Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Outcomes After Transcatheter Aortic Valve Replacement: A...

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown cardiovascular and renal benefits across various populations. However, their impact on outcomes after transcatheter aortic valve replacement (TAVR) remains unclear.

We analyzed 61,763 adults who underwent TAVR between 2013 and 2024 using the TriNetX Research Network. Patients prescribed SGLT2i before or within 1 month of TAVR were compared to nonusers. After 1:1 propensity score matching (n = 3362 per group), outcomes including mortality, hospitalization, heart failure exacerbation, acute kidney injury, genitourinary (GU) infections, renal replacement therapy, and adverse events were evaluated at 6 months, 1 year, and 3 years.

Among 61,763 individuals who underwent TAVR, 3529 (5.7%) received an SGLT2i either before or within 1 month following the procedure. SGLT2i use was associated with significantly lower mortality at all time points (hazard ratio: 0.70; 95% CI: 0.62-0.79; p < 0.001). Hospitalization and heart failure exacerbation were also reduced in the SGLT2i group. No significant differences were observed in rates of acute kidney injury, GU infections, or renal replacement therapy. Subgroup analyses showed consistent benefits among patients with diabetes, chronic kidney disease, and left ventricular ejection fraction <45%.

SGLT2i use around the time of TAVR was linked to improved survival and reduced heart failure-related morbidity, without increased renal or GU complications. These findings support a potential role for SGLT2i as adjunctive therapy in selected TAVR patients.