Initiation of peri-operative SGLT2 inhibitor reduces mortality and cardiovascular events after surgical aortic valve replacement

Abstract

Background: SGLT2 inhibitors (SGLT2i) demonstrate cardiovascular advantages for patients with heart failure and chronic kidney disease, especially in transcatheter aortic valve replacement. However, no studies have evaluated their perioperative use in surgical aortic valve replacement (SAVR). We examined the association between preoperative initiation of SGLT2i and measured the 1-year postoperative SAVR outcomes. We performed a retrospective analysis using de-identified patient data from the TriNetX Research Network database. Adults who underwent SAVR with first-time SGLT2i use within 1 month preoperatively were compared to a matched group of non-users with no prior history of SGLT2i therapy. Using 1:1 propensity score matching, adjusting for demographics, BMI categories, comorbidities, labs, and medications, we examined primary outcomes of 1-year all-cause mortality and major adverse cardiovascular events (MACE). Results: After propensity score matching (Table 1), our study included 440 patients per group. Baseline characteristics were well balanced post-matching, with a few exceptions. SGLT2i initiation was associated with significantly lower all-cause mortality at 1 year following SAVR (5.9% vs. 12.3%; OR 0.45, 95% CI 0.28–0.73; p = 0.001) but not with MACE (OR 0.73, 95% CI 0.51–1.03; p = 0.075), cerebral infarction, atrial fibrillation/flutter, or hospital readmission. There were no statistically significant differences in the odds of MI, VT, or SGLT2i-associated complications such as AKI or UTI (Table 2). Conclusions: Preoperative initiation of SGLT2i in SAVR patients was associated with reduced 1-year all-cause mortality.