AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Sodium-Glucose Cotransporter 2 Inhibitor Use and Outcomes After Isolated Surgical Aortic Valve Replacement
By Bennett S, Alswayed K, Cong O et al.
Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular (CV), renal, and heart failure (HF) outcomes and are increasingly being evaluated in valvular heart disease. In patients undergoing transcatheter aortic valve replacement (TAVR), randomized and observational data suggest fewer HF events and improved composite clinical outcomes with SGLT2i therapy. Whether these benefits extend to patients undergoing surgical aortic valve replacement (SAVR) remains less well defined. Methods: We performed a retrospective cohort study using the TriNetX Research Network comprising 112 healthcare organizations and more than 135 million patients. Adults 18 years or older undergoing isolated SAVR with nonrheumatic aortic stenosis (AS) from 2016 onward were included. Exclusions included rheumatic/congenital heart disease, endocarditis, end-stage renal disease/dialysis, kidney transplant, pregnancy, and same-day coronary bypass/other valve surgery. The exposure was SGLT2i use within 1 year before or after SAVR; comparators had no SGLT2i exposure. Outcomes were assessed from 30 to 365 days after SAVR. Cohorts were 1:1 propensity-score matched on demographics, comorbidities, medications, laboratory values, and cardiac function; Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Sensitivity analyses tested preoperative first-recorded SGLT2i use and 1-to-3-year follow-up. Results: The analysis included 706 exposed patients and 8,866 comparators; after matching, 539 remained per group. SGLT2i use was not associated with acute HF (8.5% vs 10.9%; HR 0.84, 95% CI 0.57-1.23), hospitalization/emergency department visit (34.9% vs 38.4%; HR 0.99, 95% CI 0.81-1.21), composite CV events, defined as death, acute HF, myocardial infarction, or ischemic stroke (17.6% vs 19.5%; HR 0.96, 95% CI 0.73-1.27), mortality (2.2% vs 3.9%; HR 0.65, 95% CI 0.32-1.33), or acute kidney injury (6.1% vs 9.6%; HR 0.68, 95% CI 0.44-1.05; Figure 1). In the preoperative analysis, 283 patients were matched per group; no consistent benefit was observed, although inpatient encounters were higher with SGLT2i exposure (22.3% vs 15.5%; HR 1.68, 95% CI 1.14-2.47). In the 1-to-3-year analysis, 269 patients were matched per group, with no significant differences. Conclusions: Among matched adults undergoing isolated SAVR with nonrheumatic AS, SGLT2i exposure within 1 year of surgery was not associated with significantly lower composite CV events, acute kidney injury, healthcare utilization, or mortality. These findings suggest that benefits reported after TAVR may not translate directly to SAVR and support prospective studies defining the timing and role of SGLT2i therapy in surgical valve populations.