SEOUL VALVES 2025
Optimizing Medical Therapy After TAVR: Focus on SGLT2 Inhibitors
At the 14th SEOUL VALVES 2025 meeting, during the Keynote Session: Cutting-Edge Innovations in Valve Therapies I, Duk-Woo Park, MD, PhD (Asan Medical Center, Korea), delivered a keynote lecture titled “What Is the Best Medical Therapy for TAVR Patients?” He reviewed evidence for sodium–glucose cotransporter 2 inhibitors (SGLT2i) after transcatheter aortic valve replacement (TAVR) and introduced the design of an ongoing randomized trial in post-TAVR patients. TAVR effectively relieves valvular obstruction but often leaves behind myocardial damage—fibrosis, hypertrophy—a high residual risk of heart failure (HF), especially in elderly patients underrepresented in earlier SGLT2i trials. This creates a strong rationale for optimal medical therapy (OMT) strategies that target remodeling and HF prevention in the post-TAVR period. In the DAPA-TAVI trial published in NEJM in 2025, patients were randomized 1:1 at discharge or within 14 days post-TAVR to dapagliflozin or usual care, stratified by diabetes, left ventricular ejection fraction (LVEF) ≤40%, and eGFR 25–75 mL/min/1.73㎡. Among 1,257 participants, the primary—composite of all-cause death or worsening HF—occurred in 15.0% with dapagliflozin vs. 20.1% with standard care (p=0.018; hazard ratio [HR] 0.72; 95% confidence interval [CI], 0.55–0.95), driven mainly by reductions HF hospitalizations or urgent HF visits. Effects were consistent across prespecified subgroups. Safety was acceptable overall, with higher rates of genitourinary infections and hypotension noted. Importantly, nearly one-third of post-TAVR patients experience HF readmission within 12 months, and many have preserved LVEF, a population not tested in prior TAVR-specific SGLT2i trials despite supportive data from EMPEROR-Preserved and DELIVER in general HF with preserved ejection fraction (HFpEF) populations. To address this gap, the ENAVO-TAVR trial (ENAVOgliflozin Outcome Trial in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Replacement) has been initiated. The study will randomize 1,040 post-TAVR patients with LVEF ≥40%, structural heart disease (Left ventricular hypertrophy and/or left atrial enlargement), and elevated NT-proBNP to enavogliflozin 0.3 mg once daily (a dose equivalent to dapagliflozin/empagliflozin 10 mg) versus matching placebo within 2 weeks of successful TAVR. The primary endpoint is major adverse cardiovascular events (all-cause death, nonfatal MI, or stroke) or HF hospitalization at 1 year. Approximately 40 Korean centers are participating, and enrollment has begun. In conclusion, SGLT2 inhibitors show strong promise in improving post-TAVR outcomes by mitigating HF progression and promoting cardiac recovery. While DAPA-TAVI supports their use in HF with reduced LVEF and in patients with chronic kidney disease or diabetes, the ENAVO-TAVR trial will determine efficacy in the broader HFpEF TAVR population. Accumulating evidence supports integrating SGLT2i into OMT for TAVR patients to improve long-term clinical and structural outcomes. Keynote Session: Cutting-Edge Innovations in Valve Therapies I Thursday, August 7, 1:00 PM-2:00 PM Main Arena, B2 Watch Session Video
September 05, 2025 603
