ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Valve Disease
Enhanced Recovery Mitigates Sodium-Glucose Cotransporter-2 Inhibitors Associated Mobility Decline in Valve Surgery Patients
Chengyao Xu 1
Minlai Chen 2
Enkang Lu 2
Xuezhou Zhang 2
Hao You 2
Xia Zhao 2
Yong Sun 2
Xin Xu 1
1. Shanghai University of Sport School of Exercise and Health, Shanghai, China
2. Zhongshan Hospital Xiamen University, Xiamen, China
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Abstract
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are integral to quadruple therapy for perioperative heart failure management in valvular heart disease (VHD) patients. Despite cardioprotective benefits, SGLT2i use correlates with acute sarcopenia and mobility impairment. This study evaluated whether Enhanced Recovery After Surgery (ERAS) protocols mitigate SGLT2i-associated mobility limitations. Methods: In a single-center, retrospective cohort study (conducted from [Start Date] to [End Date]), 48 VHD patients undergoing valve surgery under an Enhanced Recovery After Surgery (ERAS) protocol were analyzed (Quadruple therapy [QT] with SGLT2i, n=34; Triple therapy [TT] without SGLT2i, n=14). Primary outcomes assessed mobility via Activities of Daily Living (ADL, Barthel Index), stress ulcer risk (Braden scale), and fall risk (Modified Thomas scale) at multiple perioperative timepoints. Secondary outcomes included ERAS metrics (ICU duration, mobilization times), cardiac function, and laboratory parameters. Results: The QT group experienced significantly longer ICU stays than the TT group (median 49 vs. 43 hours, p=0.003), indicating greater initial morbidity and resource utilization. The time to first off-bed mobilization was also delayed in the QT group (67 vs. 53 hours, p=0.042), a 14-hour delay that heightens the risk of muscle atrophy and pulmonary complications. Post-anesthesia recovery: QT showed lower ADL scores (10 vs. 15, p=0.007) and higher stress ulcer risk (Braden 13 vs. 16, p=0.025). ICU discharge: QT maintained higher stress ulcer risk (Braden 16 vs. 17, p=0.006). Secondary care: QT demonstrated superior ADL recovery (95 vs. 85, p=0.017) and lower stress ulcer risk (Braden 22 vs. 21, p=0.043). No intergroup differences in cardiac function or laboratory parameters (p>0.05). Multivariate analysis identified ICU duration, mechanical ventilation time, platelets, albumin, and NT-proBNP as significant mobility correlates (|r|=0.368–0.625, p<0.05). Conclusion: SGLT2i use is associated with transient perioperative mobility impairment in VHD patients, evidenced by longer ICU stays and delayed mobilization. However, a structured ERAS protocol effectively mitigates these limitations, facilitating superior functional recovery by discharge. This is a provisional file, not the final typeset article These findings underscore the necessity of adapting or closely monitoring ERAS protocols, particularly for patients on SGLT2i, to mitigate early mobility deficits. This supports tailoring ERAS pathways, particularly early mobilization, for this patient population.
Summary
Keywords
Enhanced recovery after surgery, mobility, perioperative rehabilitation, SGLT2 inhibitors, Valvular Heart Disease
Received
14 November 2025
Accepted
30 January 2026
Copyright
© 2026 Xu, Chen, Lu, Zhang, You, Zhao, Sun and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Chengyao Xu; Yong Sun; Xin Xu
Disclaimer
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