Abstract
Heart failure is a significant complication following cardiac surgery. While sodium-glucose co-transporter-2 (SGLT2) inhibitors show established benefits in chronic heart failure, their specific role in the perioperative setting remains poorly defined. This review aims to consolidate the current evidence on the beneficial effects and underlying mechanisms of canagliflozin in managing heart failure associated with cardiac surgery. A narrative review of relevant preclinical animal studies and clinical trials was conducted to integrate and summarize the existing data. The evidence demonstrates that canagliflozin confers cardiovascular protection through multifaceted mechanisms, including improved metabolic regulation, favorable hemodynamic effects, and potent anti-inflammatory and anti-fibrotic actions. These mechanisms are highly relevant to mitigating key pathophysiological insults in the perioperative period. While current clinical data are limited to observational studies, they suggest promising benefits for canagliflozin in reducing postoperative cardiovascular complications. Canagliflozin shows considerable potential as a therapeutic agent for patients with heart failure related to cardiac surgery. However, definitive evidence from large-scale, multicenter randomized controlled trials is warranted to confirm its efficacy and safety, and to optimize perioperative management strategies.