Discontinuation or Continuation of SGLT-2 Inhibitors Before Cardiac Surgery

Prior treatment

• Treatment with SGLT-2 inhibitors initiated less than 4 weeks ago and other than empagliflozine or dapagliflozine
• surgery scheduled within less than 3 days
• surgery for active endocarditis within the last 3 months

Other illness

• patients with a contraindication to SGLT-2 inhibitors: hypersensitivity, type 1 diabetes mellitus, and renal impairment with an estimated glomerular filtration rate below 25 mL/min/1.73 m²
• heart transplant surgery or implantation of an LVAD (left ventricular assist device)
• chronic kidney disease patients with a glomerular filtration rate below 25 mL/min/1.73m²

Lab values

• acute conditions likely to call into question the continuation of SGLT2 inhibitor therapy (alone or in combination) at the time of inclusion, including in particular: shock state or acute tissue hypoxia (episode of hyperlactatemia \> 3 mmol/L within 7 days prior to inclusion); acute kidney injury within the previous 7 days (KDIGO stage ≥2); severe hepatocellular failure (factor V level \< 50%); acute alcohol intoxication within the previous 7 days or active alcohol use disorder without withdrawal
• heart failure patients with a preserved ejection fraction, equal to or greater than 50

Other

• patients on preoperative mechanical circulatory support
• pregnant or breastfeeding women
• minors or adults under legal protection (guardianship or conservatorship)
• patients participating in another interventional study patients who do not understand or speak French.

• Adult patients scheduled to undergo cardiac surgery with cardiopulmonary bypass
• patients treated with SGLT-2 inhibitors, including combined treatment with metformin, for at least 4 weeks
• heart failure patients with a left ventricular ejection fraction strictly below 50%
• patients enrolled in a social security scheme or equivalent
• patients who have signed the informed consent form