Good morning. My name is Carol. I will be your operator today. At this time, I would like to welcome everyone to the Medtronic 4th Quarter Earnings Call. All lines have been placed on mute to prevent any background noise.
After the speakers' remarks, we will have a question and answer At this time, I would like to turn the call over to Brian Weispfenning, Vice President, Investor Relations.
Thank you. Good morning, and welcome to Medtronic's Q4 conference call and webcast. During the next hour, Omar Ishrak, Medtronic Chairman and Chief Executive Officer and Karen Parkhill, Medtronic Chief Financial Officer, will provide comments on the results of our Q4 fiscal year 2019, which ended on April 26, 2019. After our prepared remarks, we will be happy to take your questions. First, a few logistical comments.
Earlier this morning, we issued a press release containing our financial statements and a revenue by division summary. We also issued an earnings presentation that provides additional details on our performance and outlook. During today's earnings call, many of the statements made may be considered forward looking statements, and actual results may differ materially from those projected in any forward looking statements. 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 statements. In addition, the reconciliations of any non GAAP financial measures are available on our website, investorrelations.
Medtronic.com. References to organic revenue growth exclude the impact of material acquisitions, divestitures and currency. References to pro form a exclude the impact of material divestitures. Unless we say otherwise, quarterly rates and ranges are given on a constant currency basis, which compares to the Q4 of fiscal year 2018 after adjusting for currency. Unless we say otherwise, annual rates and ranges are given on a comparable constant currency basis, basis, which compares to fiscal year 2018 after adjusting for currency and the fiscal year 2018 divestiture of the Patient Care DVT and Nutritional Insufficiency business.
All of these adjustment details can be found in the reconciliation tables included with our earnings press release. Finally, our EPS guidance does not include any charges or gains that would be reported as non GAAP adjustments to earnings during the fiscal year. With that, I am now pleased to turn the call over to Medtronic Chairman and Chief Executive Officer, Omar Ishrak. Omar?
Thank you, Ryan, and thank you to everyone for joining us. This morning, we reported a solid finish to a strong fiscal year for Medtronic. We delivered revenue growth, operating margin and EPS, all ahead of Street expectations. Q4 revenue grew 3.6 percent organic, with outperformance in RTG and MITG offsetting challenges in CVG and difficult comparisons in diabetes. In addition, emerging markets continue to be a big driver, growing 12%.
Our adjusted operating margin On the bottom line, we grew adjusted diluted EPS 8.5% or 9.2% at constant currency. For the full fiscal year 2019, revenue, EPS and free cash flow all came in above the guidance ranges we set at the beginning of the year as we executed against our commitments. Revenue of $30,600,000,000 grew 5.5 percent organically. Adjusted diluted EPS grew 10% on a comparable constant currency basis and 11.5% pro form a. Free cash flow of $5,900,000,000 grew 62%, much faster than earnings, reflecting the focus of our entire organization on improving this important metric.
Last June at our Investor Day, we set a target to improve our free cash flow conversion to 80% over the next 2 to 3 years, and we achieved it in just 1 year. FY 2019 free cash flow conversion was 83%, notably above our peer average. In FY 2019, we invested our capital into future growth platforms with a focus on returns, while at the same time increasing our returns to shareholders through share repurchases and a rising dividend. In Q4, we overcame significant challenges and relied upon the diversification of our business to deliver another quarter of solid top and bottom line results. Let's discuss some of the more important drivers of our performance, starting with our Restorative Therapies Group, which had another very strong quarter, growing 6.5%.
The launch of the Mazor X Stealth Navigator robotic system is off to a strong start and building momentum. We sold 26 systems this quarter, increasing our spine robotic market share to more than 70% with an installed base that is now more than 3.5x that of our closest competitor. While Mazor sales are driving Brain Therapies growth, we believe they are also a good leading indicator of future growth in our spine division as customers that are purchasing our Mazor system are also choosing to increase their share of Medtronic Spine Implants. In fact, in Q4, over 80% of our Mazor systems were sold to customers who chose to enter into combined capital and implant contracts and the percentage of Mazor robotic cases that use our Medtronic Spine implants continued to climb, exceeding 60% in Q4, a double digit increase from Q3. When you combine our Spine division sales with the sales of our capital equipment from our Brain Therapies division used in spine surgery, our Spine division grew 5.6% with the U.
S. Core spine business growing 11%. This is how our competitors report and spine implants. Will help increase sales of spine implants. In RTG, I'd also highlight neurovascular and pain therapies.
In neurovascular, our market leading stroke portfolio continues to perform extremely well with double digit growth in stent retrievers, flow diverters, coils and neuro access products. In pain therapies, we continue to gain market share despite the market's recent slowdown. Our paying stim business achieved a number one share position in Q4 for the first time in 2.5 years, driven by our differentiated Intellis system with its evolved workflow algorithm and snapshot reporting. In MITG, we grew 5.1%, driven by strength in advanced stapling and advanced energy. This is an impressive performance as the Surgical Innovations business overcame challenges resulting from the shutdown of a major sterilization supplier's facility.
I just cannot say enough about how our team stepped up and successfully managed this issue, quickly identifying alternative suppliers and rerouting our supply chain to get inventory to the right place at the right time. We expect to be back to full sterilization capacity late in Q1. In CVG, we grew 1.1% as we faced challenges in drug coated balloons and LVADs as well as CRM replacement devices given where we are in our replacement cycle. At the same time, multiple product lines showed exceptional strength in the quarter with high teens growth from our Reveal LINQ insertable loop recorder and mid teens growth from both our Micra transcatheter pacing system and our Arctic Front AF ablation catheters. We also continued strong double digit growth in our TAVR franchise.
Our TYRX anti infection product grew in the high 20s and we saw a notable pickup in its utilization following the rapid data presentation at the American College of Cardiology meeting in March. In diabetes, we grew 0.6%, an anomaly given difficult prior year comparisons that we described on our last earnings call. Despite the challenging comparisons, diabetes delivered mid teens growth in international markets and our 4th consecutive quarter of triple digit growth in standalone CGM. Looking ahead, we expect diabetes growth to reaccelerate in the Q1 and to be accretive to total company growth in FY 'twenty. At the ADA Conference in June, we plan on hosting an investor meeting where we will update you on the progress of our pipeline and an exciting series of product launches we have planned over the next 24 months.
Now turning to emerging markets, our performance continues to be strong, growing 12% this quarter and representing 16% of Medtronic revenue. Our strength was diversified across all four groups and across multiple geographies, with China growing 13%, South Asia by 22% and Southeast Asia by 20%. In addition, Middle East and Africa grew 13% and both Eastern Europe and Latin America grew 8%. Our strategies of public and private partnerships, optimizing the distribution channel and in some markets, localization of R and D and manufacturing are driving growth and differentiating Medtronic. Overall, it was another solid quarter despite the noted headwinds and a really strong year for Medtronic.
But as we look forward, we're even more excited about what lies ahead as the investments we've been making in our pipeline begin to pay off with accelerating revenue growth and ultimately value creation for our shareholders. We expect our top line to accelerate over the course of FY 2020 and into FY 2021, driven by the anniversary of recent headwinds, combined with major products that are launching now or will launch over the next 12 months. It's worth highlighting some of these near term launches. I'll start with CVG. In our TAVR business, we're expecting low risk indication expansion in the U.
S. As well as launches of our next generation TAVR valve, the Evolut Pro Plus. We intend to launch this valve across all sizes, including a large 34 millimeter valve. In CRHF, 2 of the biggest launches we have in FY 2020 are, number 1, our Reveal LINQ 2.0 insertable cardiac monitor and number 2, our Micra AV transcatheter pacing system. Link 2 will feature Bluetooth connectivity, 5 year battery longevity, enhanced sensing specificity and the ability to monitor new physiological parameters.
Micra AV, which is one of the most disruptive products in our pipeline, is expected to launch around fiscal year end. It will enable us to access and disrupt over 55% of the eligible pacemaker market, up from 16% today. In MITG, we continue to make great progress with our soft tissue robotics program, and we are now preparing for the initial launch in FY 2020 consistent with our commentary over the last several quarters. Our initial launch activities will occur outside the U. S.
And support our clinical and regulatory strategies in geographies around the globe. I know everyone is anxious to see the robot and for competitive reasons, we've obviously kept this program close to the vest. The good news is that we plan to host an analyst event this fall to show the robot. We're in the process of working on dates and as soon as we get everything confirmed, we'll be sure to send the analysts an invitation. In RTG, as I mentioned earlier, the launch of the Mazor X Stealth is off to a great start and we expect this will continue to drive growth in our neurosurgery business, along with creating demand for our core spine implants.
In neurosurgery, we are preparing for the launch of the Minus Rex MR8 drill platform in the first half of FY twenty twenty and we expect its differentiated features to drive share growth. In neurovascular, we just launched our next generation stent retriever, Solitaire X and our React 71 aspiration catheter, advancing our leadership in the treatment of ischemic stroke. In pain therapies, we expect a full launch in FY 2020 of our Acurion nerve ablation platform. In diabetes, we expect to file for a non injective indication for our CGM sensor in early FY 2020, thereby allowing us access to the U. S.
Medicare market for the 670 gs. In addition, in FY 2020, we expect to launch the MiniMed 780 gs, our advanced hybrid closed loop system with Bluetooth connectivity. The 780 gs will feature next generation algorithms designed to improve time in range to over 80%. The system will reduce the burden of carb counting, enable remote monitoring as well as remote software downloads and include several key enhancements to our CareLink system. What all this means for the company as a whole is that we expect our growth rate to accelerate over the course of FY 2020, with the second half growing faster than the first as we, 1, anniversary recent headwinds and 2, bring these innovative products to market over the next several quarters.
Moreover, we expect our top line momentum to build heading into FY 2021 as we get the increasing benefit of FY 2020 product launches that I just mentioned, as well as the benefit of several products that we expect to launch early next fiscal year, such as our Percept Deep Brain Stimulation System, the very first deep brain stimulator with sensing capabilities our DiamondTemp focal ablation catheter system, which will initially launch in Europe and our InterStim Micro 3cc MRI compatible sacral nerve simulation system, which is fully rechargeable and 80% smaller than our current market leading device. While there isn't enough time today to go through the longer term pipeline, with all of these products launching, the takeaway that I want you to have is that each of our 4 groups has the potential to see accelerating growth in FY 2021. Let me now ask Karen to take you through a discussion of our 4th quarter financials. Karen?
Thank you. As Omar mentioned, we delivered 4th quarter organic revenue growth of 3.6% and EPS growth of 8.5%. For the full year, our adjusted operating margin expanded 120 basis points, including 50 basis points on a constant currency basis and in line with the guidance we gave at the beginning of the year. We remain focused on our enterprise excellence program, better leveraging our size and scale and driving improved effectiveness and efficiency across the company. This past year in particular, the benefits of the program were most evident in SG and A, where we drove 40 basis points of improvement.
Our 4th quarter adjusted operating margin was 31.5%, an improvement of 140 basis points or 50 basis points on a constant currency basis. In addition to driving expansion by executing on our enterprise excellence program, we also absorbed the unplanned expense of China tariffs as well as a negative 20 basis point impact on our operating margin from the sterilization issue with purposeful cost control throughout the company. In the Q4, we successfully executed a €7,000,000,000 debt offering and used the proceeds to reduce U. S. Dollar denominated debt.
The new euro issuance carries a weighted average coupon rate of 7 8 percent, lowering the effective interest rate on our long term debt portfolio and providing savings for the company for years to come. Our adjusted nominal tax rate was 14.1% for the quarter and 13.6% for the year, in line with the expectations we set on the Q3 call. Excluding the non recurring tax benefits we received in fiscal year 2019, our adjusted nominal tax rate would have been approximately 14.75%. Perhaps most exciting is our annual free cash flow at $5,900,000,000 a significant improvement over the $3,600,000,000 we generated last year and well above our guidance and expectations. All of our colleagues have made improving free cash flow a priority and this focus is yielding strong results, enabling us to achieve our conversion goals well ahead of the schedule I gave you at our Investor Day in June.
Going forward, you can expect our free cash flow to grow largely in line with earnings as we continue to target an 80% conversion rate, above our peer average over our long range plan. Before I move to guidance, I want to reiterate our commitment to balanced capital deployment. We continue to invest in future growth through disciplined investment in R and D, along with tuck in acquisitions like Mazor and Epix, among others. And we remain committed to returning a minimum of 50% of our annual free cash flow to our shareholders. In fact, in fiscal 'nineteen, we returned $4,600,000,000 78% of the free cash we generated to our shareholders through both dividends and net share repurchase.
Our total shareholder payout for the year was 65% on adjusted net earnings. Now turning to our guidance for fiscal year 2020. As a starting point, we expect organic revenue growth to be 4 percent plus or minus. While the impact of currency is fluid, if recent exchange rates hold, foreign currency would have a negative impact on full year revenue of approximately 1% to 1.5%. By business group, we expect MITG to grow 4.5% to 5%, RTG to grow 4% to 4.5%, diabetes to grow 6% to 8% and CVG to grow 2% plus or minus, all on an organic basis.
We expect our Q1 growth rate to be lower than normal, on the heels of a better than expected 4th quarter, transitory headwinds from the sterilization shutdown in MITG, and a slowdown in our peripheral business from paclitaxel coated balloons. Given these, we expect organic revenue growth in the Q1 to be in the range of 2% to 2.5%, with currency having a negative impact of 2.1% to 2.6% at recent rates. By business group, MITG and RTG are expected to grow 3% to 3.5%, CVG looks flat, and diabetes is expected to grow 5% plus or minus, all on an organic basis. From there, we expect our revenue growth to accelerate over the course of the year, with constant currency growth closer to 4% in the second quarter and north of 4% in the second half. We expect to continue to drive margin expansion of approximately 40 basis points on a constant currency basis, driven by our enterprise excellence initiatives.
For modeling purposes, we would assume a modest improvement in the first half of the year, given lower revenue growth and a slight FX headwind, with increasing improvement in the second half. We expect our tax rate to increase from 13.6% last year to 16% to 16.5% in fiscal year 2020, given the changes associated with the U. S. Tax reform that we discussed previously. Of course, we remain focused on optimizing our underlying operating tax rate over time under these new regulations.
With respect to earnings, we expect non GAAP diluted EPS in the range of $5.44 to $5.50 which includes a negative $0.10 impact of currency at recent rates. For the Q1, we expect $1.17 to 1 $0.19 including a $0.04 currency headwind at recent rates. After delivering on each of our commitments in fiscal year 'nineteen, I couldn't be more excited about fiscal year 'twenty and beyond. As Omar outlined, we expect anniversary recent headwinds and launch a series of major products. And we expect this momentum to build into fiscal year '21, with each of our 4 groups having the potential to see accelerating growth next fiscal year.
Now, I will return the call back to Omar. Thanks, Karen.
Before we go to Q and A, I'd like to acknowledge our 90,000 Medtronic employees who work tirelessly and are dedicating to fulfilling the Medtronic mission, alleviating pain, restoring health and extending life for so many around the world. In fiscal 2019, our employees, together with our physician partners, served over 75,000,000 patients or more than 2 patients every second. Let's now move to Q and A. In addition to Karen, our 4 Group Presidents, Mike Coyle, Bob White, Jeff Martha and Hooman Hakimi are also here to answer your questions. We want to try to get to as many questions as possible, so please help us by limiting yourself to one question and if necessary, a related follow-up.
Thank you. Good morning and welcome to Medtronic.
Our first question this morning comes from Bob Hopkins from Bank of America. Please go ahead.
Hi, thank you and good morning. Congrats on a strong finish to the year. I just wanted to ask a little bit about some of the revenue forecast that you're making. So 2 very quick things. 1, given your Q1 guidance of that 2% to 2.5%, can you just walk us through in as much detail as you're willing to provide some of the incremental headwinds that you're seeing in Q1 or that you're forecasting in Q1 versus the 3.6% growth that you put up in Q4?
And then I'll just go ahead and ask a quick follow-up right here. This is a question for Mike. So I was wondering if you could comment on TAVR and what you're seeing since the presentation of the data at ACC, because the TAVR number looked maybe a smidge lighter than we were thinking. So those are the 2 questions. Thanks for taking them.
Karen, you want to take
the Sure. Thanks, Bob. Appreciate the question. So in the Q1, we have guided to 2% to 2.5%. And as you know, the 4th quarter came in a little better than we expected.
Recall that we had guided around 3% for the quarter, and we came in at 3.6%. So given the strong finish to the fiscal year, it's likely that we'll see a little bit of softness in the Q1. We also have the lingering effect of the sterilization issue in MITG. We did use our inventory on hand to help mitigate that in the 4th quarter, and now we have less on hand as we move into Q1. We expect the sterilization issue to be behind us, as we said, at the end of the quarter, but we'll face some slowdown in revenue, given that, probably to the tune of about $20,000,000 to $30,000,000 which is about 100 bps of MITG growth there.
And then, as you know, Q1 will be the 1st quarter, the full impact of the DCB issue following the uncertainty of the FDA announcement in June. That could be another $20,000,000 to $30,000,000 headwind in CVG and about 100 basis points of CVG growth. But as we noted on the call, we do expect our growth to accelerate over the course of the year as we anniversary various headwinds and we introduce our strong pipeline. So I'll let Mike answer the TAVR question.
Yes, Bob, thanks for the question. We were quite pleased with the TAVR number. I think the overall growth rate for both the global growth rate was around 11%, U. S. Growth rate around 12%, and we were very much in line with that.
The announcement that ACC obviously were for low risk and there have been no low risk approvals yet. And of course, there's no reimbursement for products that are unapproved. So we didn't see a marked increase in penetration of that group that will follow after the FDA does the actual approvals of the expanded indications for use. But I would point out, a year ago, we were much more active in terms of opening up new accounts, which carries with it stocking that would have put more revenue in the prior year number. So in plant growth rates for us were more in the mid teens rate in the U.
S. So we're very pleased with obviously the momentum in the business and especially with the potential to further grow it into the low risk patient population.
Great. Thank
you.
Thanks, Bob. Next question please, Carol.
Our next question comes from David Lewis from Morgan Stanley. Please go ahead.
Hi, good morning. Just one for Karen and one for Hooman here. So Karen, I wonder if you could help us with the earnings bridge here for 2020. Other income was a significant driver of EBIT in 2019. We also had a very debt restructuring.
So as you think about 2020, can you just sort of help us understand our assumptions, what they should be as it relates to other income and more specifically actually interest expense Because to us, the earnings guidance looks a little conservative. So any help there would be very helpful.
Sure. Thanks for the question, David. So on other income, it was a little strong this quarter, and we had a significant strength in it from just the currency in our hedging program. But we also did have other royalty expense come in better. And as we focus on driving improved royalty income where we can, you're seeing that play out and that should continue.
In terms of the debt restructuring, we were obviously pleased with the euro debt offering in our U. S. Debt tender. And going forward, you should expect around $200,000,000 to $210,000,000 a quarter in interest expense from us.
Okay. That's very helpful. And then just, Hooman, quick question on diabetes. I think the recent months, there's been sort of this emerging concern that the industry is changing very rapidly just given reimbursement, regulatory and various technology changes. I just wonder if you could help us understand how is Medtronic positioned over the next 1 to 2 years from a share perspective in both your pump and CGMS business?
And do you think an independent diabetes business would allow you to adapt or grow more and more quickly? Thanks so much.
Sure. Thanks, David. Let me actually take the second one first. We get a lot of benefit from being part of Medtronic. The scale and breadth of the company, we leverage every single day with respect to things like wafer scale technology that we're doing with CVG.
As we think about global expansion, we leverage our regulatory resources and relationships around the world. So there's tremendous benefit, and I think that helps us drive the growth that we need. Now with respect to the competitive positioning and all of that, for all that's been said and written about the competition and its impact on us, let me just maybe give you a few data points with respect to how we finished. First, our installed base in FY 2019 grew by mid single digits. This is true globally as well as in the United States.
In addition, our patient retention rates were in line with historical rates globally. And as we think about FY 2020, we see a lot of things to be excited about. International that you heard from the commentary is going to be and continue to be a big portion of our growth. This is about 45% of our global revenue and it's growing in the mid teens and we expect it to grow in the mid teens. And the other dynamic that we outlined at the Analyst Day is the CGM penetration and the CGM growth of our installed base as well as standalone CGM growth, which had 4 consecutive quarters of triple digit growth.
You put all of those things together, David, we feel really good about our ability to be accretive to overall Medtronic in FY 2020, And that's even before we talk about the pipeline that we'll share with you at ADA, which is incredibly exciting and will bring a whole host of new innovation over the next 24 months.
Great. Thanks, David. Can we take the next question please, Carol?
Our next question comes from Vijay Kumar from Evercore ISI. Please go ahead.
Hey, guys. Congrats on a nice quarter here. 2 quick ones for me, 1 product and 1 maybe on the guidance here. On the product side, Omar, the robot, the Analyst Day, this is new information to the suite. There had been some concerns, maybe this could get pushed out.
I'm just curious on is this now preview of the robot? Does that mean we could see a launch of the robot end of the year, some really nice Mazor X numbers? Is that sort of a pre clue to what we could see on the surgical robotics side in terms of ramp? And then on the guidance front, Karen, you mentioned tax headwinds. Are the tax regulations finalized?
And if they're finalized, when we think about fiscal 2021, are there any tax planning new structures you could put in place to offset some of this as we look forward for 2021? Thank you.
Okay. Let me start on the robot and I'll let Bob also comment on it. First of all, you will see the actual robot when we invite you. That is the product that we intend to commercialize. And I think our commitment for an FY 2020 launch is still there, as I mentioned in the commentary.
But let me just say a little bit about the comparison of the Mazor X. As you know, Mazor X is a different robot, but this methodology of combining our high value consumables, which in the Mazor case are actually our tools as well as the spinal implants. In commercial packaging, with the capital equipment is a big differentiator for Medtronic. And I can tell you that Bob's team is all over this looking at the experiences that we are getting with the Mazor X launch and we'll translate them. And this is not just the commercial framework, it's how we structure the sales force, the training and a whole variety of other areas.
So, I don't know, Bob, do you want
to add anything? No, perfect Gilmore. Again, thanks for the question. We're excited about where we're at with the program. We look forward to learn a lot more this fall when we hold the Analyst Day for you.
For obvious reasons, we're not going to go into details about our global launch and which countries and when. But consistent with Omar said and consistent with what we said in the past, we're preparing for an FY 2020 launch.
And BJ, in terms of the guidance on the tax headwind, the final regulations are not yet out, so it is not final. We will obviously be focused on optimizing our tax rate over time, and we've been working on that already. And so you've seen our guide in taxes move from a range of 16.7% the lower end of that range, 16% to 16.5%. And of course, once the regulations are final, we'll be focused on continuing to optimize where we can. In terms of FY 'twenty one, our hope is that we can improve from there, but we'll see.
And if you just think about the guidance that we've given with the tax rate headwind, tax is about a $0.20 headwind on our year. We've offset some of that with the debt offering that we did, call it about $0.08 and we've got the $0.10 headwind on FX. So when you look at all of that together, if you look at our adjusted adjusted EPS growth, it would be about 8% to 9%.
Thank you, guys.
Thanks, Vijay. Next question please, Carol.
Our next question comes from Robbie Marcus from JPMorgan. Please go ahead.
Great. And again, congrats. Either maybe for Karen or Omar, if you could just talk about some of the product launches in fiscal 2020 and then fiscal 2021, that gives you confidence in accelerating growth throughout the course of this year. And also, I think it's great to hear accelerating growth in fiscal 2021 as we sit here over a year out from that. What are the products that give you confidence?
Well, there's a whole series of them and I'll go through them because they're all contributing, they're all exciting. First, the low risk indication in the TAVR, plus they have a little pro launch, which gives you a larger valve and the confider sheet, that's in FY20. Together with that, the Link 2, which we're really excited about with more accuracy, with more physiological parameters as well as Bluetooth connectivity, That's in CVG like straight up the bat in FY 2020. And then in RTG, you have the Acuron RF ablation system and the Midas Rex MR8. I mean these are continuous innovation products that we think will make a difference.
And then the back to CVG actually the micro AV, which will have an October submission and we expect sometime late in the year sales to start, We'll also have a carryover into FY 2021 on a strong basis. And then last but not the least, diabetes with we expect the 780 to launch towards the end of the year as well as the non adjunctive labeling, which will allow us greater market access and that will happen much sooner in the year. So those are things that we can talk about like right now in FY 'twenty. And all of these will in many ways carry on into FY 'twenty one, but there are specific ones. And I'll repeat the micro AV because that will have a full year benefit and that's a big disruptive program for FY 2021.
But also the DiamondTemp RF Ablation Catheter that comes out of CVG. And then RTG has a whole series of products. The DBS Percept product from neuromodulation, which is the first product that's left sensing, that will be launched in FY 2021. In addition to that, pelvic health has the interest in micro, which will launch again early in FY 2021, maybe towards the end of FY 2020. And the diabetes will have continued rollout of the 780 gs, which will have significant benefits, which I mentioned in the commentary.
And again, RTG, the soft tissue robotics, which I've just talked about, will launch in FY 2020, but the full benefit of that you'll start to see in FY 2021. So that's a lot of products and I'm telling you, I didn't even mention all of them. There's some in staplers and other areas in neurovascular. And so there's a whole series of products that continue our momentum in CRHF. So we're pretty excited and the pipeline here is solid.
These are solid products, many of them very close to launching and others close to approval. So we're really excited about this.
And Ravi, our pipeline is the most exciting, but I would just remind you too that particularly in CVG, we have some anniversary of some headwinds that will help us with the growth acceleration as well. We had the accounting change in our services and solutions business in Q2, which is 1 anniversary. We'll anniversary the loss of our MCS share loss in Q3, and then we'll have a partial anniversary of the drug coated balloon issue in Q4.
That's really helpful. And maybe Karen, just a follow-up for you. Appreciate all the commentary on the operating margin progression through the year. Is there any help you can give us on maybe gross margin versus operating margin and how currency might flow through that line item? Thanks.
Sure. Thanks for the question. On gross margin, the gross margin, as you know, can be impacted by our product mix. And so you haven't seen, at least in FY 2019, expansion in gross margin. We've driven the expansion in operating margin and SG and A.
While our enterprise excellence program is designed to offset the pressure that we have in pricing and mix, There could be some years where we see expansion in gross margin, but I wouldn't count on a lot there. In terms of FX, we do have an FX headwind next year, and that should show up some in the gross margin line.
Great. Thank you, Robbie. Go to
the next question please, Carol.
Our next question comes from Joanne Wuensch from BMO Capital Markets. Please go ahead.
Thank you for taking the question. Can you hear me okay?
Yes. Yes, we can. Go ahead, Joanne.
Wonderful. I have two questions. The spinal cord stimulation market, could you please give us an update on your view of that?
I think you mentioned that you believe that Medtronic grew faster than the market in the quarter.
And then my second question has to do with the paclitaxel panel that's upcoming. What do you think we should expect out of that? Thank you.
Okay. Thanks, Joanne. I'll let Jeff take the spinal cord question and then on to Mike.
Yes. So, Joanne, how are you doing? On the spinal cord stimulation market, it is a little bit down, flattish even down last quarter. But we did and Intellus is performing strong relative to the competitors. We're getting great feedback on the battery, the recharge speed and how long the charge lasts and the outcomes we're getting from the EVOLVE workflow, which we published in the VECTOR's trial and the VECTOR study.
So we're getting great feedback, and we've picked up, by our estimates, about 2 points a share year over year, and we're back to the number one share position, which is the first time in 2.5 years. So we're feeling good. Now the overall market, like I I wish it were growing faster. It has slowed and we have a couple thoughts on that. I mean, one is that you see a lot of technology that's been we're on the back end, I'd say, of a nice wave of technology innovation and clinical indication expansion.
So we're on the back end of that. And then there are I wouldn't say there's new payer policies out there, but there is increased payer scrutiny that we're seeing really primarily driven by the performance of our competitors' devices that has slowed the market a bit.
And then on the question of paclitaxel, obviously, we're looking forward to that opportunity to broaden the discussion of the data that's available on paclitaxel products. Obviously, we have full visibility to our own data and are very confident in the performance of our ADNEL product because we have over 1800 patients' worth of data that has been carefully followed. So from my perspective, the discussion to date has really focused on the 3 TMA submissions from Medtronic, Bart and Cook. And I think there's a much broader set of data to be looked at that in all cases is more favorable from our perspective. First, there's additional follow-up, the capture of patients who were lost to follow-up in the data that we have been doing and it's certainly been helpful to the overall numbers for the submissions on the PMA data, which will be presented at this session.
In addition, we have other data sets, the Japan randomized controlled study of 100 patients that basically not only showed no statistical difference in death rates between DCP and balloons, but also showed a numerical higher rate in the PTA arm. And then we'll also be submitting data from the IMPACT DEEP study, which is in the critical limb ischemia group, which is a study that was sized very similar to the SFA study that FDA referenced, 358 patients followed out to 5 years. And in fact, there we saw higher death rates associated with the PTA arm than the DCB arm in 5 years. So these additional data sets we think will be helpful. There are also data sets that we would expect to see from patient meta analysis that VIVA is doing as well as we think there will be interesting data from claims analysis that should be helpful.
Of course, we don't have visibility to all of the other companies' data. So we'll only see those when we get to the actual panel itself. But everything we have seen has us even more comfortable than we were in the beginning in terms of the safety of these products and they are profoundly efficacious for limiting reinterventions in the patient group. So we go into the meeting really believing the data is very strong, but it's important to understand that no studies have been sized to answer the question of mortality in this patient group. And so it's going to be important that we look at the risk benefit of these data sets.
And as I said, everything we've seen from our own data sets, which are the largest in the industry, make us very confident.
Thank you very much and a good quarter. Thank you, Joanne. Next question please, Carol.
Our next question comes from Matt Taylor from UBS. Please go ahead.
Hi, thank you for taking the question. I just had one follow-up on the paclitaxel question. I wanted to understand if you had a view on the PCR statement that came out this week. It seemed relatively favorable. And you could talk about how much of a headwind is baked into your guidance?
Or maybe if things go well in June, how much of that you think could come back?
So we were pleased to see the PCR statement. It certainly was a more encouraging or softer statement than FDA had made, basically pointing out the limitations of the meta analysis data that had been shown and reinforcing the efficacious nature of these products in terms of improving patient outcomes. So they were clearly more balanced in their view than we have seen in the FDA discussion. Now obviously, we'll see more data coming in and we'll have to weigh that. In terms of how we have provided guidance, we are basically assuming that what FDA has stated is going to remain for the entire balance of the year.
And obviously, we've seen how the market has reacted to that. And so we've just extrapolated that out through the rest of the year. So if FDA were to become more favorable in their commentary, obviously that could improve outcomes. But right now, our guidance would assume that there'll be no change coming out of the
Thank you.
And then just wanted to
ask one question on neuro. So their neurovascular growth is very strong. Could you talk about some of the components of that and whether you're seeing a stronger market there? Are there any product launches that helped you this quarter?
Yes, sure. So first of all, neurovascular, we have Medtronic, we have a broad portfolio playing in every segment and that is our strategy. And we're number 1 positions in both ischemic and overall hemorrhagic. And we've recently refreshed that entire portfolio. Nobody else can say this, But it's a very strong market.
We're very well positioned across every segment. Now what's driving our growth in the near term is the 1st of all, entering the aspiration market, we've already launched the 68 and now the 71 RipTide systems or catheters. And we've got we're getting really, really positive feedback on both. The 68 started out a little slow because we had to make some adjustments to it. We had a soft launch, made some adjustments to the product, and now it's picking up.
The 701 hit the ground running, and we're getting great feedback. And we estimate that we're somewhere around 15% of this market already, well ahead of our plans, SaaSpiration segment, well ahead of our plans. We see ourselves getting to 25% by the end of the fiscal year, and we think we'll eventually get to 50% of the Aspiration market. And on top of that, we just launched our next gen Stentriever to maintain and extend our lead in that segment. So those are some of the things that are driving it.
And I'd say the other big driver is just the global nature. We're just growing very fast in China. And so the fact that we're global is also helping, especially in China. So it's a global and broad refresh product portfolio.
Our next question comes from Kristen Stewart from Barclays. Please go ahead.
Hi, good morning and thanks for taking the question. I just wanted to just talk a little bit just about the free cash flow. You guys did a great job of really improving the metrics there. How should we just think about the deployment of capital? I know in the prepared remarks, you talked about the commitment to at least 50% to shareholders.
But how should we just think about more on the M and A side? I think you mentioned tuck ins, but should we expect an increase in the rate of maybe acquisitions going forward and more focus on products and really leveraging the portfolio or just how should we think about that going forward?
I think, Kristin, you're sort of on the right track there. Yes, we have a lot of firepower here and we're building it and we intend to use it in M and A. And the focus on M and A indeed isn't tuck ins that accelerates our growth. And examples of things that we've already done expect more of the same. We just did the Titan Spine acquisition.
We did Epix Therapeutics earlier in the year. We did Nutrino Health, which is a great plug in into our diabetes pipeline with the nutritional database. And you'll see that that works through into our next generation pumps. And then the Mazor Robotics, obviously, which is I congratulate Jeff on that one because that's a great acquisition and what it's really pulling through in spine. So those are examples and they're not all exactly that small either and you expect more of that.
Now we'll always be disciplined about this. We'll look at the returns that we get and it has to be above our cost of capital. We look at the strategic fit and we look at the earnings impact. And we look at those three things in a balanced manner as well as our team's ability to execute and put all that together. And that's the strategy that we have for M and A and we've got tremendous firepower and you'll see us accelerate that process as much as is available.
Okay. So it sounds like kind of taking the M and A focus and driving more depth across the businesses versus going broader, you feel like you're in all the spots that you are or need to be today? Yes,
that's correct. There's enough out there that helps the growth of our current business.
Okay. Thanks very much.
Thanks, Kristen. Next question, please.
Our next question comes from Larry Biegelsen from Wells Fargo. Please go ahead.
Good morning. Thanks for taking the question. One high level question for Omar, one product related question for Jeff. So Omar, it feels like there's been a little bit of a shift in the regulatory environment towards more post market action from FDA. Do you agree with that?
Has anything changed on the pre market approval side? And what are the implications for Medtronic? And second, for Jeff, there's a new competitor coming out in the sacral neuromodulation space potentially second half of this calendar year. So what's your plan for protecting your position in that market? And just remind us of the timeline for your next generation smaller rechargeable device, I think I heard earlier fiscal 2021?
Thanks for taking the questions, guys.
Okay. First of all, the FDA question. Look, the FDA's fundamental mission is to protect the safety of the American public, and they do an excellent job in fulfilling that mission. And I think as more data becomes available, they're using it wisely to make sure that their post market studies and that the approval process has in it enough of a safety profile and we're completely supportive of that. They're working closely with the industry in making sure that approval processes are accelerated the right way, but not compromising safety at any time.
So we're pretty supportive of the moves that they're making. And we don't really see any major changes to the device approval framework that they have in place. I think that's about it. Jeff, you want to talk about Sacral Neur?
Sure. Hey, Larry. So good question. I think 1st and foremost, regarding our new product that's coming to market, we expect it to launch in the beginning of FY 2021 and it is going to be this is a rechargeable device with really strong MR labeling and around about a 3cc device. So with our overdrive battery technology on this, which we've proven with Intellis and Pain Stim, it's just superior.
And so between the size and the overdrive technology, we think this is a winner. The product that a competitor is launching here in the near term will also be a rechargeable device, but I think it's 5.5 cc. So I think we compare it very well. And the gap between when they launch, we expect them to launch, we don't know we don't really know. We don't know how the FDA is going to treat things like cybersecurity and things like that.
So we really don't know when they're going to launch. But conservatively, for us, we expect a 3 to 4 quarter gap there. And look, Larry, I can say this, this isn't the first time that we've faced at RTG a new competitor coming into our markets that we've pioneered and we maintain a high share. And I'd like to think, matter of fact, I'm confident we've learned from these experiences, which have been painful, especially like pain when you go back to think about pain stim, we've learned, we've built these lessons learned into our commercial playbook. We've changed our commercial leadership across RTG.
And all I can say is we're ready. And I don't know what else to say we're ready for this.
Thank you, guys. Thanks for taking the questions.
Thanks, Larry. Next question please, Carol.
Our next question comes from Matt Miksic from Credit Suisse. Please go ahead.
Hi. Thanks for taking the questions. So I thought maybe just a couple of quick pipeline type questions, if you could expand on your thoughts around a few things. Just one on Intrepid, any update on the transeptal delivery system pathway forward on that and thoughts on left atrial appendage closure, which is something that ought to be and I'm sure you plan to be exposed to. And then the second, just kind of general topic, we see often in these meetings, a lot of activity, clinical evidence interest around renal denervation, kind of rebounding for both hypertension and arrhythmias.
And just if you could update us on your intermediate or long term strategy for returning simplicity to commercial product, appreciate your thoughts.
So I'll take the questions. On Intrepid, we do expect in the fiscal year to do our first demand on a transeptal version of Intrepid. So that work is progressing and we're confident we're going to find a path forward to just as we did in the TAVR world to start with a valve that was transapical, but then move to a transseptal delivery system. On that atrial appendage closure, we do not currently have a product in development that we very follow developments in the space very carefully. We do have a lot of core competency in our structural heart business that's applicable to this space.
But we also would want to have a superior product before entering into that type of market. So we have a list of designs that we're interested in, but we have no announcement to make today on that topic. And renal renovation is actually progressing as we discussed. We expect to have the pivotal trial result presentations next spring, which will be sort of key to the FDA approval cycle. But as you pointed out, there's a lot of clinical evidence being generated around this topic that has been presented both at the PCR meeting here this week, as well as at the HRS meeting 2 weeks ago.
And in support both at late breaking clinical trials, both very supportive of the technology. And the ones on atrial fibrillation were particularly interesting. We sponsored the one was presented for the late rate clinical trials here this week at PCR. It basically showed a 60% reduction in patients who developed atrial fibrillation in a highly selective group of patients who had hypertension and were randomized to renal denervation. So the data continues to be very encouraging, but obviously given the events of the HTN3 study results, it's going to be very important that we have highly controlled data to show the efficacy of this product and we're very confident based on the pilot studies that we've already published on and the trial we are executing with FDA that when we get to next spring, we're going to have some very good efficacy and safety data to discuss.
So we're excited about that market.
Okay. Thanks.
Next question please.
Our next question comes from Josh Jennings from Cowen. Please go ahead.
Hi, good morning. Thanks for taking the questions. I was hoping to ask Mike just about cardiac rhythm and heart failure and the road to recovery there. It's about half of the revenue pie for CVG. And maybe if you could just focus on the anchors, high voltage and LVADs, whether we just had to wait for anniversaries or if there anything incremental you can share in terms of returning those businesses either to flat or back to growth?
And then just to add on follow-up, at HRS, you had some really interesting data on some pipeline products, pulse field ablation and the extravascular ICD and just any incremental thoughts there in terms of the signal that those data sets provided and your outlook for those two platforms? Thanks a lot.
Sure. Well, starting with the part failure product lines, actually on the CRT side, we have, I think, some very exciting product development activities in addition to some easing headwinds. And obviously, the biggest challenge we've had in CRT has been we've significantly extended the battery life of these products, we've run into that replacement headwind. And then as you know, in the CRT space for high power, half the market is replacements. We still have a few quarters to go in terms of those headwinds being significant.
But as we head into next year, into FY 2021, we actually see that go neutral and that will really help us in terms of just the overall growth profile of the business. But beyond that, at HRS, we launched the 1st active fixation quadripolar lead for use in CRT for both CRTD and CRTP, which physicians seem very excited about. And we have our new Galaxy platform, our next generation of ICDs releasing in the Q3, which basically will both add Bluetooth connectivity to the product, but also some very important pacing features that both will enhance the performance of our product from an atrial fibrillation perspective as well as from heart failure rehospitalization rate. So those will be, I think, really helpful in terms of just getting our CRTD and CRTP product lines accelerating from where they have been. And then obviously, we'll get the headwind going away as we head into FY 2021.
On the LVAD side, obviously, we saw a fairly significant reduction in market share that took place at the middle of the year as a result of competitive product launches. We are going back on the offensive with our lateral data to basically take advantage of the smaller size of the HVAD system to basically show lower complication rates in surgical implants of the thoracotomy approach to the placement of the device. And we also think the data sets around the stroke are going to be in our favor as we get further evidence of the performance of these products. And so obviously, the anniversary in the second half of next year is going to be very helpful to our overall growth rate. But then obviously, we're hoping to take sequential market share as we take advantage of the performances of the product.
Then in terms of your question around PFA and the EVICV, we're very excited about both of those programs. We will expect to basically go into pivotal studies with the EVICV this year, which obviously has the benefits over existing subcu products of actually allowing antitachy pacing and post shock pacing to be done with the product. So that we think will provide a big advantage. It's also got a footprint that looks like a standard ICD as opposed to much larger device you see in the subcu application. And so we believe that will carry with it benefits at implant, including potentially lower infection rates.
And then PFA is probably the most exciting thing that we see in the whole atrial fibrillation ablation space. This allows us to actually do ablation without thermal energy, neither heating nor cooling by essentially disrupting the myocytes directly, which has the potential to really address all of the major complications associated with atrial fibrillation or ablation of atrial fibrillation. So that coupled with our entry into the focal ablation segment with the EPIX device, the DiamondTemp device, really now significantly broadens our portfolio from what we have traditionally been a cryo company focused on the PAF ablation. So really nice work by the team to basically expand our product offerings. Both EVICD and PFA, of course, are beyond the FY 2020 window, but we will speak to those, I'm sure, at the Analyst Meeting next year to give you more guidance as to when we expect them to be major revenue drivers for us.
Thanks, Josh. We'll take one more question please, Cowen.
Our next question comes from Peter Chickering from Deutsche Bank. Please go
ahead. Good morning, guys. Thanks for squeezing me in here. A few questions on China. China is obviously a very important market for you guys.
It looks like revenues in China slowed in the quarter to 13% from 16% last quarter. How are the tariffs impacting that business? What growth are you embedded within your 2020 guidance? And how should we think about the doubling of tariffs and how that impacts your growth in that market?
Well, first, look, we're really excited about China and that is an important market like you point out. In the end, it will be the biggest healthcare market just by the size of the population and opportunity. So it's a market we intend to be present in. And look, we're quite pleased with our performance. I mean, business certainly grew sequentially quarter over quarter and continues to grow and we expect pretty reliable double digit growth from China on a very consistent basis and we're
The tariffs do
The tariffs do pose somewhat of a headwind in terms of our margins, but it's one that we will cover and we will offset. We faced some of that in FY 2019, which will manage. But which we will manage. But more importantly, the need for our products in the Chinese population is very clear. There's a demand from both the doctors and the patients and we will follow through with that.
We have an outstanding team there with scale, with critical mass, presence in the big cities as well as the outlier regions, in private hospitals as well as the government hospitals and all of those are growth drivers for us across the board and all our businesses. So make no mistake, China is a big priority for us that we're all focused on and we're very confident that it will be a continued consistent growth driver in the double digits for Medtronic.
Okay. And then one follow-up, this is a very big quarter on Mazor. Like how does the pipeline look for new robot sales in 20 20? And how does the spike consumable market share in hospitals we've had the robot installed for over a year changed?
I'll give just a follow-up. Can you repeat the second part
of that question? The first part was Gap.
Yes, you bet. For hospitals where the robot has been for over 1 year, how has the spine consumables market share changed sort of within that year?
Well, I'll start with that question. I mean, we are definitely seeing where we have robots installed and to your point up and running and we've trained the physicians, the surgical teams and our reps, we're clearly seeing faster growth and greater market share versus accounts that we don't have a robot. And that same can be said to maybe a slightly lesser degree where we have navigation and the O arm without the robot. So basically, where we have enabling technology, our value proposition is better and we're seeing faster growth and better market share. We're seeing it quite a bit different and especially in competitive accounts.
And the difference, I'd say, from a competitive standpoint between just having NAV in the O arm versus having NAV O arm and the robot is the amount of competitive accounts that we're getting into. Customers that are big spine centers where we were 0, and our competitors had these accounts very well covered, they're calling us and we're getting in there and not only getting robotic share, but we're getting non robotic cases. So it's quite dramatic. And so we're very happy with it. And it's the overall value proposition of all of this technology working together and the path to better outcomes for patients and better financial outcomes for the hospital.
And we're building evidence around both of those. So in terms of the outlook going forward, we feel bullish. So far, it's much better than our deal model, the Mazor sales and for a variety of reasons. And we feel that we feel continued strong double digit growth in this area based on the existing we just launched the Mazor X Stealth Edition with navigation, we just launched that. And so that still has a lot of runway, but we have a series of, I'll call it, continuous innovation on top of that, things like so we can navigate with the robot more of our enabling technology, like more of our Midas platform, our drills and such.
And then we'll be which I don't want to talk about competitive reasons, we'll be adding other features that I think are more even more differentiated that will improve basically the spine procedures, take time out of these spine procedures and also drive more consistent reliable outcomes. So we feel very strong and that's what's generating the excitement around the robot is the improvement in outcomes.
Great. Thanks so much. Thanks, Pito. Omar, do you want to finish? Yes.
Let me just close out here. Thanks to all of you for your questions. And on behalf of our entire management team, thank you for your continued support and interest in Medtronic. We look forward to updating you on our progress on our Q1 earnings call, which we currently anticipate holding on Tuesday, August 20. And with that, thank you again very much.