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Cardiovascular Outcomes of Perioperative Sodium-Glucose Transporter 2 Inhibition in Cardiac Surgery Patients: An
Lars I P Snel1,2,3, Maartina J P Oosterom-Eijmael1,2,3,4, Yugeesh R Lankadeva5,6,7
1Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Acta Anaesthesiologica Scandinavica
|June 22, 2025
Summary
Perioperative SGLT2 inhibition with empagliflozin increased urine output and reduced fluid retention in cardiac surgery patients. This approach showed a trend towards lower vasopressor use, suggesting potential cardiovascular benefits during surgery.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors are known for cardiovascular benefits.
- The impact of perioperative SGLT2 inhibition in cardiac surgery patients requires further investigation.
Purpose of the Study:
- To assess the cardiovascular effects of perioperative SGLT2 inhibition.
- To evaluate hemodynamic outcomes and fluid status in patients undergoing cardiac surgery with empagliflozin.
Main Methods:
- An open-label pilot study randomized 55 adult cardiac surgery patients.
- Patients received empagliflozin (10 mg daily) pre- and post-surgery or standard care.
- Key outcomes included blood pressure, heart rate, diuresis, fluid balance, and vasoactive support within 24 hours post-op.
Main Results:
- Empagliflozin significantly increased postoperative diuresis (549 mL) and reduced positive fluid balance (-1217 mL).
- No significant differences in intravenous fluid administration, blood pressure, or heart rate were observed.
- A trend towards reduced norepinephrine use (11.8 vs. 19.3 hours) was noted, though not statistically significant (p=0.080).
Conclusions:
- Perioperative SGLT2 inhibition enhances diuresis and decreases fluid accumulation without escalating vasopressor needs.
- Further validation in larger, double-blind, placebo-controlled trials is warranted.
- Findings support exploring SGLT2 inhibitors for cardiovascular patients undergoing surgery.
