Sodium-Glucose Cotransporter 2 Inhibitor Use and Outcomes After Surgical Aortic Valve Replacement

In this article, the authors evaluated perioperative sodium-glucose cotransporter 2 (SGLT2) inhibitor use in 2,930 patients undergoing surgical aortic valve replacement (SAVR), with or without coronary artery bypass grafting (CABG), who had diabetes, chronic kidney disease (CKD), or reduced left ventricular ejection fraction (LVEF). Only 85 patients (2.9 percent) received SGLT2 inhibitors. In the overall cohort, the five-year mortality was lower for patients receiving SGLT2 inhibitors compared to those who did not (13.6 percent vs 33.5 percent, p=0.022). After propensity matching (82 vs 82), this benefit persisted, with five-year mortality rates of 13.8 percent vs 25.8 percent (p=0.012). Stroke incidence was also lower after matching (2.0 percent vs 19.3 percent, p=0.046), whereas heart failure hospitalization, atrial fibrillation admission, and rehospitalization were similar. The authors conclude that perioperative use of SGLT2 inhibitors was associated with improved long-term survival and possibly lower stroke risk.