Association of SGLT2 Inhibitors with Mortality and Bioprosthesis Valve Failure After TAVR: A Propensity-Matched Cohort Study.

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown cardioprotective effects beyond glucose control. In aortic stenosis, SGLT2 expression is upregulated in myocardium and valve tissue, contributing to inflammation, oxidative stress, thrombogenicity, and calcification. SGLT2 inhibition may counteract these mechanisms, potentially reducing bioprosthetic valve failure after transcatheter aortic valve replacement (TAVR), where the diseased native valve remains in place. Objectives: This study aimed to evaluate whether SGLT2i use is associated with improved clinical outcomes, including all-cause mortality and bioprosthetic valve failure, following TAVR. Methods: We conducted a retrospective cohort study using the TriNetX global health research network. Adults with non-rheumatic aortic stenosis who underwent TAVR were stratified by SGLT2i use. Propensity score matching (1:1) was applied to balance baseline characteristics (n = 2297 per group). Primary outcomes were all-cause mortality and bioprosthetic valve failure during follow-up. Results: Before matching, SGLT2i users had more cardiovascular comorbidities. After matching, SGLT2i use was associated with a significantly lower risk of all-cause mortality (HR: 0.83; 95% CI: 0.71-0.97; p = 0.02) and bioprosthetic valve failure (HR: 0.62; 95% CI: 0.39-0.99; p = 0.04). Conclusions: In a large real-world cohort of TAVR recipients, SGLT2i use was independently associated with reduced mortality and lower risk of bioprosthetic valve failure. These findings support a potential disease-modifying role for SGLT2 inhibitors in this high-risk population and warrant further prospective investigation.