Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated benefits in cardiovascular populations, including reduced mortality and heart failure hospitalization. Their role in patients undergoing surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) remains less defined. A real-world study published in the Journal of Thoracic and Cardiovascular Surgery evaluated clinical outcomes associated with perioperative SGLT2i therapy in patients undergoing SAVR with or without coronary artery bypass grafting (CABG).

Patients undergoing SAVR or combined SAVR–CABG between 2014 and 2025 were reviewed. Inclusion criteria aligned with contemporary trials and included severe AS with left ventricular ejection fraction (LVEF) ≤40%, estimated glomerular filtration rate (eGFR) 25–75 mL/min/1.73 m², or type 2 diabetes mellitus (T2DM). Propensity score matching adjusted for baseline differences.

Among 2,930 patients (median age 76 years [69–83]; 40.3% female), 85 (2.9%) received SGLT2i therapy. SGLT2i use was associated with lower 5-year all-cause mortality compared with non-use (13.6% vs 33.5%; log-rank p=0.022). After matching, mortality remained lower (13.8% vs 25.8%; p=0.012) with reduced stroke incidence (2.0% vs 19.3%; p=0.046), while atrial fibrillation admission and all-cause rehospitalization were not significantly different.

Perioperative SGLT2i therapy was associated with lower mortality and stroke incidence after SAVR. These observational findings support further prospective randomized studies in surgical valve populations.