Background Glucagon-like peptide-1 (GLP-1) receptor agonists (RA) are increasingly prescribed for type 2 diabetes and obesity, with emerging evidence of cardiovascular benefits. However, their impact on postoperative outcomes in adult congenital heart disease (CHD) patients undergoing coronary artery bypass grafting (CABG) remains underexplored. Methods We conducted a retrospective cohort study using de-identified patient data from the TriNetX Research Network from 2005 to 2025. Adult CHD patients (International Classification of Diseases, 10th Revision (ICD-10) codes Q20-Q28) who underwent CABG (Current Procedural Terminology (CPT) codes 1006208, 1006217, 1006200) were divided into two cohorts: those with documented perioperative GLP-1 RA use, defined as use within three months prior to or one month after CABG (Anatomical Therapeutic Chemical (ATC) code A10BJ), and those with no documented GLP-1 RA use (control cohort). Propensity score matching (1:1) was used to balance the cohorts based on race, ethnicity, sex, age at surgery, comorbidities (including diabetes, obesity, and heart failure), and CHD diagnoses. Primary outcomes included one-year all-cause mortality and hospital readmission rates. Secondary outcomes included GLP-1-related complications (acute pancreatitis, gastroparesis, abnormal weight loss) and postoperative events (acute kidney injury (AKI), myocardial infarction (MI), transient ischemic attack (TIA), cerebral infarction, arrhythmia, and hypoglycemic events). Results A total of 720 patients were included after 1:1 propensity score matching; 360 patients remained in each group (GLP-1 RA users vs control). Baseline characteristics, including age, sex, and key comorbidities, were well balanced. GLP-1 RA use was associated with a significantly lower one-year hospital readmission rate (odds ratio (OR) = 0.68;= 0.0118), but no difference in one-year all-cause mortality (OR = 0.747;= 0.3506). No significant differences were found in GLP-1 RA-related complications: gastroparesis (OR = 1.00;= 1), abnormal weight loss (OR = 1.00;= 1), or hypoglycemic events (OR = 1.103;= 0.82). Postoperative outcomes, including AKI (OR = 0.97;= 0.8612), MI (OR = 0.878;= 0.4713), TIA (OR = 0.763;= 0.5249), cerebral infarction (OR = 0.852;= 0.5267), and arrhythmia (OR = 0.978;= 0.8815), showed no significant differences between groups. Conclusion In adult CHD patients undergoing CABG, perioperative use of GLP-1 receptor agonists was associated with a significant reduction in one-year hospital readmission rates, without increased risk of mortality, postoperative complications, or known GLP-1-related adverse events. p p p p p p p p p p
