

Altaviva, Medtronic's urge urinary incontinence device, is building momentum with nearly 1,000 physicians trained since launch. Sequentially, active implanters are up 3x and patients treated are up 2.5x, indicating accelerating adoption as physicians gain experience and navigate prior authorizations more efficiently.

Strategic M&A and Venture Investments

Medtronic completed the MiniMed IPO and made significant strategic investments, including the acquisition of Cath Works (FFRangio system for coronary decision-making), planned acquisitions of Scientia (neurovascular) and SPR Therapeutics (chronic pain), and investments in Beluga Medical and CardioACC (ICE catheters). These tuck-in investments, totaling nearly $2 billion in Q4, are aimed at accelerating innovation and growth in high-growth adjacencies.

Neuroscience Portfolio Strength

The neuroscience portfolio delivered 3% revenue growth globally, with strong performance in Cranial and Spinal Technologies (CST) driven by Stealth AXiS, which received FDA and CE Mark clearances. Neurovascular grew 6%, supported by innovation and the planned Scientia acquisition. Pelvic Health saw solid Altaviva growth, and Neuromodulation is a strategic focus with expansion in BVNA and the SPR Therapeutics acquisition.

Operational Rigor and Financial Performance

Medtronic achieved Q4 adjusted EPS of $1.55 and FY26 adjusted EPS of $5.53, ahead of expectations. Adjusted gross margin improved by 30 basis points year-over-year, driven by disciplined pricing and COGS efficiency programs. Free cash flow reached $5.4 billion in FY26, the strongest since 2022, positioning the company favorably for M&A.

Summary of the company's earnings call; see how call summaries are prepared. Not investment advice.