SGLT2 Inhibitor Therapy and Long-Term Outcomes After Transcatheter Aortic Valve Implantation in Patients with Low Ejection Fraction

<i>Background and Objectives</i>: Patients with impaired left ventricular ejection fraction (LVEF) undergoing transcatheter aortic valve implantation (TAVI) remain at high risk for adverse outcomes despite successful procedures. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in heart failure, but their long-term impact after TAVI is not well established. <i>Materials and Methods</i>: This single-center retrospective study included patients with LVEF < 50% who underwent transfemoral TAVI between January 2015 and September 2025. Patients were stratified according to SGLT2i use. The primary outcome was a composite of all-cause mortality and heart failure (HF) hospitalization requiring intravenous diuretics. Secondary outcomes included all-cause mortality, HF hospitalization, and changes in echocardiographic parameters at 6 months. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to adjust for baseline differences. Time-to-event analyses were performed using IPTW-weighted Cox models and adjusted survival curves. <i>Results</i>: The study included 226 patients (78 SGLT2i users, 148 non-users) with a median follow-up of 37 months. After IPTW adjustment, SGLT2i use was associated with a lower rate of the composite outcome (32.8% vs. 50.8%, <i>p</i> = 0.019) and a lower crude long-term mortality (32.8% vs. 47.4%, <i>p</i> = 0.056). Acute kidney injury after TAVI occurred less frequently among SGLT2i users (3.4% vs. 17.4%, <i>p</i> = 0.013). In IPTW-weighted Cox analyses, SGLT2i use was associated with a reduced risk of all-cause mortality (HR 0.57, 95% CI 0.32-0.98) and the composite outcome (HR 0.56, 95% CI 0.33-0.96). SGLT2i users demonstrated greater reductions in left ventricular end-diastolic diameter at 6 months. <i>Conclusions</i>: In patients with impaired LVEF undergoing TAVI, SGLT2 inhibitor therapy was associated with improved long-term survival, better composite outcome-free survival, and lower rates of post-TAVI acute kidney injury. Larger prospective studies are warranted to confirm these findings.